Round It Out, Talk It Out

By: Stephanie Jean

At nearly every hospital across the nation, there is a rounding system that medical professionals use to provide efficient care for the patient and communication between providers. You may have seen a version of this on popular medical TV shows such as Grey’s Anatomy. I have seen my share of medical shows, but until I took part in real life rounds during my clinical rotation, I never really understood how important they are. As an enthusiastic intern with very little hands-on clinical experience, I was somewhat new to the idea of rounding. What are we going to talk about, and why are there so many different medical professionals here, I wondered as I gathered for rounds on my first day. My rotation gave me a solid understanding of the multidisciplinary team, and what rounding on patients means.

The multidisciplinary team can vary from hospital to hospital, but at my rotation site the team typically included a pharmacist, nurse, doctor or physician’s assistant, case manager, and dietitian. The nurse begins by presenting the patient’s case to the group. Much of this included medical terminology that I had heard before, but sometimes a quick Google search helps me piece the picture together. I found it very useful to have a small spiral notebook in my lab coat to jot down notes that I could refer to later. The nurse also discussed any medical procedures and labs that were done, as well as the results. Once the nurse finished presenting, the doctor or physician’s assistant provided feedback and the plan of care for the patient. Typically, this was when other providers  chimed in to reveal their plan of care (if pertinent to the patient). Depending on how long the patient has been there or the complexity of the case, this may include almost every member of the multidisciplinary team.

The goal of the multidisciplinary team is to provide efficient patient care that is strengthened when everyone works together. However, even though we all share the same goal, we have our own way of achieving this goal. What does the dietitian do for the patient that is different from everyone else’s scope of practice? The RD focuses on the patient’s weight status, nutrition status, adequate or insufficient oral intake, medications that may have nutritional implications, electrolyte imbalances, and so much more. These considerations are crucial to the patients care, and at times are instrumental to the patient’s recovery. Not every hospital includes RD’s on rounds, but I believe dietitians are a valuable part of the team who can utilize medical nutrition therapy, provide the team with greater detail about a patient’s nutritional needs and improve outcomes.

Each hospital is different with their rounding system and how often they round on patients. At my hospital, the dietitian is required to be on rounds every day and for every patient. The hospital is on the smaller side, so rounds included as few as 30 patients per day. The team tried to be as efficient as possible by ensuring that everyone was on time for the commencement of rounds, and with very little distractions. During my rotation, the rounds I participated in began at 10:00 AM. My work day started around 7:30 AM, so I had enough time to look up my patients for the day and see a couple patients before rounds started. This taught me the importance of time management, and how every minute spent is valuable to my workflow. Looking up my patients beforehand, if even briefly, prompted me to begin thinking about what care my patient might need and what questions I may need to ask. Rounds were one of the only times that the team was together at once, so it was an ideal time to receive additional information that may not be in the patient’s chart yet. Even though every provider is not present during rounds, I could find out what providers would be consulted for the case and how their services will optimize patient care.

During my clinical rotation, I developed an appreciation for the symbiotic relationship between the interdisciplinary team and patients.Dietitians provide professional and expert advice, but it is always interesting to see what other providers recommend for the patient as well. To gain even more from my clinical rotation, I have

used this experience to learn about other professions, and their role in critical care. I am fascinated by the  various ways in which patients receive care in the hospital setting, and how it largely impacts outcomes. From admission to discharge, providers are working together to optimize patients’ health, and each provider has a valuable role in achieving this. Together, we all leave an impact on the patient and our daily efforts ensure outstanding patient care.