Hospital rounds?

[lizzo76]

I'm just not sure where to stick this question, so I am sticking it here, since I'm non-trad, even though this has nothing to do with being non-trad. I'm sure people will be able to answer it... oddly, a quick Google did not answer it.

What do hospital "rounds" mean... are there multiple definitions? I always thought that a doctor "makes rounds" by going around to all his/her patients in the morning.

I am about to start volunteering in the ACE Unit of a community hospital. I'm really excited - most hospitals don't have ACE units and those that do tend to be academic hospitals. This hospital has just finished its first, trial year, and so I am happy that I am kind of getting in on the ground floor. It's also perfect for what I want to go into. (ACE is Acute Care for Elders - a model which seeks to prevent or correct cognitive and physical decline in elderly people who are admitted to the hospital (for some other problem) so they can go home rather than being admitted to long-term care. In more traditional models of care, elderly people (and everyone, really, though it is most dramatic in the elderly) loses some level of cognitive and physical abilities.)

In any case, I am being encouraged to come in the morning because that is when the ACE team has "rounds". But, this apparently means that they go into a conference room and one by one talk about the patients, with each team member adding something, clarifying something, etc.. The team includes doctors, nurses, rehab therapists, etc..

I'm really excited to be involved in this each time I go to volunteer - I think it will be really valuable... but is this what "rounds" usually means? Is it done like this in this case because there's a team-based approach to care?

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[Catalystik]

In my experience, "rounds" means the doctor visiting patients at the bedside, with or without a team of others: med students, residents, fellow, etc., which may begin or end in a conference room, or not.

In your special situation, I suspect that the rounds may be taking place solely in a conference room because a team of invasive, multidisciplinary relative strangers (from the elders' point of view) may be intimidating or frightening. Also, it slows traditional "rounds" considerably when relatives wanting information are in the room. I'm sure a physician will visit each patient personally sometime later in the day.

It sounds like you have a great opportunity to "shadow" a variety of health-related occupations.

 

[felixthekat]

In one facility where I work "rounds" consists of us telling the doc about the pt since he was last seen...progress, setbacks, suggestions, ect. It is more of the conference room type although the doc does see the patient at some point during the day. In another facility where I work, it is more of the traditional rounds with attending, fellow, residents, interns,med students, shadowers all moving from room to room talking about the patient outside the door.

 

[Law2Doc]

I'm just not sure where to stick this question, so I am sticking it here, since I'm non-trad, even though this has nothing to do with being non-trad. I'm sure people will be able to answer it... oddly, a quick Google did not answer it.

What do hospital "rounds" mean... are there multiple definitions? I always thought that a doctor "makes rounds" by going around to all his/her patients in the morning.

I am about to start volunteering in the ACE Unit of a community hospital. I'm really excited - most hospitals don't have ACE units and those that do tend to be academic hospitals. This hospital has just finished its first, trial year, and so I am happy that I am kind of getting in on the ground floor. It's also perfect for what I want to go into. (ACE is Acute Care for Elders - a model which seeks to prevent or correct cognitive and physical decline in elderly people who are admitted to the hospital (for some other problem) so they can go home rather than being admitted to long-term care. In more traditional models of care, elderly people (and everyone, really, though it is most dramatic in the elderly) loses some level of cognitive and physical abilities.)

In any case, I am being encouraged to come in the morning because that is when the ACE team has "rounds". But, this apparently means that they go into a conference room and one by one talk about the patients, with each team member adding something, clarifying something, etc.. The team includes doctors, nurses, rehab therapists, etc..

I'm really excited to be involved in this each time I go to volunteer - I think it will be really valuable... but is this what "rounds" usually means? Is it done like this in this case because there's a team-based approach to care?

"Rounds" is a catch-all term that describes the action of going through a medical teams patients in one form or another. You will come across "walking rounds", "table rounds", "inter/multi-disciplinary rounds", etc. Everyone will simply call it rounds. In general, the med students and then residents will do "pre-rounding" where they go to each patient's room and check the labs. Then when the attending/fellow/chief shows up, there will be another set of rounds. This may be a room by room with the attending, or it might be sitting at a table with the attending going to the rooms later to write his notes. In either case the patient is going to have been seen first by a resident and later by an attending at least daily. In many cases will be seen by a med student multiple times as well. And in many cases there will be both morning and end of the day walking rounds. Now in most cases you don't walk room to room with the rehab therapists, social workers, dieticians, speech therapists, etc. They aren't going to be involved in every patient's care and they aren't involved in the patients medical/pharmaceutical treatment so it would be a lot of dead time for them. So generally you will also have interdisciplinary rounds at some point each day attended by some of the physician team and representatives from these other disciplines that sit at a table and run through the list of patients and their needs. So this isn't really anything unique, but there will be more than 1 type of rounds at the typical hospital. Many people learn in med school that fields like IM are not for them because you can be rounding in one form or another throughout the whole day. It's a good way to make sure everyone agrees on the plan and that everyone knows every patient, but it can be tedious.

I would caution that you may be buying into the hype is going to rub a lot of folks the wrong way in your description of how "ACE" is supposedly superior to the "traditional" geriatric care you get at most hospitals. Honestly, most hospitals that deal with geriatric care do their best to ensure that their patients maintain independent living for as long as possible. Nobody can turn back aging and no hospital simply has as its goal to not correct correctable decline and simply sending folks off to be warehoused. Programs like yours use puffery to make their programs sound better and to get more donors/funding, but honestly, EVERY hospital does it's best to ensure that their geriatric patients get whatever treatments would allow them to maintain their independence for as long as feasible. Doctors and social workers work hard at this with patients and families and your suggestion that the "traditional" method is inferior because it "loses some level of cognitive and physical abilities" while your hospital somehow doesn't is going to rub people the wrong way. I would think of a very different description before you have to write up essays and interview. Many adcoms work with the geriatric population and don't like a premed to tell them they are doing it poorly.