What is the appropriate way to discuss a patient's case during ward rounds?

Appropriate Patient Case Discussion During Ward Rounds

The most effective approach to discussing a patient's case during ward rounds is to use a structured, patient-centered format that ensures privacy, promotes clear communication, and actively involves the patient when appropriate.

Preparation Before Ward Rounds

• Arrange for an appropriate location that ensures patient privacy and minimizes interruptions 1
• Have all necessary information available before beginning the round 1
• Clarify who should be present for the discussion, including consideration of family members 1
• Have clear goals and take-home messages in mind for the conversation 1
• Anticipate potential emotional responses and questions from patients 1

Structure of Ward Round Discussion

• Begin by introducing all team members and their roles to the patient 1
• Establish a starting point by asking patients to explain their understanding of their illness 1
• Use a structured approach that includes: addressing the patient, presenting relevant information, patient-related discussion, and treatment planning 2
• Present information in simple, direct terms avoiding medical jargon 1
• Provide information in multiple formats (words, numbers, ranges) and in small, discrete units 1
• Check regularly for patient understanding using "teach back" methods 1

Patient Participation in Rounds

• Give patients the opportunity to participate in rounds when appropriate 1
• Allow patients who participate to ask questions that clarify information discussed 1
• Create space for patients to express their concerns through encouraging questions and using silence effectively 1
• Respond empathically to patient emotions by acknowledging and naming them 1

Communication Strategies

• Maintain a calm demeanor and make appropriate eye contact 1
• Use reflective listening techniques to ensure understanding 1
• Engage in behaviors that foster trust and collaboration 1
• Avoid minimizing concerns or changing the subject when patients express distress 1
• Titrate information based on the patient's emotional state 1
• Use mixed framing when discussing outcomes (e.g., chances of improvement and potential complications) 1, 3

Team Communication

• Ensure all team members have opportunities to contribute relevant information 4
• Maintain clear leadership to ensure active involvement of all interprofessional team members 4
• Communicate with consultants and others involved in patient care to provide coherent recommendations 1
• Consider using a ward round checklist to improve documentation and patient safety 5

Special Considerations

• When delivering bad news, ensure appropriate timing and setting 1
• Express solidarity with the patient (e.g., "I wish I had better news") 1
• Give bad news clearly and succinctly, then pause to allow the patient to absorb the information 1
• For agitated patients, employ verbal restraint strategies including respecting personal space, minimizing provocative behavior, and using active listening 1

Post-Round Follow-Up

• Document important discussions in the medical record 1
• Affirm commitment to supporting the patient regardless of treatment decisions 1
• Ensure patients know how to reach the care team with additional questions 1
• Consider debriefing with staff after difficult discussions 1

Ward rounds that incorporate bedside interprofessional discussion preceded by a team huddle outside the room appear to optimally support comprehensive, collaborative patient-centered care 4.