Rounding | UWPeds

Rounding Tips
Rounding Structure – New Patient
Rounding Structure – Established Patient

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)	Explain rounds to families Ask about team coming in room vs staying outside Plan to go into all rooms if family allows (including iso)
Call RN	n/a	TC if there Senior	Call RN or charge if RN unavailable
Headlines (outside patient room)	30 sec	Intern #1 Entire team	One liner (while putting on PPE if needed) Plus: “Any issues before we go in the room?” Discuss “off-stage” issues away from family: psychosocial concerns, major questions to plan, safety (med rec, etc) Attending – note if patient was seen / level of detail needed
Introductions	30 sec – 1 min	Entire team	All team members AND roles [Interpretation starts. After introductions, team explains to family that interpreter will be asked not to interpret the “technical part”; summary afterwards]
HPI, pertinent VS/PE	1-4 min	Intern #1	Intern to face family and speak to them, senior to stand next to family, attending behind intern if not examining patient (avg 2 min, max 3) – avoid jargon HPI, PMHx, pertinent FAM, SOC only Initial PE – only pertinent +/- Ins/Outs (only if relevant) Abnormal/pertinent vitals and updated PE (if any changes since admission) Abnormal/pertinent labs and studies only Solicit input from family and team: “Does anyone have anything to add?”
Perform exam	During or after HPI, 2 min	Attending +/- Senior	PE in cooperative children during HPI, otherwise afterwards with team – may narrate for family and/or teach team
Assessment/Plan	1-4 min	Intern #1	Intern #1 – Present A&P (do not repeat one liner) Intern #2 – Write orders, update D/C criteria and, if desired, update daily note RN – Update patient white board
Input from team	1-2 min	Family + team	[Interpretation resumes] “Does anyone have anything to add?”
Summarize plan + D/C criteria	1 min	Intern #1 (Senior may help)	Plan of the day Plan of the stay What’s in the way
Family questions	0-3 min	Intern #1	“What questions or concerns do you have?” If too many: In order to address all questions thoroughly, set a time to return [Interpretation ends]
Order read back	30 sec	Intern #2	Review and stop any unnecessary labs, tubes, and lines
Teaching pearl	1 min	Attending	Ask patient/family permission to teach [interpret]

Rounding Structure -Established Patient

Task	Time	Who	Description
Prior day or pre-rounds: Check family preferences	n/a	Primary intern (#1)	Explain rounds to families Ask about team coming in room vs staying outside Plan to go into all rooms if family allows (including iso) Examine patients who want team outside for rounds
Call RN	n/a	TC if there Senior	Call RN or charge if RN unavailable
Headlines (outside patient room)	30 sec	Primary Intern (#1) Entire team	One liner (while putting on PPE if needed) Plus: “Any issues before we go in the room?” Discuss “off-stage” issues away from family: psychosocial concerns, major questions to plan, safety (med rec, etc) Intern – note if pt examined prior to rounds
Introductions	30 sec – 1 min	Entire team	All team members AND roles [Interpretation starts. After introductions, team explains to family that interpreter will be asked not to interpret the “technical part”; summary afterwards]
Overnight events, subjective, pertinent VS +/- PE	1-2 min	Intern #1	Intern to face family and speak to them as well as team (average 1 min, max 2 min) – avoid jargon Elicit subjective from family: “How was your night?” / “How is _ doing this morning?” (if patient not seen prior to rounds), present subjective otherwise Elicit concerns from RN Ins/Outs (only if relevant) Abnormal/pertinent VS, labs or studies Solicit input from family and team: “Does anyone have anything to add?”
Perform exam	2-3 min	Intern Attending +/- Senior	Perform focused exam (if patient is stable, intern exam before rounds is not necessary), narrate or summarize for family and team
Assessment/Plan	1-4 min	Intern #1	Intern #1 – Present A&P (do not repeat one liner) Intern #2 – Write orders, update D/C criteria and, if desired, update daily note RN – Update patient white board
Input from team	1-2 min	Family + team	[Interpretation resumes] “Does anyone have anything to add?”
Summarize plan + D/C criteria	1 min	Intern #1 (Senior may help)	Plan of the day Plan of the stay What’s in the way
Family questions	0-3 min	Intern #1	“What questions or concerns do you have?” If too many: In order to address all questions thoroughly, set a time to return [Interpretation ends]
Order read back	30 sec	Intern #2	Review and stop any unnecessary labs, tubes, and lines
Teaching pearl	1 min	Attending	Ask patient/family permission to teach [Interpret]

Rounding Tips

Rounding Structure – New Patient

Rounding Structure -Established Patient

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