IM: Efficient rounding strategies

[Successor12]

Hello
So do you mind sharing efficient rounding startegies for IM. There will be residents but patients census tends to run high. For someone who is new to this whole thing as an atttending what would be the best apprpach to stay on top of things?

---

Members don't see this ad.

 

[rokshana]

Hello
So do you mind sharing efficient rounding startegies for IM. There will be residents but patients census tends to run high. For someone who is new to this whole thing as an atttending what would be the best apprpach to stay on top of things?

Efficient for who? If it’s to decrease time spent with rounding with the team, I have found it helpful to do table rounds to go over pts and give teaching points...then round on the new pts , discharging pts, and anyone where seeing the pt adds to the education of the residents...the rest I see by myself. If rounds start at 9, then can table round for about 60-90 mins and physically round for 30-60 mins...done by 1130 so they can call consults and finish up discharge paperwork before noon. Other is to have a computer with the team and someone assigned to put in orders as you go, then call consult, sw/cm,etc before noon conference.

 

[xoggyux]

Similar to what rokshana said. Except perhaps quickly glance at EMR to make sure you don't have to rush to see a patient deteriorating, discuss quickly with the senior resident if someone needs immediate attention. If so, do that one first. Then do everyone else at once, finally physically round on people. You can always see by yourself chronic patients waiting for placement, no need to have the whole team waiting 3mins for an elevator, 3 mins walking towards the patient room, 3 mins talking to the nurse, 10mins talking to the family and 1min seeing the patient.

 

[rokshana]

Similar to what rokshana said. Except perhaps quickly glance at EMR to make sure you don't have to rush to see a patient deteriorating, discuss quickly with the senior resident if someone needs immediate attention. If so, do that one first. Then do everyone else at once, finally physically round on people. You can always see by yourself chronic patients waiting for placement, no need to have the whole team waiting 3mins for an elevator, 3 mins walking towards the patient room, 3 mins talking to the nurse, 10mins talking to the family and 1min seeing the patient.

On a slower day, the family talk can be educational...so many times med students don’t get exposed to the minutiae of IM...though only once a rotation is sufficient!

 

[xoggyux]

On a slower day, the family talk can be educational...so many times med students don’t get exposed to the minutiae of IM...though only once a rotation is sufficient!

Well yes, but in this case, I think the keyword is efficiency which in this context implies a time restraint component. If the OP has a soft day it is fair to round on everyone, even chronic "boring" patients, there is always something that can be learned.
Now, discussion with family of patients or with patients themselves that are new and/or with active/acute issues is definitely high yield although problably there should be some degree of judgement from the attending/senior resident regarding the exposure of early (first 2-3 month) resident to big discussion with patients (e.i avoid the "well because of your diabetes and the way you have been ignoring your sugars we need to chop off your foot" kind of interaction.

 

[Trogghunter]

Working with a 20 patient cap on our IM team.... Start rounding as early as you can, no later than 8. Make sure that they have their notes done/pended for final modification before rounds, as well as DC summaries. I table round only on the overnights and I address the unstable patients during table rounds and see them first, then the overnights. I personally check labs/overnight notes before I start rounds and I personally prefer bedside rounds. We round with a computer so that the team can input orders and call consults. Almost always done by 11.