”When the consultant came round this morning with his assistants and attendants, he said something that I did not understand to the ward doctor.”Unknown patient, Damascus, 13th century |
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What’s Wrong With Ward Rounds?
John Launer, Postgrad Med J. 2013;89(1058):733-734.
If you have ever been a hospital in-patient, you will know what it means to look forward to ward rounds and to fear them at the same time. On the one hand, you lie there hoping for the doctors to come round because you will hear news of your progress, and perhaps whether you can go home. On the other hand, you almost certainly know from experience that the encounter with doctors will be brief and frustrating, with little opportunity to ask all the questions you wanted, no privacy, and the annoyance of having half a dozen strangers around your bed who might well be looking bored and in a hurry to move on.
Times Change, Ward Rounds Don’t
Likas Zinnagl, Feb 3, 2011, Medcrunch.net
Ward rounds are crucial elements in any hospital environment. They are routinely being performed, no matter in which country, which day of the week or which medical speciality. Physicians and patients alike either do look forward to them – or they don’t.
The hospital ward round is the only regular chance for conversation between the inpatient and the doctor. Most patients have the greatest expectations before the round but many look back on it with great disappointment. Bliesener and Köhle (1986) neatly refer to the traditional ward round as a “handicapped dialogue”.
Anatomy of the ward round
O’Hare JA., Eur J Intern Med, 2008 Jul;19(5):309-13A
The ward round has been a central activity of hospital life for hundreds of years. It is hardly mentioned in textbooks. The ward round is a parade through the hospital of professionals where most decision making concerning patient care is made. However the traditional format may be intimidating for patients and inadequate for communication. The round provides an opportunity for the multi-disciplinary team to listen to the patient’s narrative and jointly interpret his concerns. From this unfolds diagnosis, management plans, prognosis formation and the opportunity to explore social, psychological, rehabilitation and placement issues. Physical examination of the patient at the bedside still remains important. It has been a tradition to discuss the patient at the bedside but sensitive matters especially of uncertainty may better be discussed elsewhere. The senior doctor as round leader must seek the input of nursing whose observations may be under-appreciated due to traditional professional hierarchy. Reductions in the working hours of junior doctors and shortened length of stay have reduced continuity of patient care. This increases the importance of senior staff in ensuring continuity of care and the need for the joint round as the focus of optimal decision making. The traditional round incorporates teaching but patient’s right to privacy and their preferences must be respected. The quality and form of the clinical note is underreported but the electronic record is slow to being accepted. The traditional multi-disciplinary round is disappearing in some centres. This may be regrettable. The anatomy and optimal functioning of the ward round deserves scientific scrutiny and experimentation.
Ward rounds in medicine: principles for best practice
Ward rounds play a crucial part in reviewing and planning a patient’s care. They are an opportunity to inform and involve patients, and for joint learning for healthcare staff. However, there has been considerable variability in the way ward rounds are conducted.
This guidance, jointly produced by the Royal College of Physicians and the Royal College of Nursing, sets out core recommendations and principles for best practice for conducting medical ward rounds.
It calls for the multidisciplinary team – doctors, nurses, pharmacists, therapists and allied health professionals – to be given dedicated time to participate, with clarity about individual roles and responsibilities during and after ward rounds.