Rounding Tips
Most attendings look to the senior resident to keep rounds organized, efficient, and on time. Here are a few ideas to try out if to increase efficiency of rounds, especially if you are dealing with a high census.
- Family Preparation: Interns should prepare families during pre-rounds for what to expect on rounds. Coach your interns to do this well. They can elicit the family’s most important questions, ensure the family understands that rounds are meant to be brief, and identify a time in the afternoon for more in-depth discussion if they need that. These simple measures can go a long way to making rounds short and
- “The Rounds Huddle”: At the start of each portion of rounds each day (i.e. with each attending), take 2 minutes with your entire team to huddle. Look over your schedule, and specifically call out when that portion of rounds is scheduled to end. Many subspecialty attendings do not know how long they have for rounds. Determine if anyone should be skipped or rounded on outside of the room, and discuss any other potential barriers to rounds flow. Remind people how much time they have for patients. Clarify roles if needed.
- Prioritize early discharges: If the plan is to send a patient home, you don’t need to wait for rounds to determine that. Call your attending to discuss discharging before rounds.
- Table or Sit-Rounding in the team room is an option. Consider sit-rounding on a few stable patients with no anticipated changes in plan (i.e. day 7/10 antibiotics…) and prepare the family and nurse accordingly. Don’t sit round on the same patients every single day unless they specifically don’t want to be rounded on. If that’s the case, make sure to include the nurse in table rounds daily.
- Don’t be afraid to gracefully move things along! Remember family-centered is not family-run rounds. If families have more questions than are appropriate for rounds, saying something like, “These are really important questions and we’d like to have more time to spend on them but unfortunately, we have another appointment to keep. When can Dr. intern and Dr. Attending come back this afternoon to talk more?” Also, while we all cherish bedside teaching on rounds, help keep attendings on track when the census is high and try to limit bedside teaching to a few minutes or less per patient, or while walking, or at the end of rounds. The power of walking and talking is real!
If you have other rounding tips you’d like added to this sheet, email us at pedschiefs@seattlechildrens.org
Rounding Structure – New Patient
Task | Time | Who | Description |
---|---|---|---|
Pre-rounds: Check family preferences | n/a | Primary intern (#1) |
|
Call RN | n/a | TC if there Senior |
|
Headlines (outside patient room) | 30 sec | Intern #1 Entire team |
|
Introductions | 30 sec – 1 min | Entire team |
|
HPI, pertinent VS/PE | 1-4 min | Intern #1 |
|
Perform exam | During or after HPI, 2 min | Attending +/- Senior |
|
Assessment/Plan | 1-4 min | Intern #1 |
|
Input from team | 1-2 min | Family + team |
|
Summarize plan + D/C criteria | 1 min | Intern #1 (Senior may help) |
|
Family questions | 0-3 min | Intern #1 |
|
Order read back | 30 sec | Intern #2 |
|
Teaching pearl | 1 min | Attending |
|
Rounding Structure -Established Patient
Task | Time | Who | Description |
---|---|---|---|
Prior day or pre-rounds: Check family preferences | n/a | Primary intern (#1) |
|
Call RN | n/a | TC if there Senior |
|
Headlines (outside patient room) | 30 sec | Primary Intern (#1) Entire team |
|
Introductions | 30 sec – 1 min | Entire team |
|
Overnight events, subjective, pertinent VS +/- PE | 1-2 min | Intern #1 |
|
Perform exam | 2-3 min | Intern Attending +/- Senior |
|
Assessment/Plan | 1-4 min | Intern #1 |
|
Input from team | 1-2 min | Family + team |
|
Summarize plan + D/C criteria | 1 min | Intern #1 (Senior may help) |
|
Family questions | 0-3 min | Intern #1 |
|
Order read back | 30 sec | Intern #2 |
|
Teaching pearl | 1 min | Attending |
|