Table 2 NET Rounding strategies organized by category

Novel Rounding Strategies

Whole Team Readiness for Rounds: All team members commit to coming to rounds with available data from the EMR, thus allowing presentations and discussion to focus on “Assessment and Plan” and not recapitulation of available data

Rounding with Purpose: Team resident will identify a maximum of 6 patients for the team to bedside round on, with emphasis on patients who are critically ill/clinically active, discharging, followed by medical student(s), or have physical exam findings that are essential to clinical decision making and/or are educational. The remainder of patients will be rounded on by “cardflipping” with discussion of active inpatient problems only

Buddy System Rounding: Patient care is to be shared amongst the team rather than being rooted on the intern, with planned accountability for each team member for given task(s). During rounds, the team resident and/or co-intern will utilize a computer during rounds to help complete tasks in real time. Team attending and/or resident should identify tasks on rounds that they will complete independently to offload the intern’s post-rounds tasklist

Problem-Based Planning Rounds: Presenters will pause after each system/problem for the team to discuss and finalize a plan for that problem before moving on to the next problem. The goal of this is to minimize the “stacking” of feedback and summarizing the plan that can occur at the end of patient presentations

Shared Expectations

Establishing a Daily Rounding Agenda: Team leader (senior resident and/or attending) will establish a specific and time-based agenda for rounds (including holdover signout), and communicate that agenda with time goals to the team before the start of rounds

Identifying Goals for Rounding: The team will identify specific and measurable goals for rounding efficiency and task delegation at the start of rotation, with planned evaluations for all team members at mid-point and end-of- rotation feedback

Time

Management

Using Timers: Team leader (senior resident and/or attending) will utilize a timer for student and intern presentations that progressively shortens presentation length to the goal average of 7 minutes per established patient and 12 minutes per new patient.

Prioritizing Relevant Data and Active Problems: Interns and residents will present relevant data, assessments and plans for active problems only (usually 2–3); stable/chronic problems should either not be verbally discussed if no change/updates are available, or discussed in one brief statement.

Limiting Post-Presentation Comments: Limit feedback to one team member per presentation and/or reschedule presentation related, individualized feedback either to transitioning between patients or to after rounds. Avoid reiterating plans.