What is the proper procedure for taking rounds in an Intensive Care Unit (ICU)?

How to Conduct ICU Rounds

ICU rounds should be conducted as a structured, multidisciplinary team process at consistent daily times, using standardized checklists to address all critical care elements systematically at each patient's bedside. 1

Core Structure and Timing

• Schedule rounds at a fixed time each day to establish predictability for the team and protect patient rest periods (avoid 12-5 AM). 1
• The senior ICU specialist should lead or directly oversee the rounding process, ensuring accountability and clinical oversight. 1
• Limit each bedside discussion to approximately 5 minutes per patient to maintain efficiency while covering essential elements. 2
• Protect rounds from interruptions by establishing organizational measures that allow the team to concentrate on patient assessment—only 17% of interruptions relate to urgent decisions. 3, 2

Team Composition and Roles

• Include all ICU health professionals involved in direct patient care: physicians, nurses, pharmacists, respiratory therapists, and other relevant specialists. 1
• Define explicit roles for each team member before rounds begin to improve quality and efficiency. 4
• Ensure the intensivist focuses primarily on patient inspection rather than administrative tasks during bedside evaluation. 3

Pre-Round Preparation

Before entering each patient's room, the team should briefly discuss the patient outside to review complex issues and sensitive topics—this approach increases team satisfaction (78.0 vs 68.3 on VAS) and provides better opportunity for sensitive discussions (84.3 vs 59.3) without confusing patients with medical jargon. 5

Systematic Bedside Assessment Using Checklists

Use a standardized rounding checklist containing 6-20 items (median 17 items) to ensure comprehensive coverage of all critical elements. 3

Essential Checklist Components

Your daily rounding checklist must address these specific domains:

• Respiratory system assessment: Document ventilator settings, mode, inspired O₂ concentration, weaning readiness, and VAP prevention bundle compliance. 1, 2
• Cardiovascular system: Review hemodynamics, vasopressor requirements, and fluid balance. 2
• Neurological status: Perform delirium screening using the 8-item ICDSC (the most validated ICU checklist), assess sedation level, and document orientation aids. 3, 1
• Infection surveillance: Review microbiology results, antibiotic appropriateness, central line necessity, and catheter-associated infection prevention measures. 1, 2
• Pain assessment and management: Evaluate pain scores and analgesic effectiveness. 1
• Mobility status: Document early mobilization efforts (passive, assisted, or active exercises) started within the first few days of ICU admission. 1
• Nutrition: Assess nutritional support adequacy and route. 6
• Central line necessity: Evaluate whether central venous access remains indicated and remove when no longer needed to prevent CLABSIs. 1
• Daily goals: Establish and document specific, measurable goals for the day with the entire team. 1

Communication Practices at the Bedside

• Address the patient by greeting them ("hello") before beginning clinical discussion. 2
• Present information in this sequence: case history, acute status with organ system function, infection status, and nursing concerns. 2
• Explicitly encourage patient participation—only 54% of physicians currently do this, yet 71% of patients expect clear information about their medical situation. 5
• Use teach-back techniques to verify patient understanding of medications and behavioral instructions (OR 1.84 for medication understanding, OR 1.83 for behavioral instructions). 5
• Avoid medical jargon when discussing in front of patients to prevent confusion from technical terminology. 5

Family Involvement

• Offer families the option to be present during rounds, as this increases family knowledge of care plans, improves communication quality, and reduces family anxiety. 1
• Assign a staff member to support family members during rounds to explain medical terminology and answer questions. 1
• Document family conferences and information shared with family members in the medical record. 1

Data Review and Documentation

Focus data review on these priorities during rounds (based on actual physician decision-making patterns):

• Laboratory data (clinical, microbiology, blood gas): 38-41% of data reviewed, most frequently used category. 6
• Clinical observations: 21-22% of data reviewed. 6
• Medications and IV fluids: 13-23% of data reviewed. 6
• Bedside monitor data: 12.5-22% of data reviewed. 6

Common information gaps to proactively address: Microbiology results (missing 10% of the time) and surgical procedure details (missing 6% of the time). 2

ICU Liberation (ABCDEF) Bundle Integration

Incorporate the ABCDEF Bundle systematically into every patient discussion: 7

• A: Assess, prevent, and manage pain
• B: Both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT)
• C: Choice of appropriate analgesia and sedation
• D: Delirium assessment, prevention, and management
• E: Early mobility and exercise
• F: Family engagement and empowerment

Implementation Strategies

• Use electronic integration with the EHR when possible to streamline checklist completion and improve efficiency. 1
• Subdivide long checklists into small, meaningful sections and pay close attention to completion time to maintain usability. 1
• Implement interdisciplinary checklists that empower nurses to verify physician compliance with best practices. 1
• Re-evaluate and update checklists periodically based on new evidence and organizational experience. 1
• Provide formal training on handover procedures using standardized checklists, as communication failures during handovers are among the most common factors contributing to adverse events. 3

Quality Improvement Measures

• Conduct regular assessment of rounding practices to identify areas for improvement. 1
• Monitor checklist adherence rates—median adherence ranges from 73-91% when checklists are properly implemented. 3
• Establish daily "reflection circles" with nursing and medical staff to identify and resolve conflicts, as hierarchical structures and workplace conflict are significant risk factors for poor performance. 3

Critical Pitfalls to Avoid

• Never conduct rounds without waveform capnography available for intubated patients—absence or change of capnograph waveform is the primary "airway red flag." 3, 8
• Do not allow rounds to become physician-dominated discussions—interprofessional collaboration requires inclusive communication strategies. 7
• Avoid discussing sensitive topics at the bedside without prior team discussion outside the room. 5
• Never skip delirium screening—the 8-item ICDSC should be completed daily on all ICU patients. 3
• Do not proceed with rounds if the difficult airway trolley and bronchoscope are not immediately available for patients at risk of airway complications. 8