AOGS EDIT ORS M ES SAGE
Morning meetings and ward rounds must be retained as the essential components of clinical service GANESH ACHARYA
DOI: 10.1111/aogs.12851
Morning meetings and ward rounds could arguably be the longest surviving tradition in clinical hospital medicine. They are practiced in one form or the other in almost every country around the world. Morning report has been described as a “traditional ritual in academic medical services” (1). If you visit a teaching hospital and attend a morning meeting in one of its departments, you will get a general impression of the department’s organizational culture, working conditions, learning atmosphere, and the level of theoretical knowledge and clinical competency, as well as communication skills, of the doctors at all levels, almost by default. Clear evidence regarding the value of morning report for the training of clinicians and its effectiveness in improving patient care might be lacking (2), but trainee doctors usually rank it as one of the most important and valuable educational activities (3). The definition of a morning meeting/report is debatable as its purpose, setting, structure and components vary (2). In the past, the emphasis has been on the daily monitoring of clinical activities and patient care rather than on the education and training of health professionals. This system existed mainly to provide an overview of clinical activities to the service chief who had the overall responsibility for patients managed within the department. Over the time, it has evolved into a system for case-based learning that facilitates education of residents/trainees, as well as specialists. Today, morning meetings are used for discussing patient management issues, teaching and learning clinical methods, including diagnostic tests and therapeutic procedures, developing presentation skills, ensuring implementation of guidelines and protocols, as well as for service evaluation purposes using adverse incident reporting and clinical audits. With reduced working hours, duty hour restrictions and shift systems, effective communication and efficient transfer of patient care information between teams has become essential to ensure continuity of care. Morning meetings can facilitate a scheduled face-to-face handoff process that has been shown to have the fewest protocol deviations compared to written and electronic sign-in protocols (4). Overall, morning report provides an excellent
opportunity for trainee doctors to exercise and improve their knowledge, leadership, presentation and problemsolving skills (5). Ward rounds are an integral part of inpatient service in most hospitals. They are an effective means of interaction between patients (and their relatives), physicians and other health professionals, and provide opportunity for systematically and collectively ensuring that proper care is delivered to individual patients. Conducting a ward round requires clinical acumen, good bedside manners, professionalism, compassion, communication skills and the spirit of teamwork. Therefore, senior experienced physicians are usually seen as the role models who teach and inspire, while the juniors learn by observing and practicing. Ward rounds influence patient experience and failures can directly affect patent safety (6). In recent years, simulation ward rounds have allowed medical students and junior doctors to practice their skills in a safe environment. A joint report by the Royal College of Physicians and the Royal College of Nursing in the UK set out standard recommendations for ward round practice in 2012, recommending the use of safety checklists to reduce omissions and variations in practice while strengthening team communication, performance and patient experience (7). Poor communication and a lack of respect are common causes of patient complaints. Therefore, communicating clearly, face-to-face in a dignified manner, is important. Health professionals must get a clear picture of their patients’ symptoms, accurately assess patients0 condition and evaluate the success of management plans on a regular basis to be able to give appropriate advice. Bedside teaching rounds are important in many respects as they provide opportunities for learning from, communicating with and caring for our patients. Moving ward rounds from bedsides to conference rooms is undesirable and should therefore be resisted. Morning meetings and ward rounds are widely considered an underutilized resource and there has been a trend towards reducing the time allocated for such
ª 2016 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 95 (2016) 257–258
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Editor’s Message
