Guest post: Establishing a rounding routine

by Marlene Goodwin-Esola, MSN, RNC, NE-BC

Approximately 11 months ago, I accepted the role of the CDI manager in a facility where I formerly held a nurse executive position. Although I was new to the CDI world, I was given the role of manager based on my experience in leadership, my clinical acumen, and my long-standing positive relationships with members of the healthcare team and physicians on staff. In my new role, I contemplated how to benefit from my knowledge of how the hospital operates to benefit the CDI team in their review of charts. To accomplish this, I adopted some daily strategies to assist with the gathering of information that allows me to align assignments in the CDI department.

I begin my day at 6 a.m. by rounding in the intensive care units and getting an update from the charge nurse regarding any new admissions, any recent transfers in from the floor as a result of a rapid response or code blue, any deaths or impending deaths, any expected operations planned for an ICU/CVICU bed, any newly intubated or patients who have had a change in their clinical course, and I ask “who is your sickest patient?”

While in the ICU, I often meet with the lead respiratory therapist to get their input on any clinical event that would add to my knowledge of the patient acuity in the hospital. Then, I visit the nursing supervisor to look at the overall operating room schedule (any add-ons), how many in-house COVID-19 patients we have, any new admits waiting in their ED and what their admitting diagnosis is thought to be, any closed/newly opened units so we can understand the patient’s acuity based on their placement in the hospital.

Like most members of CDI teams, I also consistently round to meet with physicians about their patients. Most of the physicians know me from my prior role, so they are familiar with my collaborative, supportive demeanor and are open to meet with me about their patients, and other hospital events. I was an active participant on many of the medical staff committees in my prior role, so the trust and openness were easy to build as the CDI manager.

My first area for physician rounding is the ED, and if the ED is not busy, I will have a quick conversation with the ED physician or charge nurse to get more information on new admits. I also round frequently and as needed in the critical care areas to have updates with the intensivist team about the patients in critical care.

Most nurses are good at detecting when a physician is too busy to meet with them, so this perception is a consideration when approaching our doctors to engage in discussion about the clinical status of the patient the CDI specialist is following. Most CDI team members know the biggest challenges in rounding on physicians is locating them, respecting their time, and having meaningful conversations about the queries we have written.

An interesting note to all of this is that two months into my new role in CDI, the COVID-19 pandemic became a reality. In March, April, and May, the anxiety of the new virus and the amount of unknowns about how to manage the care of the patient with SARS-CoV-2 produced a palpable tension that led us to rounding with brevity, and showing more respect for the physician’s time and honoring this time with less interruptions. Due to my early visit with the night shift nursing supervisor, I was able to provide the physicians with information about operational changes occurring in the hospital (e.g., updates on the designated COVID-19 unit, where to get personal protective equipment, etc.).

After my “clinical updates” travels, I then meet with the CDI team to share what I learned from my multidisciplinary rounding, which hopefully leads to assisting them with the prioritization of cases and facilitates their chart reviews.

Editor’s note: Goodwin-Esola is the CDI director at Jupiter (Florida) Medical Center. Contact her at marlene.goodwin-esola@jupitermed.com. Opinions expressed are those of the author and do not necessarily reflect those of ACDIS, HCPro, or any of its subsidiaries.