Rounds: Ensuring They Work for the Patient & the Practice
Conducting rounds imperative for your practice to continually improve patient care and ensure constant learning, which leads to synergy within all areas.
How can you create an environment that uses rounds effectively to start the day right? Who should attend? What information should be gathered? Our answers are based on our team approach to patient rounds at our emergency practice in New Jersey.
Who Should Attend Rounds?
All available veterinarians should be present for rounds. As a 24-hour practice, 8 AM and 6 PM work well for us. It is imperative that the overnight veterinarian presents cases that were admitted during his or her shift. Having every department at rounds lets everyone to easily pick up and/or transfer cases and allows for input from veterinarians and consultations among departments.
Stopping treatments while all technicians attend rounds is not feasible, so only head technicians and/or floor leads should attend practice-wide patient rounds; they can assign ward technicians to cases when needed. Technicians scheduled in specific wards should attend their ward’s rounds. We also conduct technician-only rounds (typically 10 ¬15 minutes long) several times a day at shift changes.
Move from cage to cage, putting faces to names, allows veterinarians to have another look at the treatment sheet and patient. Is there a case that is stumping you? Break it down during rounds with your team members. Reviewing cases with different departments or specialties brings everyone together, helping create a collaborative work environment.
What Information Should Be Gathered?
Let’s get to the crux of rounds. We find the following questions help ensure productive, informational rounds; a lot information needs to be covered in a short time, so stay on topic and be brief and concise.
All the answers to the questions below should be on your census:
1. Why did the patient come to the practice? What is the presenting complaint and what were the findings on presentation?2. Which veterinarian/service is managing the case?3. Any pertinent history (eg, diabetes, IMHA [immune-mediated hemolytic anemia], ACL [anterior cruciate ligament] repair)?4. Any current medications at home?5. What diagnostics have been performed? What were the results?6. What is the treatment plan for today? What treatments are being added or discontinued?7. Is the patient staying with the current department, or being transferred? Was the chart passed along with all the workups?8. Can the patient go home or can the client visit?9. Is a technician, a veterinarian, or the referring veterinarian going to update the client (see Working Together for Effective Communication)?10. Are we within the cost estimate? Do we need to get an additional deposit?11. Do the clients have any concerns (financial or other)?
The information you obtain by answering these questions can help your practice run smoothly by keeping receptionists, technicians, veterinarians, and clients informed with accurate information.
Working Together for Effective Communication
If you are a specialty practice, your communication does not stop with talking to the client or each other. Keeping the patient’s referring veterinarian in the loop is crucial to your working relationship. Remember, you are an extension of their practice. Either the specialist or emergency veterinarian is responsible for updating the referring veterinarian. An initial consult form detailing what diagnostics were performed, the initial diagnosis, and the recommended treatment plan should be sent to the referring veterinarian when the patient is admitted. When the patient is discharged, a discharge consult is also sent; this form should include post-operative or follow-up recommendations and whether they should be performed by the referring veterinarian or at the specialty hospital. Some veterinarians prefer daily calls regarding their patients while others are happy just receiving faxed or emailed updates. Be sure to tailor your communication to each veterinarian’s preferences.
Whether you have a 2- or 30-veterinarian practice, by participating in daily rounds and creating a census, you are trimming the time it takes to determine vital information, increasing collaboration within your team, and assuring better communication both inside and outside your hospital.