What exactly happens during 'rounds'?

[ktworld]

Because I'm getting two different definitions for it: 'a teaching conference or a meeting in which the clinical problems encountered in the practice of nursing, medicine, or other service are discussed' & 'Bedside visits by a physician–or other health professional, to evaluate treatment, assess current course and document the Pt's progress or recuperation'

which one is correct?

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[Tatastrophy]

Because I'm getting two different definitions for it: 'a teaching conference or a meeting in which the clinical problems encountered in the practice of nursing, medicine, or other service are discussed' & 'Bedside visits by a physician–or other health professional, to evaluate treatment, assess current course and document the Pt's progress or recuperation'

which one is correct?

who says they are mutually exclusive?
I worked in the ICU for that past two summers and was required to attend rounds....basically the attending teaches med students (and to a lesser extent residents) about various conditions represented in the population of patients as well as types of treatment, therapies and diagnostic measures. The issues that present themselves in each patient are basically the subject of the day and at the end of it any needed changes to care are made.
Hope that kind of synthesizes the two descriptions well for you.


P.S. I wouldn't call it a conference-although I have seen rounds that are done in a work room rather than in the ICU itself with a quick look over the patient afterward.

 

[smq123]

Because I'm getting two different definitions for it: 'a teaching conference or a meeting in which the clinical problems encountered in the practice of nursing, medicine, or other service are discussed' & 'Bedside visits by a physician–or other health professional, to evaluate treatment, assess current course and document the Pt's progress or recuperation'

which one is correct?

Which kinds of rounds do you mean? There are a few different types - mostly "sit-down rounds," or "walk rounds/work rounds."

At sit down rounds, the entire team will literally sit down around a table or a computer and run through each patient on their service. This sounds more like your first definition.

At walk rounds/work rounds, you literally walk from room to room with the senior physician, and he examines the patient himself. This sounds more like the 2nd definition.

There are both kinds of rounds. Different services and different physicians prefer different types.

 

[ktworld]

wait do medical students have rounds or interns? Thats an interesting response...what about on grey's anatomy/other medical shows when they consider their 'rounds' as the going into the patients room and presenting their condition and assessments?

 

[TheMightySmiter]

"Rounds" basically refers to any time doctors or nurses go "around" and check in on all of their patients. It can be academic but the primary purpose is to see how the patient is doing.

 

[ktworld]

Which kinds of rounds do you mean? There are a few different types - mostly "sit-down rounds," or "walk rounds/work rounds."

At sit down rounds, the entire team will literally sit down around a table or a computer and run through each patient on their service. This sounds more like your first definition.

At walk rounds/work rounds, you literally walk from room to room with the senior physician, and he examines the patient himself. This sounds more like the 2nd definition.

There are both kinds of rounds. Different services and different physicians prefer different types.

Probably the second one, the walk rounds/work rounds. I'm helping my sister write this essay and the prompt it: " .Imagine that you are a medical student on your rounds in the hospital. Discuss some important interactions that you might observe between staff and patients and amongst staff members themselves." I would think that would relate to walk rounds. How else would you observe a interactions without walking around?.

 

[Tatastrophy]

wait do medical students have rounds or interns? Thats an interesting response...what about on grey's anatomy/other medical shows when they consider their 'rounds' as the going into the patients room and presenting their condition and assessments?

The hospital I worked at in the SICU the med students did a lot of the "gather all the info and present" type stuff. I think since trauma surgeons have to do internship in like general surgery (I think) there were no interns on the SICU service-only residents and attendings.
it could be different depending on the place but the rounds I was at were literally a thorough presentation of each patient's condition with a computer on a special cart to look up any images/lab results/whatever by each patient's room.

 

[Law2Doc]

wait do medical students have rounds or interns? Thats an interesting response...what about on grey's anatomy/other medical shows when they consider their 'rounds' as the going into the patients room and presenting their condition and assessments?

Rounds is a term used in a variety of settings. There are "grand rounds" which are basically conferences, table rounds, where the team (attending, residents, med students) discuss all the patients, and the more traditional, walking rounds, where the team (attending, residents, med students) go room to room and present the patient and come up with an assessment and plan. On medical shows, you see the interns go around with the attending to each patient's bed, but in fact the team usually includes third and fourth year med students as well.

 

[Law2Doc]

...with a computer on a special cart to look up any images/lab results/whatever by each patient's room.

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

 

[Tatastrophy]

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

Haha. I never heard our docs call it anything other than "cart"...and yes it was either the med students pushing it (along with a rolling shelf with physical paper charts) or when the med students have spent a few weeks on the service and realized that they are actually our "superiors" they would delegate the cart pushing to us lol

 

[J ROD]

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

Cow wow!!!

 

[calimed214]

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

I've worked at 3 different hospitals and they all called it a cow as well. Thankfully someone explained it to me early on or else I wouldve been so confused the first time my preceptor asked me to find the cow. 😕

 

[Tatastrophy]

I've worked at 3 different hospitals and they all called it a cow as well. Thankfully someone explained it to me early on or else I wouldve been so confused the first time my preceptor asked me to find the cow. 😕

lol. I can imagine you thinking "WTF is he talking about!"

 

[Disinence2]

Student responsibilities on "rounds" very from service to service. If your hospital uses an EMR system with electronic order input usually the senior resident who is technically "leading" rounds will take care of the computer. Your responsibility as a medical student is generally to have written a progress note on your patient before rounds (and before the interns) and to give an acceptable case presentation to the attending.

