Medical Rounds: The Good, the Bad, and the Ugly
Medical Rounds: The Good, the Bad, and the Ugly
Daily medical rounds are the heartbeat of hospital care. One article in 2013 estimated that in the NHS 30,000 hours of staff time per day are expended in rounds, costing up to £18 million PER DAY (Laurner, 2013). Every morning, decisions that shape patient outcomes, recovery trajectories, and even life-or-death moments are made during these critical encounters. But not all rounds are created equal, and when you know, you know. Understanding the spectrum of rounding practices, from the deeply problematic to the genuinely transformative, can help healthcare teams make better choices about how they deliver care.
The Ugly: Care in Silos
Traditional hospital staffing models create what researchers have described as fragmented and chaotic care delivery. Under conventional arrangements, providers often treat patients scattered across multiple units, sometimes as many as eight or ten, while nurses and allied health professionals remain cohorted to specific wards. This geographic dispersion makes it practically impossible to build the relationships and systems needed for effective teamwork (Stein & Shapiro, 2018).
The consequences are predictable. Care becomes fragmented and asynchronous: physicians visit patients when their schedules permit, often early morning or late afternoon, while nurses and therapists work to entirely different rhythms. These professionals may never actually meet during a shift. When they do communicate, exchanges tend to be episodic, unstructured, and inefficient, a passing conversation in a corridor, a text page with incomplete information, or a scramble to decipher cryptic notes in a patient's chart (Howard et al., 2019).
For patients and families, this fragmentation can feel alienating and alarming. In one Australian study, patients experiencing traditional rounds offered stark feedback: "The reason for my negativity during ward rounds was no one actually spoke to me" and "Would like to be involved in rounds and understand what's going on" (Chow et al., 2019). When the people at the centre of care feel invisible, something has gone fundamentally wrong.
The Bad: Good Intentions Without Structure
Some hospitals have attempted to address these problems through interdisciplinary rounds conducted in conference rooms, away from the bedside. While well-intentioned, this approach has significant limitations. Research suggests that neither physician regionalisation alone nor unstructured interdisciplinary bedside rounds consistently improves teamwork or unit outcomes (Stein & Shapiro, 2018). Getting people together, does not guarantee success.
The problem lies in what's missing: without explicit protocols guiding who speaks, when, and about what, these gatherings can become dominated by hierarchy, deferring to the lead provider, interrupted by competing priorities, or simply ineffective at integrating the full range of professional perspectives. And that’s just if the required people attend. Studies in intensive care environments have shown that traditional rounds are subject to communication lapses that create significant potential for errors, delays in care, and frustration for both patients and staff (Lopez et al., 2019).
Consider a practical example: a patient's blood work shows new concerning markers. Without a structured approach, the provider might interpret this as an isolated finding. But the bedside nurse observed an aspiration event overnight, and the family noticed the patient seems altered from baseline. In a fragmented system, these crucial puzzle pieces may never come together and a developing aspiration syndrome goes unrecognized until it's too late.
The Good: Structured Interdisciplinary Bedside Rounds
Structured Interdisciplinary Bedside Rounds, commonly known as SIBR rounds, represent a fundamentally different approach. First developed at Emory University Hospital in 2010, SIBR brings the entire care team (physician, nurse, pharmacist, social worker, and allied health professionals) together at the patient's bedside using an explicit communication protocol (Stein et al., 2015).
The evidence supporting SIBR rounds is compelling. Research from a large academic medical center found that patients receiving SIBR had significantly lower 7-day readmission rates compared to standard care (6.3% versus 9.0%), suggesting better discharge planning and patient preparation (Sunkara et al., 2020). In intensive care settings, structured interdisciplinary bedside rounds improved communication of management plans, increased input from the entire team, and provided greater clarity on task assignments, each statistically significant improvements and noteworthy in their own right (Cao et al., 2018).
Perhaps most importantly, SIBR transforms the patient's role. One study found family members were present during 31% of SIBR encounters compared to just 10% of traditional rounds (Cao et al., 2018). The same study reported increases from patients in ‘Knowledge of main doctor’, ‘Doctors update you’ and ‘Nurses update you’.
For healthcare staff, the benefits extend to workplace experience. Nurses participating in SIBR reported significantly higher ratings for teamwork, communication, and efficiency. They felt better able to address patient fears and worries, and their understanding of care plans improved substantially (Gausvik et al., 2015). When staff feel informed and empowered, they can advocate effectively for their patients.
What Makes the Difference?
The key insight from the research is that interdisciplinary rounds require an adequately explicit communication protocol to standardize the content and sequence of contributions from each participant. Effectiveness depends on observable skills within that protocol, skills that can be taught, practised, and should be assessed (Stein & Shapiro, 2018).
SIBR rounds typically follow a structured six-step format, ensuring that safety checklists are reviewed, all disciplines contribute their expertise, the patient and family have voice, and everyone leaves with a clear understanding of the plan for the day and plan for discharge, redundancy plans are discussed and tasks are clearly assigned, including to the patient and family. It is essentially about creating clarity of expectations and the conditions where interprofessional collaboration can genuinely flourish.
The transformation isn't instant. Implementation requires commitment, support and enthusiasm. But hospitals that have adopted SIBR report that staff overwhelmingly recommend continuing the approach, citing improved communication, better teamwork, and enhanced patient safety (Redley et al., 2020).
So what?
how a hospital conducts its daily rounds is a fundamental choice about what kind of care patients will receive. Structured Interdisciplinary Bedside Rounds offer an evidence-based pathway toward the collaborative, patient-centred care that both patients and professionals deserve. Why would you not? And more importantly, how can you not now that you know what can be achieved?
References
Howard, D.H., Shapiro, S.E., Murphy, D.J., Overton, E.C., Chadwick, L., & Stein, J.M. (2019). The impact of Accountable Care Units on patient outcomes. Internal Medicine Research – Open Journal, 4(1), 1–6.
Redley, B., Campbell, D., Stockman, K., & Barnes, S. (2020). Mixed methods quality evaluation of structured interprofessional medical ward rounds. Internal Medicine Journal, 50(2), 222–231.
Stein, J. & Shapiro, S. (2018). Modernizing rounds—Why it's time to redesign our hospital practice. Annals of Internal Medicine, 168(2), HO2–HO3.
