Attending rounds in the current era: what is and is not happening

Abstract

Importance: General medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized.

Objective: To describe the characteristics of attending rounds for internal medicine inpatients in a large teaching hospital system.

Design: A cross-sectional observational study of attending rounds in internal medicine. Rounds were observed directly by research assistants.

Setting: Four teaching hospitals associated with a large public medical school.

Participants: Fifty-six attending physicians and 279 trainees treating 807 general medicine inpatients.

Main outcomes and measures: Duration and location of rounds, composition of teams, and frequency of 19 potential activities during rounds.

Results: We observed 90 days of rounds. A typical rounding day consisted of 1 attending with 3 trainees visiting a median of 9 (range, 2-18 [SD, 2.9]) patients for a median of 2.0 hours (range, 25-241 [SD, 2.7] minutes). On rounds, teams most frequently discussed the patient care plan (96.7% of patients), reviewed diagnostic studies (90.7%), communicated with patients (73.4%), and discussed the medication list (68.8%). Teams infrequently discussed invasive lines or tubes (9.3%) or nursing notes (6.2%) and rarely communicated with nurses (12.0%) or taught physical examination skills (14.6%), evidence-based medicine topics (7.2%), or learner-identified topics (3.2%). Many commonly performed activities occurred infrequently at the bedside.

Conclusions and relevance: Most activities on attending rounds do not take place at the bedside. The teams discuss patient care plans and test results most of the time but fail to include many items that may be of significant value, including specific aspects of patient care, interprofessional communication, and learner-centered education. Future studies are needed to further assess the implications of these observations.