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Table 1 Summary of Root Cause Analysis from “5 Why” Exercise, Resultant Countermeasures, and Application to the NET Rounding Framework

From: NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment

Root Cause

Countermeasure

Application to “NET Rounding” Framework

Rounds lack clarity of purpose; purpose of rounds is not shared amongst team members

Define and set expectations amongst team members for rounding agenda, time goals, roles, expectations, and purpose of rounds

Include “Shared Expectations” as a major category for the NET Rounding framework, including:

 Establishing a daily rounding agenda

 Identifying goals for rounding

Rounds are structured to accomplish a wide range of tasks in patient care, trainee education, and clinical reasoning

Adopt best practices from other services and positive outliers within Department of Medicine

Apply learned practices to the “Novel Rounding Strategies” and “Time Management” categories, including:

 Buddy System Rounding

 Problem Based Planning Rounds

 Limiting post-presentation comments

Presentations are often unfocused, redundant with information available in the EMR to all team members

Optimize pre-rounding for all team members

Pilot alternative rounding methods that better utilize the EMR and time spent on presentations

Gain buy-in to set minimum standards for resident and attending preparation for rounds:

 Whole team readiness for rounds

 Prioritizing relevant data and active problems

Efficiency is not valued or taught to residents; “hidden curriculum” epitomizes efficiency as opposite to thoroughness

Educate team members about efficiency mechanisms that can be used during rounds

Set time goals to help guide teams in rounds completion

Model prioritization of patient safety and education while ensuring completeness of rounds within a reasonable time-frame:

 Rounding with purpose

 Using timers