Structure and concept of ICU rounds: the VIS-ITS survey.

Bastian Hillmann,Reimer Riessen,Daniel Schwarzkopf,Tanja Manser,Christian Waydhas

doi:10.1007/s00063-021-00830-3

Abstract

ObjectiveTo gather data about structural and procedural characteristics of patient rounds in the intensive care unit (ICU) setting.DesignA structured online survey was offered to members of two German intensive care medicine societies.Measurements and main resultsIntensivists representing 390 German ICUs participated in this study (university hospitals 25%, tertiary hospitals 23%, secondary hospitals 36%, primary hospitals 16%). In 90% of participating ICUs, rounds were reported to take place in the morning and cover an average of 12 intensive care beds and 6 intermediate care beds within 60 min. With an estimated bed occupancy of 80%, this averaged to 4.3 min spent per patient during rounds. In 96% of ICUs, rounds were stated to include a bedside visit. On weekdays, 86% of the respondents reported holding a second ICU round with the attendance of a qualified decision-maker (e.g. board-certified intensivist). On weekends, 79% of the ICUs performed at least one round with a decision-maker per day. In 18%, only one ICU round per weekend was reported, mostly on Sundays. The highest-qualified decision-maker present during rounds on most ICUs was an ICU attending (57%). Residents (96%) and intensive care nurses (87%) were stated to be always or usually present during rounds. In contrast, physiotherapists, respiratory therapists or medical specialists such as pharmacists or microbiologist were not regular members of the rounding team on most ICUs. In the majority of cases, the participants reported examining the medical chart directly before or during the bedside visit (84%). An electronic patient data management system (PDMS) was available on 31% of ICUs. Daily goals were always (55%) or usually (39%) set during rounds.ConclusionThis survey gives a broad overview of the structure and processes of ICU rounds in different sized hospitals in Germany. Compared to other mostly Anglo-American studies, German ICU rounds appear to be shorter and less interdisciplinary.

Highlights

Rounds are a central part of daily clinical routine on almost every intensive care unit (ICU) globally
In 2017 a total of 1160 hospitals with ICUs were registered in Germany [9]
ICUs were often organized as mixed interdisciplinary ICUs, whereas in university hos

Summary

Introduction

Rounds are a central part of daily clinical routine on almost every ICU globally. They play a key role in communication within the ICU team and with patients and their families. Rounds have an important influence on patient safety and play a vital role in quality management on the ICU [2]. Rounding features are good starting points when planning to improve ICU performance [3]. There are hardly any standards or guidelines as to how ICU rounds should be structured and performed. In 2013 Lane et al [4] published a first systematic review that provided 13 best practices for ICU rounds. In a 2015 published survey conducted using 111 Canadian ICUs, Holodinsky et al [5] described considerable variations in rounding practices and several opportunities for improvement. No comparable data is available characterizing ICU rounds in other parts of the world

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Conclusion