Bedside rounds at teaching hospitals

[bad virus]

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Hi everyone,

I was curious to see if any of you are at a residency does bedside rounds. At my place, we usually round as a team walking by each bed and giving a short sign out while noting the vitals, but not much else. I am curious to see if any of you are at a residency program that the entire team goes into the room, examines and discusses the patient and updates them about what the team sees and expects in terms of ongoing work up.

I know that this is not appropriate for every patient, aka the malingerer or pill seeker, but for a lot of other patients, like the one waiting for the VQ scan or one waiting for CT to identify source of obstruction etc . . . it is.

So anyway, do any of your programs do bedside rounds and teaching, and what do you like or dislike about it?

 

[deleted547339]

Signout is at the desk where I'm training.

 

[namethatsmell]

We do both.

While at first I greatly preferred just sitting and running the list, now I waaay prefer walking the room. It probably takes an extra 10-20 minutes to walk, but it really helps to put a face to the story and seeing the pt with the outgoing team gives you a better idea of the patient's trajectory (ie improving, staying the same, or worsening).

 

[alpinism]

Nope. Most signouts are a quick rundown of the pt list at the physician workstation.

If its a challenging/complicated pt we might pop in the room for a couple mins.

 

[Arcan57]

Hi everyone,

I was curious to see if any of you are at a residency does bedside rounds. At my place, we usually round as a team walking by each bed and giving a short sign out while noting the vitals, but not much else. I am curious to see if any of you are at a residency program that the entire team goes into the room, examines and discusses the patient and updates them about what the team sees and expects in terms of ongoing work up.

I know that this is not appropriate for every patient, aka the malingerer or pill seeker, but for a lot of other patients, like the one waiting for the VQ scan or one waiting for CT to identify source of obstruction etc . . . it is.

So anyway, do any of your programs do bedside rounds and teaching, and what do you like or dislike about it?

That sounds suspiciously like the rounding that we all hated as med students. If a patient has an interesting physical exam finding they usually would be examined by the residents one at a time or in small groups but rounding as an entire group outside of turnover for educational purposes is something of a non-starter for EM.

 

[deuist]

We did walk around when I was a resident. At signout we would get a portable computer and then go to every patient's room and talk briefly about each one. The entire process took about 15 minutes for the entire census.

 

[e30ftw]

"portable computers" "round as a team" "census"

*shudder*

you might as well just say that terrible phrase "run the list"

The only shift we have where sign-out between residents occurs at a time when one resident is leaving and the other resident is just getting there is the AM shift. most of the time when starting an AM shift I take ~2-3 sign-outs from the off-going senior and pick up 2-3 new patients within the first thirty minutes. Going to every room in the ED as a group to discuss each patient could provide additional education but sounds more like a slow descent into the 9th circle of hell.

All our other shifts have overlap so trying to round then would be impossible. The last 3 shifts I worked were so busy I didn't notice until the end of the day that I hadn't drunken water or peed..

 

[deuist]

The bedside walk rounds were required not only as a means of teaching, as also as a way to keep track of all of the patients. The hospital where I did residency had such a problem with boarding, that many of the patients were mislabeled as being in different locations. On one instance, a patient who had been sitting in a hallway bed for several hours had never been seen because the oncoming team assumed that she was already admitted and waiting for a bed to open upstairs.

 

[e30ftw]

Yeah that definitely makes sense if you don't have a reliable tracking board.

 

[RPedigo]

We do sit-down rounds and discuss each patient on our board (the R2s take the "pickups" who still have work to do before dispo, and the R3s take the "follows" who have been admitted). We now have a special unit for boarding patients that the hospitalist oversees, so most of our patients on the list are active or boarding ICU-level patients (cannot send the ICU-level patients to the boarding unit if beds are not available because it is considered a lower level of care than the ICU). In that case we sign out each case, have teaching points and a quick discussion of the case, and that helps with (1) learning, and (2) knowing the patients in the ED well since the signouts are either sick patients or active patients. I really like it; I think it's very helpful. I do not like walk rounds because often it's done without a computer and people don't have immediate access to the vitals, imaging, and lab results so I feel the signouts are actually less accurate and less complete ("I think the lactate was like 5").