Walk Rounds

[Furuncle]

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I have a question for other peds residents out there. My hospital is currently trying to switch to walk rounds, rather than traditional "sit-down" rounds. I, and most of the other residents at my program, are pretty miserable about the change for a variety of reasons (eg, round take much longer, so we have less time to get all our work done, there's much less teaching being done since the patient load is so high that there's no chance to do bedside teaching, teams are so huge - 15 members/team - that we can't physically all get in the room, there aren't private rooms, and so on). We had an attending from Cincinnati Children's come and talk to us about how great walk rounds were, and how at his hospital, the residents love walk rounds, and would never want to be at a program without them. I have a VERY hard time believing this, though I'd love to hear otherwise - I was hoping to hear other people's thoughts on the subject.
Thanks very much...

 

[carpe diem]

I'm honestly not sure if the program I'm about to start does walk rounds but I hope so. Yes, they may take longer but my opinion is that attendings should make a point to teach about significant physical findings or special teaching points at the bedside.

It is extremely helpful to the ones on the team who really need to know (i.e. interns following the patient and all other interns on the team); it's also extremely helpful for the families of the patients and the nurses.

Large teams are also doable ( I participated in walk rounds at a major pediatric teaching hospital for 6-7 years in another capacity, before medical school). You present the synopsis of the patient's progress outside the room; the attending leads only the most pertinent team members into the patient's room to discuss pertinent physical findings/ teaching points , and to discuss the latest updates with the family.

Apart from walking between rooms, it really doesn't have to take much more time than a sit-down presentation and probably saves times for everyone in the long run. I saw it work for 6-7 years where I was previously and don't understand why more places don't practice this.

Carpe

 

[marathon30]

i am going to be a resident at cincinnati children's this july. I have been on three different rotations as a medical student where we did walk rounds. the residents do like walk rounds, because all the work for a patient is done while in the room with the patient. this leaves the resident free to get teaching on the cases they see from the attendings. at CCHMC we have a rounding attending and a teaching attending that also rounds with the team and whose sole job is to offer teaching points on the patients we have on the team. there are then impromptu lectures given each late morning and early afternoon on subjects pertinent as well. the things that make cincy's walk rounds work very well is that there are two laptop computers that travel on rounds with the team that enable one resident to enter in all orders the team places on a patient (while in the resident who is covering the patient is presenting them to the team) while another resident simultaneously updates/starts the discharge summary for that same patient. it works pretty efficiently. this is not to say that some days the rounds go long, but i have been in sit down rounds where the rounds drag on for hours as well (on our medicine side). both have plusses and minuses, but the walk rounds work pretty well and the families and residents love them.

 

[baby doc j]

I second the above. Walk rounds, although sometimes longer, kill every bird with one stone. The family, housestaff, attending, nursing, pharmacy, and (if you are in a place that has them) patient care coordinators all hear the exact same thing at the same time so there are fewer problems with communication which can make the rest of your day pretty light. Also, with the computers, you get notes and orders done while on rounds. Attendings can do a little bedside teaching which I have found most parents LOVE to listen to. I really think it increases the trust and repoire (how the hwell do you spell that??) Given the choice, I'd choose walk rounds every time.

 

[Furuncle]

Thanks for the replies - I appreciate the input. I noticed that all the replies seem to be from medical students. It makes sense that students like walk rounds, but it would be great to hear from other interns/residents, since the high patient load per intern/resident tends to shift one's perspective a bit. Thanks again...

 

[fourthyearmed]

We actually do both. First we sit with the entire team and discuss since it really isn't ideal to talk in the hallways since anyone can overhear you and it's hard for a large team to all hear well. Then we walk quickly around with some of the team going in the room while the other residents/interns put in orders.