Game Plan

A major goal is to complete work rounds in a timely fashion (generally in < 2 Hours), and this requires a game plan

• To accomplish this goal the team resident (quarterback) should set up a rounding schedule each morning before rounds.
• Allocate 10 minutes per active patient. The patients to be discharged that day should be seen by the attending prior to work rounds
  • Example of rounding schedule game plan
    9:00 AM       Rm 9425 – Jones
    9:10 AM       Rm 9427 – Smith
    9:20 AM       Rm 7452 – Adams
    9:30 AM       Rm 6524 – Baker
    9:40 AM       Rm 6552 – Miller
    9:50 AM       Rm 6401 – Williams
    10:00 AM     Rm 6403 – Samuel
    10:10 AM     Rm 6411 – Washington
    10:20 AM     Rm 6423 – Williams
    10:30 AM     Rm 6460 – Matheson
    10:40 AM     Rm 6454 – Simpson
    10:50 AM     Rm 6438 – Billings

• Create an effective multidisciplinary team focused on improving each patient’s health and well being.
• Huddle at each patient’s bedside where physicians, the bedside nurse, the case manager, pharmacist, and medical students create the daily management plan with the input of the patient (the team owner), and enter orders at the bedside.
• Everyone should feel safe to share their ideas
• Orders for the day are entered at the bedside using laptop or tablet computer and also written on the patient’s white board. Orders should be orally repeated to assure the nurse and pharmacy understand and approve of the orders
• Assure that everyone including the patient understands the daily care plans. (use the TEMP  bedside checklist)

A second major goal is to successfully and effectively discharge patients before 12 noon each day. 

• This requires huddle at 4 pm the day before.
• All potential discharges should be reviewed by the residents, attending and case manager the afternoon before discharge.
• The discharge summary, and discharge instructions should then be written the night before, and all medications reconciled.
• The charge nurse should be informed of the pending discharges.
• Before work rounds the attending should see all patients who will be discharged. and ask them if they understand their discharge plans. When possible a contact number should be provided in case the patient or family has future questions. The discharge order can be written and activated following the attending visit, assuring all discharge orders are written before 10 AM.

To accomplish our goals:

• Every team member must understand his/her role (see playbooks)
• Every team member must be proficient in the fundamentals of succinct and effective communication (See Communication protocols: SOAP, SBAR, Bedside checklist, I-PASS, and Admission)
• Bedside nurses should know when the team will be arriving at the bedside (the rounding schedule is given to the charge nurse)
• Rounds should be completed with 120 minutes to provide time to call consultations, work on disposition issues, and to provide time for didactic teaching sessions.
• Each day there should be an afternoon huddle to review all cases and to identify potential discharges for the morning.