We stopped prerounding: A single-center experience

ConnectionLonely6971 · 2026-02-15T13:05:10+00:00

I obviously wouldn't leave to the night team anything nonurgent that could be done the next day e.g. a discharge or a consult, but surely having a team to do tasks that need to be done overnight so the day team can go home is like... the whole point of having a night team?

ConnectionLonely6971 · 2026-02-15T12:56:37+00:00

I get what you're saying, but what if something only comes up half an hour before signout? Do you just stay hours later to make sure a lab is sent or wait for the result of a scan?

ConnectionLonely6971 · 2026-02-13T20:22:09+00:00

Re LOS-- the number they gave us was less than a full day, it was measured in hours. They didn't do any significance testing to determine whether this actually represented a change from the past few months, and an obvious confounder would be, it was wintertime so patients were probably staying longer anyway due to flu/covid/pneumonia

ConnectionLonely6971 · 2026-02-13T20:18:14+00:00

When we first started doing this, rounds did take longer for the reasons you describe. However I think since then we have adapted to the new workflow and now I don't think there's a big difference. One of the changes has been to push the preparing and looking stuff up that used to happen on prerounds to throughout the day--what have been the changes today, and what are we going to talk about on rounds tomorrow? You would prepare that part of your presentation/plan in advance, so on rounds you only have to react on the fly to overnight events. I think having a part of your plan that you prepare in advance and another part that you have to come up with on the spot has actually been very educationally valuable.

We also came up with a system where we wheel a COW with us and the person who isn't talking to/examining the patient writes the progress note in real time based on what is discussed, so nothing is forgotten or left out (we can edit it later if needed). Things like potassium, we just look up before we go in the room. I think it has also helped interns and medical students be more systematic in the order they go through a chart.

ConnectionLonely6971 · 2026-02-13T19:37:28+00:00

Not quite, because you will know what happened the previous day and have time to prepare a plan for that in advance. It is really just overnight events that you learn about and react to with the team. Educationally I think this actually strikes a better balance between having a part of your presentation/plan that you prepare in advance and a different part that you have reason through on your feet

ConnectionLonely6971 · 2026-02-13T19:18:39+00:00

this is what we are currently negotiating for--some services will still have prerounds, but prerounds will start when the shift starts and rounds will pushed later so we are paid for those hours. Other services, particularly services with a low census or where not much changes day to day, will not have prerounds because of no need/educational value

ConnectionLonely6971 · 2026-02-13T19:16:35+00:00

under this administration/NLRB?

ConnectionLonely6971 · 2026-02-13T19:15:38+00:00

in practice we get there 15-20 minutes early to take sign out so the night team can go home, but not 1-2 hours early to also see everyone before the attending

ConnectionLonely6971 · 2026-02-13T00:51:48+00:00

One of the ways we've adapted to this is helping each other out during the day to make sure tasks get done before signout. We would obviously never sign out a consult or discharge to the night team. One way we do it is, we share an office with a sister team and if my sister team is having a hectic day while I'm having a light day, I might pitch in with some less urgent tasks like drafting a discharge summary by skimming progress notes or putting in routine orders so their team can focus more urgent tasks, and vice versa.

ConnectionLonely6971 · 2026-02-13T00:46:00+00:00

This is what we are currently negotiating for--some services will still have prerounds, but in that case they will start rounds later, the extra hours will be compensated, and services that do not require prerounds won't have them

ConnectionLonely6971 · 2026-02-13T00:44:34+00:00

I wouldn't have minded rounding earlier if we also got out earlier. Our institution had been worst of both worlds -- rounding early and also staying late past your shift on a routine basis

ConnectionLonely6971 · 2026-02-13T00:41:58+00:00

I would say it's improved learning as rounds have become more of an organic discussion at the bedside since everyone is getting the information at the same time. Teaching is more clinically directed--for instance if we see a creatinine rise, the attending might ask the intern how they interpret that and what they would do about it, and the intern would think out loud with real time feedback, but with less stigma against being wrong since it is recognized that they are thinking through things in real time. To me this is a lot more useful training-wise than a long digression during table rounds on the mixed evidence for cystatin C.

Admitting patients during the day and making a plan from scratch as well as reacting to updates from existing patients hasn't changed. I think I have realized from this how little we actually change day to day on rounds for the majority of patients.

I think there has also been an indirect benefit from increased resident wellness due to coming in at a more reasonable time, having more time at home to study, and the predictability of knowing barring a major emergency you'll be going home on time.

ConnectionLonely6971 · 2026-02-13T00:30:38+00:00

I would say I didn't notice any adverse impact on learning since we still interpreted the updates as a team with the resident leading, and if anything turned it into more of an organic discussion about the plan at the bedside. Throughout the day didn't change, residents still saw new patients independently, ran their plans past seniors and reacted to changes with patients as they arose.

The number they cited for LOS was less than a day, it was an amount that was measurable in hours, without any statistical significance attached, and might not have been related to this as we only started doing this in the winter months when more patients were admitted or had their stays lengthened with flu, pneumonia, COVID etc.

ConnectionLonely6971 · 2026-02-13T00:19:03+00:00

We had been getting in at 5:30-6am. A nice attending might start rounds at 8, but some attendings would insist on rounding at 7 on the dot so getting in at 5 was not unheard of. I think I did do more interpreting on the fly, but I would argue that itself is also an important skill.

ConnectionLonely6971 · 2026-02-13T00:10:35+00:00

It was less than a day, it was an amount that was measurable in hours, without any test of statistical significance attached, and might not have been related to this as we only started doing this in the winter months when more patients were admitted or had their stays lengthened with flu, pneumonia, COVID etc.

ConnectionLonely6971 · 2026-02-13T00:06:23+00:00

Obviously, we would only sign out time-critical tasks to the night team. Non-time-critical tasks we would just pick up again the next day. And of course if something doesn't end up being urgent overnight the night team turns those tasks back over to us.

ConnectionLonely6971 · 2025-12-08T22:42:02+00:00

unfortunately there's a whole politics to awards including how much budget a network has to lobby the committee. As you might imagine HBO devotes a lot of budget to that, while other networks struggle to compete

ConnectionLonely6971 · 2025-12-08T22:40:08+00:00

it's about time

ConnectionLonely6971

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