Bedside rounding, a practice dating back more than a century, is not uniformly implemented. Many physicians are unsure of its effectiveness in improving patient care and teaching learners, and it conflicts with many pandemic protocols.
Some hospitalists suggest selecting patients or scenarios for bedside rounding instead of meeting in a conference room or catching colleagues in the hallway. Others believe it should be used for all patients.
Many clinicians see advantages to bedside rounding; for one, patients seem to like it.
“When done well, everyone benefits,” said Annie Massart, MD, assistant professor of medicine at Emory University in Atlanta. “The literature suggests that patients prefer it, which makes sense because it’s an important tool for centering our patients in their care.” Dr. Massart, who says she’s passionate about bedside rounds, describes the opportunity to foster shared decision-making as one major pro for bedside rounding.
In pediatrics, involving patients—or, more accurately, their parents—in decision making is the norm, says Christopher Landrigan, MD, MPH, chief, division of general pediatrics at Boston Children’s Hospital in Boston and the William Berenberg Professor of Pediatrics at Harvard Medical School. This helps to keep them informed and involved with their child’s care. Still, Dr. Landrigan thinks bedside rounding can translate into adult medicine well and that the biggest barrier is the hospital culture.
Another advantage to bedside rounding is that it can help trainees grow as more experienced physicians can observe them and provide granular feedback, Dr. Massart said. “Learners want to improve and are tired of being told to ‘read more’ at the end of each rotation. When I’ve spent each morning with them at the bedside, I’m able to observe their exam skills and give them nuanced feedback on how they connect with their patients.”
Specifically bedside rounds can help assess trainees on empathy, how they answer patient questions, how they relay a plan with minimal medical jargon, and how they navigate language and cultural barriers, says Ali Farkhondehpour, MD, FACP, FHM, associate clinical professor with the University of California San Diego, and a hospitalist in the division of hospital medicine at U.C. San Diego Medical Center.
Bedside rounding also can be just as, or more, efficient compared to other methods. A Journal of Hospital Medicine article found that when comparing bedside rounds to walking rounds, the time spent on them per patient tends to be similar.1 However, it may not feel that way, says John T. Ratelle, MD, associate professor of medicine and a hospitalist with the Mayo Clinic in Rochester, Minn. “There’s some upfront investment required. It’s a learned skill. It’s hard to go into a room and talk to a patient about their condition with them as well as to attendings and professional staff,” he said. He describes bedside rounding as cognitively more demanding, which is likely what makes it feel longer.
They may be in the minority, but bedside rounding is also what just seems to work best for some hospitalists. Dr. Ratelle worked previously with an intern who was trained early on in bedside rounding and actually preferred it to other methods.
Of course, if bedside rounds were perfect, everyone would use them. Yet they have some drawbacks.
As Dr. Ratelle mentions, the cognitive demands of bedside rounding compared with simply meeting with peers outside of the patient’s room could make the latter approach preferable. The current demands on medical professionals in hospitals combined with the idea of doing bedside rounds may sound overwhelming. “It’d be cognitively less demanding to meet in a conference room that’s a ‘safe space’,” he said. “I think that’s one reason why bedside rounding is withering.”
Another reason that bedside rounding may be used less frequently is that many hospitals are still in “COVID-19 mode,” even if the threat of the virus is less foreboding than it once was. The routine of discussing care outside of the patient’s room continues at many medical centers, Dr. Farkhondehpour says. Some are pushing to return to pre-COVID-19 bedside routines while others are sticking with the methods they have used over the past few years. “I think this has become an ‘old habits are hard to break’ scenario,” he said.
Bedside rounds may not be the right choice for every patient scenario, Dr. Farkhondehpour says. For instance, complex goals-of-care discussions are often lengthy, especially when hospice may be part of it. “The mornings are hard to initiate a meaningful goals-of-care discussion and then leave and come back to pick up where you left off from,” he said.
While some hospitalists may have a strong proclivity for bedside rounding or card flipping in internal medicine, Dr. Ratelle says the right answer may be somewhere in between, deciding which scenarios would benefit the most from bedside rounds.
First, you need to be with a patient who needs it and benefits from it, he says.
Next, you need a leader who feels comfortable at the bedside. “Often that’s the attending physician, but it doesn’t have to be,” Dr. Ratelle said. Leadership support from the hospital system is also crucial.
The third factor is having the time and space to do a bedside round. If the workload for a particular day seems manageable, that also sets the day up for bedside rounding. However, Dr. Landrigan points out, research finds the time it takes is about the same as conference-room rounds.
Dr. Farkhondehpour favors a hybrid model of bedside rounding for new patients admitted overnight or patients with new acute overnight events, a table round or card flip on patients who tend to be stable with less acute medical issues, and a walk-around on all others.
Dr. Landrigan prefers using bedside rounds for all patients, even if that creates a mental frameshift and additional education and coaching. “Because bedside rounds have been shown to broadly improve care, there is a risk that if you pick and choose whom you’re going to do them on, systemic bias might creep in. Better to do them for everyone, and do them well,” he said.
Vanessa Caceres is a medical writer in Bradenton, Fla.
- Ricotta DN, et al. Things we do for no reason: Card flipping rounds. J Hosp Med. 2020;15:498-501.
- Spicer JO, et al. Optimizing the educational value of bedside rounds by exploring perceptions of internal medicine residents. South Med J. 2022;115:294-300.
Additional Reading from The Journal of Hospital Medicine