Advice on improving patient/charting time

[MexicanFNP]

Good morning-

I started working at an IM outpatient place a few months ago 2-3 times a week.  All my previous hx is inpatient.

Things in general are going great, the only issue is my charting.  I find myself charting at home sometimes because I have a hard time structuring patient time when going into the room.  Acute visits are pretty good, the issue is with follow ups as patients talk about many other things and drift off a lot from the pertinent things we are following up.. It is difficult to chart some in the room due to the same issue.  I don't want to come off as rude, so I need some help.  As my number of patients keeps increasing, I keep finding this more difficult at times.  I am seeing around 20-22 patients a day, but at times it can be around 25.

1- What is the average time you spend with a follow up patient? DM/HTN/Hyperlipidemia, etc..

2-  What is your routine when you go into the room. 

3- What is the average time you spend in the room for an acute vs a follow up visit?

4- What techniques do you have/use to keep patients on topic and have the pertinent conversation/exam and then get out of the room?

Any other advice/input is greatly appreciated. 

[aok7, NP]

This is an ongoing challenge.  I find leaving a clear "greeting time" at the start of visit, sit down in front of patient and chat with complete focus on them, and I must interrupt and direct with a transition.  The transition can be sharp and almost rude-seeming, I suppose, but I clearly open my computer, and I run the show with the visit.  I do prepare my charts usually the day or two before my visits, and this helps with direction making sure patient feels a personalized visit.  At the end of visit I might stand up and go to the door, as I try to think it is not fair to the next patient that I am in a rush due to a chatty patient.  I also find patients will either "like" me or not, it has nothing to do with me listening to them chatter 15 minutes or not, so this relieves some tension.  It's so difficult for me, too, but this is the best set-up I have found.