Rounding Up: Perfecting ICU Rounds

Interprofessional rounding in the ICU is not going away. You may as well adopt it, get good at it, and curate it, according to Jaspal Singh, MD, MHA, MHS.

Dr. Singh joined Robin Gross, MD, and Ellen Hillegass, PT, EdD, CCS, to lead an interactive discussion about the Best and Worst of ICU Rounds on Monday in the Clinicians Center. The trio outlined obstacles to clean, communicative, and productive rounds and asked their audience to weigh in on potential solutions for each.

Robin Gross, MD, explored barriers to effective ICU rounds with a standing-room-only audience in the Clinician Center.

First on the list: Never-ending rounds. “If you have 17 patients and the attending goes into a dialogue on every single one, how much capability do learners have at that rate?” asked Dr. Singh. “What’s going to happen at patient 17 if everyone is mentally checked out by patient six or seven?”

Managing the time component of rounds while still recognizing the importance of the educational component is key.

“It’s about finding teachable moments,” said Dr. Gross. “Maybe use that time while you’re donning your gown and gloves or while you’re walking down the hall.”

“Or perhaps consider having teaching rounds and patient rounds, dividing the two,” added Dr. Hillegass.

As you consider efficiency, don’t lose sight of what’s best for the patient. If it becomes solely about a checklist, the patient could suffer.

“When the checklist becomes the be-all, end-all, it takes away from the center of what’s happening,” said Dr. Singh.

Ideas from the audience included setting expectations with the team to tell them how the checklist should be used. Use of the checklist should be done in a minute or less, not five minutes.

A barrier to efficient and effective rounds is lack of teamwork, which can lead to misinformation, especially as it relates to orders. If a surgeon stops in to give orders and no one is there to receive them, who ensures they are carried out?

“Rounds are the perfect place for good communication,” said Dr. Gross. “Sixty to 70 percent of errors can be linked to communication.”

Ultimately, for rounds to be the best they can be, they should include the patients’ families, as well. Even though it may seem counterproductive to include families in rounds, it actually increases efficiency.

“Some people think it will add time to rounds, but it doesn’t. It actually makes them faster,” said Dr. Gross. “They don’t ask you to explain technicalities, but are there to weigh in on big-picture items, such as bathing.”

Adding a patient’s family to rounds also helps them see how doctors come to their conclusions. It creates transparency and is less confusing, added an audience member. Plus, you eliminate the need to explain things again to families after rounds.

“You are part of the team,” Dr. Gross said, describing what she tells the family of patients. “You know your loved one so much better than we do. We rely on you.”