The Things All Doctors Need to Know About Ward Rounds

After qualifying as a doctor, you soon begin to understand the central role a ward round carries within your day. This is of course assuming that there are no emergencies requiring your immediate attention. As monotonous and time consuming as they may be, ward rounds are integral to managing inpatients, are central to hospital care and have been part of our job for over a century. 

What happens during a ward round?

During a ward round the diagnosis, prognosis and treatment plans for each patient take place and they also serve as a method by which medical trainees and junior doctors areeducated. In practice, from my own experience as a junior doctor, ward rounds consist of; a group of healthcare professionals huddled around the patient’s bedspace with the junior doctor juggling patient notes and blood results, taking notes, presenting the patient and management to date, carrying out clinical examinations and completing radiology request forms. Unfortunately, the opportunity to learn from senior team members is often lost in the pursuit of a smooth ward round. Immediately after a ward round the consultants and senior registrars return to clinic, theatres and medical take in A&E and therefore further learning opportunities are lost. 

Issues junior doctors might face during a ward round, with potential solutions

Knowing what information to share

As a junior doctor it might be difficult to identify relevant clinical information to share with the team. Information sharing is crucial for the right decisions to be made in regards to patient care and management. 

Solution: Speak to other team members (doctors, nurses, physiotherapists, pharmacists, dietitians, SLT members, social care workers etc.) about the information that you have about the patient. They will be able to advise what should be shared on the ward round and you will obtain multidisciplinary viewpoints by harvesting the collective intelligence of the entire team. 

Knowing what to document

We are taught about the significance of clear and accurate medical documentation. A study has however shown [1] that information recording and the understanding of what is pertinent varies between different team members. Being a junior doctor with limited experience it might be difficult to know what information is relevant for documentation in the medical notes. The issue is that vital information might be missed if it has been documented in such a way that it is illegible or leaves room for interpretation. Time constraints are recognised and the time for documenting everything including thought processes might be impractical. 

Solution: It is absolutely crucial that accurate, timely and legible documentation of any involvement of patient care is made. This includes; clinical examinations, investigation results, discussions with the patient and their relatives, thought processes behind management plans, multidisciplinary team recommendations and any concerns that the patients have expressed.

Knowing what to contribute

As a junior doctor it can sometimes be daunting to share thoughts in regards to diagnoses or management plans amongst senior healthcare professionals. Hierarchies do influence whether participants believe they can contribute [1]. Junior doctors might feel a lack in confidence or believe they have little to offer and this will prevent them from participating in discussions in forming management plans with their peers and a potential learning opportunity. 

Solution: It must be mentioned that confidence and accuracy in diagnoses and forming management plans comes with clinical experience. However, self-development is an important part of enhancing confidence and non-clinical skills should be worked on in tandem. In this situation, particular focus should be given to; the development of communication skills to facilitate team work, self-awareness to understand how your actions affect others and knowing the limitations of your abilities and negotiation skills.

Non-clinical skills that enhance your learning opportunities during a ward round 

1 – Solid communication skills are required to share your understanding and interpretation of the patient’s status with the rest of your team.

2 – Negotiation skills are necessary for optimal teamwork in order to form a patient management plan. Negotiation skills are often discussed but what does this mean for us doctors?

The following are everyday clinical examples where negotiation skills are necessary:

  • When the physiotherapists can mobilise patients post hip replacement 
  • When SLT can attempt speaking valve trials in ICU patients with tracheostomies
  • When the Ryles tube can be removed in patients with resolving ileus post laparotomy
  • When discussing indications for CTPA with the radiologist for a patient with breathlessness on medical take in A&E
  • When discussing anticoagulation plans with haematologists and pharmacists for bridging with LMWH for patients on Warfarin awaiting surgery

3 – Organisation and time management skills are essential and are related to; preparing all investigation results pre-ward round, reading the notes for new admissions to present on the ward round and prioritising jobs. This will reduce the likelihood for medical errors as well. 

Time management is about being efficient with your time, so that you are able to take essential breaks to ensure you are looking after your wellbeing and reduce burnout. Good time management will allow for time outside the ward in clinics and theatres to increase your learning opportunities. 

In conclusion, ward rounds will always be part of our daily work as doctors. Small incremental changes can make a big difference to how we work. Next time you are on the ward, what will you improve? 

Look out for our next blog post on How to structure your ward round”.

References

  1. Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study