• Chad Stickrath, Melissa Noble, Allan Prochazka, Mel Anderson, Megan Griffiths, Jonathan Manheim, Stefan Sillau, and Eva Aagaard.
• Department of Medicine, University of Colorado Denver School of Medicine, Denver, CO 80220, USA. Chad.stickrath@va.gov
• JAMA Intern Med. 2013 Jun 24;173(12):1084-9.

ImportanceGeneral medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized.ObjectiveTo describe the characteristics of attending rounds for internal medicine inpatients in a large teaching hospital system.DesignA cross-sectional observational study of attending rounds in internal medicine. Rounds were observed directly by research assistants.SettingFour teaching hospitals associated with a large public medical school.ParticipantsFifty-six attending physicians and 279 trainees treating 807 general medicine inpatients.Main Outcomes And MeasuresDuration and location of rounds, composition of teams, and frequency of 19 potential activities during rounds.ResultsWe observed 90 days of rounds. A typical rounding day consisted of 1 attending with 3 trainees visiting a median of 9 (range, 2-18 [SD, 2.9]) patients for a median of 2.0 hours (range, 25-241 [SD, 2.7] minutes). On rounds, teams most frequently discussed the patient care plan (96.7% of patients), reviewed diagnostic studies (90.7%), communicated with patients (73.4%), and discussed the medication list (68.8%). Teams infrequently discussed invasive lines or tubes (9.3%) or nursing notes (6.2%) and rarely communicated with nurses (12.0%) or taught physical examination skills (14.6%), evidence-based medicine topics (7.2%), or learner-identified topics (3.2%). Many commonly performed activities occurred infrequently at the bedside.Conclusions And RelevanceMost activities on attending rounds do not take place at the bedside. The teams discuss patient care plans and test results most of the time but fail to include many items that may be of significant value, including specific aspects of patient care, interprofessional communication, and learner-centered education. Future studies are needed to further assess the implications of these observations.

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