Gilly Fleming is a Consultant in Critical Care in NHS Lothian. She has an interest in medical education and is a part of the the FICM Education Subcomittee.
Striving for patient progress : What makes a successful ward round ?
Critical Care is a complex setting, with complex teams, and complex patients. As a Critical Care Consultant, leading the ward round, we’re responsible for orchestrating efficient, effective and nuanced care for our patients. The team works together towards shared outcome goals for our patients. But how can we make sure we’re delivering a “good” ward round? What does that really mean? As a new Consultant, I’m still in the process of finding my flow in ward rounds. If you, like me, are keen to develop and improve your rounding skills, below are some tips gleaned from wise colleagues over the past few years.
Embrace the Power of the Multi-Disciplinary Team:
Leading an ICU ward round involves collaborating with various healthcare professionals, such as nurses, physiotherapists, pharmacists, and other specialist teams to create shared knowledge and goals to move the patient forwards in care. It’s key to acknowledge the expertise and unique perspectives each team member, and to encourage open communication and active participation from all involved. Promoting an open culture of respect and inclusivity helps create a strong team who can all individually flourish.
Prioritise Teaching and Learning:
To drive quality of care, we must foster a culture of continuous learning within our team. Our system and patient population are ripe with opportunities for teaching and sharing knowledge. Encourage active participation by asking open-ended questions and allowing team members to contribute their insights. Spend time explaining your thought process and decision making, as this helps everyone get on the same page. If you’re busy it’s tempting to avoid teaching on ward rounds, however, if it’s integrated well into discussion it adds very minimal time to the round, and likely leads to more efficient ward rounds in the longer term.
Engage Patients and Families:
Patients are the core of the ICU team, and their families are integral members. Engaging them in the ward round process helps build trust, improves patient satisfaction, and encourages shared decision-making. Take the time to introduce yourself and the team, communicate your plans in understandable terms, and address any questions or concerns they may have. Role model empathy and respect for others as key priorities in care. Patients or their families don’t generally care what vasoactive drug they received, but they do care about feeling heard, cared for, and respected.
Set Clear Goals and Priorities:
Efficiency is key in the ICU, and setting clear goals and priorities for each ward round is essential. Identify specific goals for the day, making sure you pay attention to the small, often forgotten routine elements of care. Communicate these goals to the team, ensuring everyone understands their role and responsibilities. Regularly reassess and update goals based on the patient's progress or evolving needs.
Foster Effective Communication:
Communication lies at the heart of a successful ICU ward round. Foster an environment where team members feel comfortable expressing their opinions and concerns. Encourage active listening, ask for input, and ensure all team members have an opportunity to contribute. Effective communication helps prevent errors, enhances teamwork, and ultimately improves patient outcomes.
In today's digital era, technology can significantly enhance the efficiency and quality of ICU ward rounds. Although face to face patient interaction is at the core of what we do as intensivists, try to use technology to your advantage to make things more efficient. Spend time learning about and actively embrace your hospital’s electronic medical records. Leverage technology to streamline information access, document patient progress, summarise information and facilitate interdisciplinary communication.
Adaptability in Dynamic Situations:
ICU ward rounds can be unpredictable. Patients can deteriorate unexpectedly, new admissions arrive, and the on-call bleep can interrupt your flow. It’s key that we can adapt to these dynamic situations. Foster a flexible mindset and be prepared to make timely adjustments to your ward round timings, staffing, and plans dependent on what is happening at the time. Encourage open discussions among the team, seeking input on potential alternative approaches when necessary. Being adaptable allows us to effectively prioritise safe care for patients at all times.
Leading a successful ICU ward round requires a combination of strong leadership skills, effective communication, and a patient-centered approach. It’s an art, not a science, and it’s a goal I’ll be working towards for the rest of my Consultant career.