Rounding In The Racc printable pdf download

Rounding in the RACC

We want to formalize the transition rounds between the morning and afternoon shift in order to

ensure comprehensive handoffs and bolster teaching. Please follow these steps:

1. At 5pm (4pm on Mondays) have the clerk overhead announce that rounds will be starting

at bed 1 (this is to allow the nurses to participate—we want the nurses!)

The patient’s nurse, the docs, the incoming scribe, and the ED Pharmacist should be present

3. Get at least one Computer-On-Wheels; two are preferable. One resident should pull up

labs and radiology, the 2

resident should put in orders as they are discussed.

4. The senior resident should know ALL of the patients and should present each patient on

rounds. The junior resident and the outgoing attending should fill in any additional details

5. For non-critical patients, there should be a brief description of the situation that brought

the patient to the ED, followed by pertinent PMH/PSH/background, and then a problem

list and what is being done about each item.

6. For Critically Ill patients, the presentation should follow ICU-systems based approach (See

Page 2)

7. If a new patient arrives during rounds, the junior resident should break off and assess the

patient, place initial orders and then return to rounds. Only if the patient requires

immediate resuscitation, should rounds be paused and the entire team should go and

stabilize the patient.

8. Non-emergent issues and requests for orders by nursing should wait for the team to arrive

at that patient during rounds. This is one of many reasons that nursing should be involved

in this multi-disciplinary rounding.

9. For some reason the attending taking over is always much smarter than the attending

signing out. Oh, wait, that’s not it; it’s that when rounding in a 25 bed unit, there are

bound to be things that are discovered on rounds—in fact that is one of the main benefits

of rounds. If you are taking over, be kind and judicious when asking about, “Why has

BLANK not been addressed or acted upon. These are discovery rounds. The outgoing

attending should not feel they have somehow failed if the lab they have been waiting-for

for the past 3 hours finally comes back during rounds and changes the disposition—this is

why we are comprehensively rounding.

10. At the end of each patient, a closed-loop summary should be reiterated of plan, orders, and

disposition.

Rounding In The Racc