03. Rounding Checklist

  • Are the nurses able to contact the appropriate physicians via first call orders?
  • Have the nurses been updated regarding the plan for the day?
  • Have AM labs been ordered if necessary?
    • Remember that routine AM labs are not always necessary. Frequent phlebotomy can cause iatrogenic harm through hospital-acquired anemia, false-positive results and patient discomfort with repeated blood draws.
  • Review indwelling urinary catheters and IV access.
    • Can I remove any unnecessary lines and/or catheters?
      • After removing indwelling urinary catheters, make sure patient is able to void several hours afterwards and consider checking a post void residual.
    • Does the patient need long term IV access (e.g. PICC) for antibiotics or chemotherapy?
  • Review laboratory results, imaging studies and culture data.
  • Is my patient eating?
    • Do I need to consult nutrition and/or speech therapy to optimize their diet?
    • Are there any plans for procedures that require my patient to be NPO?
    • Does my patient require intravenous fluids or additional nutrition such as tube feeds or total parenteral nutrition (TPN)?
  • Is my patient walking?
    • Discuss any mobility or safety concerns with nursing staff. Have a low threshold to involve physical therapy and occupational therapy early. Early rehabilitation can prevent need for placement.
  • Have I reviewed the list of medications that the patient is on?
    • Pay particular attention to antibiotic duration, whether or not DVT and GI ppx are indicated and if the patient has an appropriate bowel regimen.
    • Review PRN usage from overnight to make sure patients’ symptoms are being adequately addressed.
  • If the patient is on telemetry, has it been reviewed? Assess daily if it can be discontinued.
  • Have I talked to all the consultants that are involved in the patient’s care?
  • Where will the patient go after discharge? – It is never too early to think about this.
    • Consider the stability of the patient’s living situation. Are they likely able to return home after this hospital admission? Consider referral to acute rehab, skilled nursing facility, board and care, or permanent placement. Consider referral to Home Health services and discuss patients who will have home needs like durable medical equipment (DME) with case management early. 
    • Social work: discuss socially complicated patients with your social worker. Consider that the patient may already have an assigned community caseworker who should be notified of the admission.
    • Conservatorship: if your patient is not felt to be competent to make medical decisions, consider medical conservatorship. If your patient already has a conservator, contact them early in the hospitalization. See The Hospitalist: Decision Making Capacity and The Hospitalist: Involuntary Holds.
    • Home safety: consider a home social worker evaluation and a home safety evaluation, even for patients who have family members caring for them at home.