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 |