There are also "teaching rounds" and "Grand rounds" just to add a couple more descriptors to the mix.

 

[bannie22]

go from ward to ward checking in on each patient.

 

[45408]

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

Many places no longer call it that, because the patients might think that "cow" refers to them. Wouldn't go over well on a bariatric service.

 

[GlamDoc]

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

I was definitely confused by this terminology. We just got "Cows" in the ER I volunteer at earlier this year. Everytime it runs out of charge, it starts beeping incessantly, and the nurses run through halls yelling "Cow down, Cow down!"

I, of course, spent most of my time wondering why they chose the cow (instead of any other animal) to nickname their computers. 😀

 

[Law2Doc]

Many places no longer call it that, because the patients might think that "cow" refers to them. Wouldn't go over well on a bariatric service.

Actually, it's not the patients that complain about this nomenclature, it's the nurses. Far too many instances of attendings pointing over toward the nursing station (where the carts are often kept) and saying to the med student, "go grab the cow".

 

[apumic]

Most places call this a "Cow" (computer on wheels), and it is often the med student on the team's job to push it along.

...Or an NP/PA or PharmD from what I've seen.

At some metro hospitals' ICU, you may also see other non-physicians participating. For example, here our team generally consists of the physicians overseeing the care of a group of patients, a senior attending, a couple of NPs/PAs, and a PharmD (who basically acts as a consultant on complex cases where a pt is taking 20-30+ medications for a variety of conditions that may have complex and/or unknown interactions).

 

[Law2Doc]

...Or an NP/PA or PharmD from what I've seen.
...

Well, it's often the least senior (most expendible) person on the team because you tend to lose that person for a chunk of rounds each time you enter a stairwell and that person has to wait for an elevator. Hardly an honor to push that around, unless you are otherwise looking for an excuse to be useful.

 

[J ROD]

lol. I can imagine you thinking "WTF is he talking about!"

this was me for the first week!!

 

[J ROD]

I was definitely confused by this terminology. We just got "Cows" in the ER I volunteer at earlier this year. Everytime it runs out of charge, it starts beeping incessantly, and the nurses run through halls yelling "Cow down, Cow down!"

I, of course, spent most of my time wondering why they chose the cow (instead of any other animal) to nickname their computers. 😀

I will have to remember that one! Cow Down!! 👍

 

[nogolfinsnow]

When I was on our HIV service, our rounds one week consisted of 2 3rd years, 1 4th year, 2 interns, 1 resident, 1 attending, 2 pharm students, 1 pharmD, 2 nutrition interns, and one nutrition consultant. So that's 13 people on rounds. And we had 4 patients

 

[J ROD]

When I was on our HIV service, our rounds one week consisted of 2 3rd years, 1 4th year, 2 interns, 1 resident, 1 attending, 2 pharm students, 1 pharmD, 2 nutrition interns, and one nutrition consultant. So that's 13 people on rounds. And we had 4 patients

Lets see we had 2 pharm students, 1 pharm resident, 1 clinical PharmD, 2 med students, 4 residents, 1 fellow, and 1 attending......only 12!!!

We also had nurses coming in and out....one day the nurse even did the presentation when the residents and med students got mixed up and forgot to assign a patient to someone.

Way too many folks to me to go into a room!!

 

[icalz]

Doesn't it depend on the department? When I had done my shadowing it was with an anesthesiologist on a labor and delivery ward. I was allowed to sit it in on 'rounds' which consisted of everyone sitting in a room and going over their patients one by one with the doctor who was going to take over for that day....we never went room to room. I would imagine a different department would have to do it differently. I've often wondered what "Grand Rounds" was.

 

[mvenus929]

Doesn't it depend on the department? When I had done my shadowing it was with an anesthesiologist on a labor and delivery ward. I was allowed to sit it in on 'rounds' which consisted of everyone sitting in a room and going over their patients one by one with the doctor who was going to take over for that day....we never went room to room. I would imagine a different department would have to do it differently. I've often wondered what "Grand Rounds" was.

Nurses call this 'report', but it tends to vary from hospital to hospital. Evidently at the hospital I work at, the doctors very rarely go see the patients themselves (which leads to a lot of complaints and patients wondering what the heck is going on with them). At other hospitals, I've seen the doctors actually go around and see the patients, even after the report given by the on-call doc the night before.

 

[psipsina]

Doesn't it depend on the department? When I had done my shadowing it was with an anesthesiologist on a labor and delivery ward. I was allowed to sit it in on 'rounds' which consisted of everyone sitting in a room and going over their patients one by one with the doctor who was going to take over for that day....we never went room to room. I would imagine a different department would have to do it differently. I've often wondered what "Grand Rounds" was.

Every department does it differently but in general it is the medstudent/intern presenting their patients to the attending, the attending pimping and teaching and then deciding on a final plan for that patient. I've been on teams that only table round, teams that only walk round, teams that do both, teams that want you to present at the bedside and encourage the patient that interrupt, teams that present in the hallway and then the attending goes in and examines the patient etc. The general idea is that you come in ahead of time and see your patients, check out their lab results and new imaging, read their chart to see what happened overnight and write up a progress note summarizing all this and coming up with what you want to do with them . . . this is what you present to the attending who uses it as an opportunity to 1) teach you and 2) make the final decisions for patient care.