How to review a patient on a ward round
Before the ward round
Make it clear who is leading, usually the most senior doctor. But it may be a PA or ACP. Before the WR, the leader should identify themselves, who everyone is, and assign roles (e.g. X checks bloods on computer, Y checks observations).
The leader should add an expectation of learning for students. Students should mainly listen and learn, but can ask questions at correct time, usually towards the end of the patient assessment.
Determine the order. This is very important. Before you go to Bed 1 (or 30) ask to start with the ‘quick then the sick’:
- The quick – to discharge before lunch and free up the bed, and thereby encourage hospital flow. Aim for 2 off ward and in discharge lounge by 12pm
- The sick – as they deserve your best (freshest) brain.
Junior should give the first patient’s drug card to leader. Start.
1. Introduction – start well
Leader introduces him/herself clearly, saying “these are doctors and nurses in the team”. Senior should stand or sit nearest patient and lead questions
2. Confirm current diagnoses
Leader states current diagnoses
3. Ask patient current problems
Leader says “How are you feeling today?”
4. Review patients’ progress against previous plan
Ask to see most up-to-date information, especially ‘big tests’ (e.g. biopsies and scans)
5. Check safety measures, including review of observations and drug card
Leader makes sure team have written down abnormal observations, and has checked the drug card themselves. Make changes. Check:
- Allergies filled out?
- VTE done?
- Antibiotics reviewed? Do they still need to be IV?
6. Summarise the revised plan, with key actions
Leader “Ok, so this is the plan .. ” This must include a discharge plan. Juniors should ask senior for one if not given
7. Review documentation of WR and plan, assigning key actions
Leader makes sure the WR and plan have been correctly documented, and it is clear who is carrying out which action
8. Goodbye – End well
Ask the patient if they have any questions.
Next patient!
How long should a ward last?
That is a hard one. It depends on the number, types of patient, and proportion of new patients. Allow 3 hours maximum. 2-2.5 hours is better. It’s hard to concentrate over 3 hours.
Start early, no later than 8.30 am. Allow 10 mins for each patient. Don’t rush it but have it done by 11.30am so the patients can have lunch. Surgical WRs tend to be much shorter, partly as there are fewer patients, and often have one problem.
Summary
We have described how to review a patient on a ward round. We hope it has been helpful.
Top Tips
- Progress actions during ward round when possible. There will be less work later and things will be fresh in your mind
- All staff need a mechanism of recording their actions (e.g. paper or cyber diary)
- Remember it may be just 10 mins of your day, but those 10 mins may be the biggest moment of the patient’s day
- Don’t always start with Bed 1, after ‘the quick and the sick’. The patient in Bed 30 gets a raw deal as you will all be exhausted. Start at Bed 30 tomorrow.
