You are the team’s Assistant Athletic Director, Assistant or Associate Coach and Team manager. You are the critical glue for the team and are the continuity for Gatorounds. You are the team’s primary link with the administration and our health care systems
- Round with the team during work rounds (maximum time requirement 2 hours) and contribute to the management plans whenever possible.
- Understand the needs of the patients and their families by discussing them in the presence of the patient (and when possible a family member), the physicians, and bedside nurse to assure coordination of care
- Share all management plans with the team.
- Assist in placement of patients in nursing homes and rehabilitation facilities
- Assist with other discharge planning issues and assure that the proper documentation accompanies the discharged patient establishing an efficient and accurate handoff
- Encourage bedside nursing participation on rounds
- When possible work with the operations administration of the hospital to second-order problem solve to overcome delays in care
Remember you are the continuity for Gatorounds and can advise the attending and resident on proper protocols and expectations. Just as each football player or a symphony orchestra member needs to learn the plays and music sheets, so do the physicians and nurses. You can help to assure they apply these skills by referring them to the Gatorounds website to review their playbooks and fundamentals. Key areas of performance include:
- Succinct and efficient presentations: You need to speak confidently and efficiently. No mumbling and no standing behind the circle. Quickly summarize disposition issues and make quality care suggestions so that specific changes in management can be ordered during rounds. Remember efficient communication is a key fundamental.
- Active involvement. You will be encouraged to participate. If you contribute to and understand the management plans, care will be more efficient and less error prone. This will allow more efficient and accurate discharge planning.
- Horizontal communication: Unlike traditional models, this is not a top-down structure. Each person has unique roles and makes unique contributions. It is important that everyone feel empowered to contribute during rounds. It is critical that you actively participate. It is important for you to contribute your ideas in order to learn and also in order to provide your patients with the best care.
- Teamwork: All patients belong to the team, not just a single intern. Every physician on the team is expected to know the basic history and active problems of all patients. Therefore if the intern is off for the day you should feel free to ask questions of other members of the team. It will be important to work with the house staff to efficiently complete the discharge forms and discharge summary so that the patients is properly handed off to the primary care physician, long term care facility (LTAC) or skilled nursing facility (SNIF), and the appropriate support systems and contingency plans are in place. We all sink or swim as a team.
When possible communicate the daily rounding schedule to the charge nurses
The schedule for the next days rounds should be completed by 8:50 AM and provided to you. This will allow you to communicate to the charge nurse the time that the team will be at the patient’s bedside.
Typical Team Rounding Schedule
Census for Care Prov: (12 patients)
8:45-9:00 AM Attending sees patients to be discharged before 10AM
9:00-9:30 AM Teaching session in the room. Students presents a case in detail. Emphasis on pathogenesis, clinical manifestations, diagnosis (differential diagnosis whenever possible), and treatment. Alternatively start bedside rounds at 9AM and devote 10-15 minutes to teaching at the bedside of 2-3 selected patients.
9:30-11:15 Bedside Rounds (average 5-10 minutes per patient) Schedule is created by the Team resident the afternoon before rounds. The PCRM relays the schedule to the nurses.
1. 9:35-9:45 Bed 11-524 IMC case
2. 9:45-9:55 Bed 9538-A
3. 9:55-10:05 Bed 6401
4. 10:05-10:10 Bed 6405-B
5. 10:10-10:20 Bed 6415-A
6. 10:20-10:25 Bed 6423
7. 10:25-10:35 Bed 6458-A
8. 10:35-10:45 Bed 6454-B
9. 10:45-10:50 Bed 6450-A
10. 10:50-11:00 Bed 6448-B
11. 11:00-11:10 Bed 6444-A
12 11:10-11:15 Bed 6440-B
On completion of rounds interns provide copies of their “To Do” list to the team resident who distributes the work evenly among the team members. You can assist the attending with any administrative impediments including resistant or delayed diagnostic tests.
Physicians Work Rounds Protocol (Duration< 5 min)
– List Positive ROS
– Emphasize complaints relevant to the current problems
– Vital Signs
– Positive physical findings
o Focus on findings related to the patients active complaints
o What findings were positive on admission (be sure to include these)
– Abnormal laboratory findings
o Usually include CBC, Electrolytes.
o Results of new diagnostic tests
For Each Active Problem Give:
o When appropriate give your differential diagnosis
o Is this problem improving, worsening, or staying the same?
- List blood tests
- Radiologic tests
- Other tests
- What medications are you administering for this problem
- What other modalities are you instituting
Disposition – will the patient be able to go home, go to a SNIF or an LTAC.
Today’s to do list
Potential Discharge Issues . You should make comments at this time. It will be important for you to make suggestions about disposition to the team and begin disposition planning. If the patient will be going home it will be important to anticipate equipment needs and home nursing needs and make suggestions to the team. A major issue can be approval of home O2, make sure respiratory therapy has documented desaturation within 24 hours of discharge.