Rounds can fail for several reasons. Watch for the signs and address them before the rounds spiral out of control:

• Participants are late: It is vital to set the expectation that everyone will show up on time. Without that, the start time for rounds will drift from day to day and waste time;
• Participants come unprepared: Taking part at rounds requires that the nurse leaves nursing hand-off with the necessary information to participate effectively. This is the same for the hospitalist with morning hand-off from the doctor who worked overnight. Without sufficient information, participants will find themselves with nothing to say—or worse, provide erroneous or useless information; or
• Participants stray off the topic: It is easy to digress during group discussions. As the rounds leader, the hospitalist must keep discussion pertinent so rounds are not prolonged with unnecessary discussion. Think of rounds as an investment. We are asking busy providers to take 30 minutes out of their busy schedule to talk about patient care. A wise investment saves providers more time than they invested.

A primary benefit of rounds is as a forum for communication. All providers should try to funnel communication toward rounds rather than stopping the doctor or nurse throughout the day with questions and comments. Minimizing interruptions will foster more efficient care. Some hospitalist programs even huddle briefly in the afternoon to review plans discussed at morning rounds. TH