What are the guidelines for conducting intensive care unit (ICU) rounds?

Guidelines for Conducting ICU Rounds

ICU rounds should be conducted using a structured, multidisciplinary team approach that includes provider education, standardized protocols, and quality checklists to optimize patient care and outcomes. 1

Core Components of ICU Rounds

Team Composition

• The core ICU rounding team should include intensivists, respiratory therapists, pharmacists, and bedside nurses 2
• Additional participants should include specialists relevant to patient care needs, nutrition support, rehabilitation services, and social support practitioners when available 2
• The head of the ICU, typically a senior accredited specialist in intensive care medicine, should lead or oversee the rounding process 1

Rounding Structure and Format

• Rounds should be conducted at least once daily with all ICU health professionals involved in direct patient care participating 1
• A standardized structure with explicitly defined roles for each team member should be implemented to improve communication and efficiency 3
• Rounds should follow a goal-oriented approach that includes the use of best practices checklists to ensure comprehensive care 3, 4
• ICU rounds should be scheduled at consistent times, with evidence suggesting that uninterrupted periods for patient rest should be protected (e.g., between 12-5 AM) 1

Communication Practices

• Teams should use standardized approaches for interdisciplinary communication during rounds 1
• Structured family meetings should be incorporated into the rounding process when appropriate 1
• Documentation should be clear and organized, with strategies for diagnostic procedures and management plans clearly outlined for each patient 1
• The rounding team should coordinate with referring physicians to ensure continuity of care 1

Family Involvement in ICU Rounds

• ICUs should consider offering families the option to be present during rounds 1
• Family participation in rounds may increase family knowledge of care plans, improve communication quality, and reduce family anxiety 1
• Implementation challenges such as coordinating logistics and potentially overloading family members with information should be anticipated and addressed 1
• An assigned staff member should be available to support family members during rounds and explain medical terminology or concepts as needed 1

Quality Improvement Measures

• Regular assessment of rounding practices should be conducted to identify areas for improvement 1
• Multidisciplinary care teams conducting daily rounds are associated with lower mortality among medical ICU patients 5
• Standardizing key elements of rounds has been shown to improve interdisciplinary communication and reduce errors 4
• Ad hoc multidisciplinary team meetings should supplement regular rounds for complex cases requiring extended discussion 6

Implementation Strategies

• Use an interdisciplinary ICU team approach that includes provider education about effective rounding practices 1
• Develop preprinted or computerized protocols and order forms to standardize the rounding process 1
• Implement quality ICU rounds checklists to ensure all critical elements of patient care are addressed 1, 3
• Adapt recommendations to local practice patterns and resource availability 1

Common Pitfalls to Avoid

• Poor information retrieval and documentation during rounds can lead to medical errors 3
• Frequent interruptions during rounds disrupt the flow and may cause important information to be missed 3
• Excessively long rounding times reduce efficiency and team engagement 3
• Allied healthcare providers may feel undervalued if not given opportunities to contribute during rounds 3
• Failure to clearly define roles and responsibilities can lead to confusion and gaps in care 4

By implementing these structured guidelines for ICU rounds, healthcare teams can improve communication, reduce errors, and ultimately enhance patient outcomes through coordinated, multidisciplinary care.