Unit Based Rounds

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General

  • Unit Based Rounds start at 9:30 AM
  • There may be chances to place orders here and there, but do not expect to get any individual patient work done at this time.
  • This is often the first time you meet the attending in the morning.
  • Be sensitive to curious bystanders. Help redirect traffic. Avoid HIPPA violations.

Format

  1. Generally the charge nurse will take the lead in conducting UBR.
  2. UBR is usually attended by Nursing, Case Management, Social Work, Physical & Occupational Therapy, Respiratory Therapy, Pharmacy, Chaplin, and the Physician Team.
  3. Although each support service has the opportunity to voice patient or support team needs, UBR is typically dominated by the nurse, physician, and Case Management.
  4. Each nurse will take turns briefly presenting their respective patients. Presentation is primarily focused on disposition. New orders are often requested at this time.
  5. Physician will clarify plan, issue new orders, and propose expected discharge date and location.
  6. Case management will usually comment on disposition, particularly for patients with expected discharge to IPR, SNF, LTACH.
  7. Charge Nurse will review any barriers to discharge.
  8. This process is repeated for each team patient.

Resident Role

  • The upper level will typically assume the role of the Physician during UBR.
  • This typically includes:
  1. Elaborating on the plan of care.
  2. Issuing new verbal orders.
  3. Assigning tasks to support services if necessary.
  4. Expected discharge date
  5. Expected disposition or discharge location
  6. Eliminating barriers to discharge.
  • Be prepared.
  • Be brief.
  • Be attentive. Conduct yourself well.
  • Remember this is not medicine rounds. UBR is for support staff. Avoid medically complex details of patient care.
  • Learn staff names. This is a great opportunity for staff to get to know you, and you, them.
  • Be more than polite, be cordial. Express gratitude. Make others feel important.
  • Do not embarrass or belittle support staff. Represent yourself and the program well.

Barriers to Discharge

  • This stuff should be on your mind daily.
  • Common barriers to discharge include:
    • Tubes, Lines, Drains
    • Consults
    • Procedures
    • Diet
      • PICC
      • Biopsy
      • Surgery
    • Diagnostic studies
      • Necessary Labs
      • Imaging: particularly MRI and echo
      • Cultures
    • IV medications
      • Fluids
      • Antibiotics
      • Pain medication
    • Placement
      • PT/OT Eval
      • Referral
      • Acceptance
      • Approval
      • Bed
      • Transport
  • Additionally, patient and family perception and miscommunication is often a huge barrier.