Save time charting the history of present illness (HPI)

As The Nurse Practitioner Charting Coach, I teach the easy-to-implement habit changes can help nurse practitioners save time charting! These small changes can add up to make a huge impact!

Just think, if you implement a charting tip that saves you a few minutes per patient, it can help you to STOP charting at home! For example, if you start using smart phrases and save 2 minutes per patient, and you are seeing 25 patients/day, that is 50 minutes saved! What would you do with 50 extra minutes at the end of the day!

Implementing these easy-to-use tips will help you to save time charting! I encourage nurse practitioners to focus on one charting tip at a time. And one of the ways NPs can save time is when obtaining/charting the history of present illness (HPI).

What is the HPI?

The HPI is an important part of a chart note. ***For more information on the basic format of a SOAP note, check out this article. The HPI is where the nurse practitioner obtains the patient’s subjective information. This is what the patient says about their own health. For example:

• Onset and severity of symptoms
• Aggravating and alleviating factors
• Current treatment and treatment failure
• Relevant past medical history
• Chronic visits may include when the medical condition was first diagnosed, previous treatment, etc.

The HPI is the information that the patient tells the nurse practitioner and is an important part of the chart note. However, I have seen a lot of nurse practitioners spend too much time on this section. Many nurse practitioners add too much information, creating note bloat. Luckily, APRNs can implement tips to help them save time charting the HPI. 

Save time charting the HPI

Read through these tips and save time charting the HPI!

Straight forward.

When asking your patient the subjective questions of their condition, I recommend asking straight forward questions. I know this differs from using open ended questions like we learned in RN school. When we use open ended questions, many patients will give you their entire life story including their neighbor’s cousin’s daughter-in-law’s medical condition. When we ask straightforward questions, it helps us better obtain the information without taking too much time.

For example instead of saying, “So what brings you in today?” or “Tell me about your cough,” I will ask questions such as, “When did your cough start? What medications have you tried? Do you have a fever?” These questions are straightforward and take less time to obtain the information. When obtaining the HPI it is important to ask these specific questions which will ultimately save time charting!

Use OLDCARTS.

Did you learn the acronym OLDCARTS in NP school?

• O- onset
• L- location
• D- duration
• C- characteristics
• A- aggravating
• R- relieving
• T- treatment
• S- severity

This acronym is helpful when obtaining the HPI and can help save time charting. This is an easy way of asking the right questions in a systematic order. It is easier for the nurse practitioner to remember what to ask and also ask the direct questions (see charting tip above). When you go to document the HPI, you can save time charting but creating a systematic flow from these questions.

For example you would say, “Pain started 2 days ago after injury during basketball game. Pain is 5/10 to left knee. Worsens with activity and improves with use of OTC analgesics.” This flow of your documentation gets all of the facts in a systematic order and can ultimately save time charting!

Chart using short phrases.

Another tip I have to save time charting the HPI is using short phrases instead of full sentences. When I am documenting the information, I will write out the info with phrases. This takes less time to document phrases and is easier to consume.

For example, instead of writing, “The patient reports chest pain and shortness of breath but does not experience a cough,” I will write, “Reports chest pain and shortness of breath. Denies cough.” This provides the same information but will help to save time charting! 

Set boundaries.

One thing many NPs fall prey to is allowing patients to address 4+ chief complaints in a clinic visit. Unfortunately there is not enough time to address each concern. Especially when patients are scheduled for 15 min appointments and even double booked. That’s why setting boundaries with the patient is so important! 

Make sure you are clear about only addressing 2-3 concerns in one visit. But setting boundaries doesn’t have to feel like you’re being rude or that you don’t care. Go about setting the boundary in a nice way.

For example, when you walk into the patient room, notify the patient that the next 10-15 minutes are dedicated to that patient. Then ask the patient what are the top 2 health concerns they would like to discuss. This empowers the patient to be in charge of their health but also nicely sets the boundary. 

If a patient tries to address multiple health concerns in one clinic visit use the phrases below for a nice way to set that boundary:

“I want to give this concern the proper time and attention to truly know what is going on, please schedule a follow-up visit.”

Setting boundaries is a great way nurse practitioners can save time charting the HPI.

Use Freed AI Medical Scribe.

Freed AI writes your chart note for you!

Freed AI is an artificial intelligence system that uses voice recognition to abstract important info said by the provider and the patient. Freed AI then populates into a SOAP note format. You can then copy and paste into your own charting system. 

I love how Freed AI saves time charting by creating the HPI. Before Freed AI, I would take my computer in the room and try to type out all of the information for the HPI. It was distracting for both the patient and myself. Since using Freed AI, I don’t have to worry about furiously charting! Freed AI writes my chart note and saves so much time charting! Be sure to check out Freed AI as it also writes the reminder of the chart note!

Freed AI offers 10 free visits so make sure to give it a try using the link here. And when you are ready to purchase, feel free to use my affiliate coupon code: NPCHARTING for $50 off your first month!

Need more help charting?

Use these tips to help save time charting the HPI! Implement just one of these charting tips and see how much time you will save! If you would like to learn other tips to help you save time charting, be sure to check out The STOP Charting at Home Membership! 

This membership is for the nurse practitioner who is ready to:

• Have too much free time on evenings and weekends you’ll have to start a new hobby!
• Cultivate strong relationships with your kids/spouse because you’ll actually have the energy to show up how you want!
• Finally gain the respect from your colleagues and learn to love your job again. 

Be sure to check out the STOP Charting at Home Membership so you can finally get your life back!

**Full disclosure, this post contains affiliate links. I do receive a small commission if you subscribe to Freed AI using one of the links. This is at no extra cost to you but does help me continue to run The Nurse Practitioner Charting School.

Thank you for your support!