activities (8). It has been argued that morning meetings are not sufficiently structured and are not effective, as teams appear to mainly discuss patient care plans and test results, but fail to include many other important aspects of patient care (9). Of course it is unnecessary to start the working day with an unproductive morning meeting. However, the solution should be to improve the meetings rather than eliminating them. Similarly, in hospitals nowadays, many activities traditionally associated with ward rounds no longer take place at the bedside (9) but at computer screens and in meeting rooms. Sometimes, it may be more appropriate to discuss test results and patient care plans with a multidisciplinary team in a safer environment than at the bedside. However, time spent at patients’ bedsides is appreciated both by the patients as well as the healthcare professionals. Morning meetings and medical ward rounds are time-honored traditions in hospital medicine that are perceived to be meaningful by both clinicians and patients. They enable skill development, role modeling, team building, and most importantly, contribute to better quality patient care through joint clinical decisionmaking and team consensus (10). Some adjustments may be required to tailor these routines to the demands of contemporary medicine and ensure that their educational potential is not lost. There is a need to make morning meetings and ward rounds less hierarchical, better structured, and more effective. However, retaining and prioritizing them is essential not only to sustain standards in clinical training but also for patients’ safety and satisfaction. Active participation of different members of multidisciplinary teams in morning meetings and ward rounds may help to reaffirm
their roles and add extra value to the quality of patient care. References 1. Parrino TA, Villanueva AG. The Principles and Practice of Morning Report. JAMA. 1986;256:730–733. 2. McNeill M, Ali SK, Banks DE, Mansi IA. Morning report: Can an established medical education tradition be validated? J Grad Med Educ. 2013;5:374–84. 3. Ways M, Kroenke K, Umali J, Buchwald D. Morning report: a survey of resident attitudes. Arch Intern Med. 1995;155:1433–37. 4. Craig SR, Smith HL, Downen AM, Yost WJ. Evaluation of patient handoff methods on an inpatient teaching service. Ochsner J. 2012;12:331–7. 5. Sanfey H, Stiles B, Hedrick T, Sawyer RG. Morning report: combining education with patient handover. Surgeon. 2008;6:94–100. 6. Herring R, Desai T, Caldwell G. Quality and safety at the point of care: how long should a ward round take? Clin Med. 2011;11:20–2. 7. Royal College of Physicians and Royal College of Nursing. Ward rounds in medicine: principles for best practice. London: RCP, 2012. 8. Cohn A. Restore the prominence of the medical ward round. BMJ;347:f6451. 9. Stickrath C, Noble M, Prochazka A, Anderson M, Griffiths M, Manheim J, et al. Attending rounds in the current era: what is and is not happening. JAMA Intern Med. 2013 Jun 24;173:1084–9. 10. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick GS, et al. The value of bedside rounds: a multicenter qualitative study. Teach Learn Med. 2013;25:326–33.
Upcoming meetings: 2nd European Spontaneous Preterm Birth Congress. May 26-28, 2016, Gothenburg, Sweden. NFOG Congress 2016. June 12-15, Helsinki, Finland.
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ª 2016 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 95 (2016) 257–258
Morning meetings and ward rounds must be retained as the essential components of clinical service GANESH ACHARYA
DOI: 10.1111/aogs.12851
Morning meetings and ward rounds could arguably be the longest surviving tradition in clinical hospital medicine. They are practiced in one form or the other in almost every country around the world. Morning report has been described as a “traditional ritual in academic medical services” (1). If you visit a teaching hospital and attend a morning meeting in one of its departments, you will get a general impression of the department’s organizational culture, working conditions, learning atmosphere, and the level of theoretical knowledge and clinical competency, as well as communication skills, of the doctors at all levels, almost by default. Clear evidence regarding the value of morning report for the training of clinicians and its effectiveness in improving patient care might be lacking (2), but trainee doctors usually rank it as one of the most important and valuable educational activities (3). The definition of a morning meeting/report is debatable as its purpose, setting, structure and components vary (2). In the past, the emphasis has been on the daily monitoring of clinical activities and patient care rather than on the education and training of health professionals. This system existed mainly to provide an overview of clinical activities to the service chief who had the overall responsibility for patients managed within the department. Over the time, it has evolved into a system for case-based learning that facilitates education of residents/trainees, as well as specialists. Today, morning meetings are used for discussing patient management issues, teaching and learning clinical methods, including diagnostic tests and therapeutic procedures, developing presentation skills, ensuring implementation of guidelines and protocols, as well as for service evaluation purposes using adverse incident reporting and clinical audits. With reduced working hours, duty hour restrictions and shift systems, effective communication and efficient transfer of patient care information between teams has become essential to ensure continuity of care. Morning meetings can facilitate a scheduled face-to-face handoff process that has been shown to have the fewest protocol deviations compared to written and electronic sign-in protocols (4). Overall, morning report provides an excellent
