Why do we need to set specific times for seeing our patients on rounds?
Planning out rounds before morning rounds establishes specific times when the team will be on the floor allowing the nurses to plan their work so they can be present at the allotted time. In addition, the nurses can let the patients and their families know when the team is expected in their room. This provides the patients and their families a sense of organization and efficiency, and encourages efficient communication with the family about management and disposition issues. After the first day the team can round on the patient at approximately the same time each day.
Having timed rounds makes me nervous. What happens if there is an unexpected management problem during rounds?
Just as the offensive coach creates a series of plays prior to the start of each game, the team resident plans out rounds ahead of time. Just as coaches are often required to adjust their plays as a consequence of unexpected player match ups or injuries, the medical team often will need to adjust the times of rounds at the bedside in response to unexpected medical events. The timing of rounds is meant only as a guide, and a delay of 5-10 minutes is expected. The nurses can be notified by the Case Manager that there is a delay. Establishing approximate times for rounding at each bedside is far better than showing up at every room at a random time. Put one student in charge of monitoring time and letting the team know when they are delayed.
Won’t a rounding system with strict job descriptions interfere with my personal approach to medicine?
This is one of the first concerns many physicians express. However, in reality, by improving communication and overall efficiency the background work of being an attending is completed in a more timely fashion. The rounding becomes habit and can be performed in the background allowing members to focus on management issue rather than procedural issues. Completion of rounds in under 2 hours allows the attending time to teach after rounds and to discuss the management complex cases in more detail. Gatorounds allows each attending to better showcase their individual skills.
Shouldn’t the house staff see many different ways of running rounds? This will allow them to decide how they will manage their cases when they become attendings. Because most faculty attend on Medicine for only 2-4 weeks per year, this means each resident and intern will be subjected to approximately 20 different rounding systems per year. This is the equivalent of a football team having 20 different coaches and 20 different playbooks during the year. We have found that our attending physicians have difficulty switching from their own system to Gatorounds. That represents one change in playbooks, imagine 20! Surveys of our house staff consistently point out that they would prefer a single rounding system. A single rounding system becomes habit (background) and allows the team to concentrate on patient care issues rather than the adjusting to a new playbook every two weeks.
How should you describe an overnight complication? When a complication or unexpected event occurs overnight use the SBAR communication protocol.
- Situation: What exactly occurred overnight.
- Background: remind everyone of the patients reason for admission, events over the past several days in the hospital, and how they relate to the present situation.
- Assessment: What is your evaluation of the patient based on current subjective and objective findings.
- Recommendations: What diagnostic and therapeutic interventions do you want to initiate at this time and why.