opportunity for trainee doctors to exercise and improve their knowledge, leadership, presentation and problemsolving skills (5). Ward rounds are an integral part of inpatient service in most hospitals. They are an effective means of interaction between patients (and their relatives), physicians and other health professionals, and provide opportunity for systematically and collectively ensuring that proper care is delivered to individual patients. Conducting a ward round requires clinical acumen, good bedside manners, professionalism, compassion, communication skills and the spirit of teamwork. Therefore, senior experienced physicians are usually seen as the role models who teach and inspire, while the juniors learn by observing and practicing. Ward rounds influence patient experience and failures can directly affect patent safety (6). In recent years, simulation ward rounds have allowed medical students and junior doctors to practice their skills in a safe environment. A joint report by the Royal College of Physicians and the Royal College of Nursing in the UK set out standard recommendations for ward round practice in 2012, recommending the use of safety checklists to reduce omissions and variations in practice while strengthening team communication, performance and patient experience (7). Poor communication and a lack of respect are common causes of patient complaints. Therefore, communicating clearly, face-to-face in a dignified manner, is important. Health professionals must get a clear picture of their patients’ symptoms, accurately assess patients0 condition and evaluate the success of management plans on a regular basis to be able to give appropriate advice. Bedside teaching rounds are important in many respects as they provide opportunities for learning from, communicating with and caring for our patients. Moving ward rounds from bedsides to conference rooms is undesirable and should therefore be resisted. Morning meetings and ward rounds are widely considered an underutilized resource and there has been a trend towards reducing the time allocated for such
ª 2016 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 95 (2016) 257–258
257
Editor’s Message
activities (8). It has been argued that morning meetings are not sufficiently structured and are not effective, as teams appear to mainly discuss patient care plans and test results, but fail to include many other important aspects of patient care (9). Of course it is unnecessary to start the working day with an unproductive morning meeting. However, the solution should be to improve the meetings rather than eliminating them. Similarly, in hospitals nowadays, many activities traditionally associated with ward rounds no longer take place at the bedside (9) but at computer screens and in meeting rooms. Sometimes, it may be more appropriate to discuss test results and patient care plans with a multidisciplinary team in a safer environment than at the bedside. However, time spent at patients’ bedsides is appreciated both by the patients as well as the healthcare professionals. Morning meetings and medical ward rounds are time-honored traditions in hospital medicine that are perceived to be meaningful by both clinicians and patients. They enable skill development, role modeling, team building, and most importantly, contribute to better quality patient care through joint clinical decisionmaking and team consensus (10). Some adjustments may be required to tailor these routines to the demands of contemporary medicine and ensure that their educational potential is not lost. There is a need to make morning meetings and ward rounds less hierarchical, better structured, and more effective. However, retaining and prioritizing them is essential not only to sustain standards in clinical training but also for patients’ safety and satisfaction. Active participation of different members of multidisciplinary teams in morning meetings and ward rounds may help to reaffirm
their roles and add extra value to the quality of patient care. References 1. Parrino TA, Villanueva AG. The Principles and Practice of Morning Report. JAMA. 1986;256:730–733. 2. McNeill M, Ali SK, Banks DE, Mansi IA. Morning report: Can an established medical education tradition be validated? J Grad Med Educ. 2013;5:374–84. 3. Ways M, Kroenke K, Umali J, Buchwald D. Morning report: a survey of resident attitudes. Arch Intern Med. 1995;155:1433–37. 4. Craig SR, Smith HL, Downen AM, Yost WJ. Evaluation of patient handoff methods on an inpatient teaching service. Ochsner J. 2012;12:331–7. 5. Sanfey H, Stiles B, Hedrick T, Sawyer RG. Morning report: combining education with patient handover. Surgeon. 2008;6:94–100. 6. Herring R, Desai T, Caldwell G. Quality and safety at the point of care: how long should a ward round take? Clin Med. 2011;11:20–2. 7. Royal College of Physicians and Royal College of Nursing. Ward rounds in medicine: principles for best practice. London: RCP, 2012. 8. Cohn A. Restore the prominence of the medical ward round. BMJ;347:f6451. 9. Stickrath C, Noble M, Prochazka A, Anderson M, Griffiths M, Manheim J, et al. Attending rounds in the current era: what is and is not happening. JAMA Intern Med. 2013 Jun 24;173:1084–9. 10. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick GS, et al. The value of bedside rounds: a multicenter qualitative study. Teach Learn Med. 2013;25:326–33.
Upcoming meetings: 2nd European Spontaneous Preterm Birth Congress. May 26-28, 2016, Gothenburg, Sweden. NFOG Congress 2016. June 12-15, Helsinki, Finland.
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ª 2016 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 95 (2016) 257–258
