816 - The History of Rounding: Osler, Family and Patient Centered Rounds, and Beyond

Suzanne Rybczynski, East Tennessee Children's Hospital, Knoxville, TN, United States; Julia G. Arana, East Tennessee Children's Hospital, Knoxville, TN, United States

Background: Medical rounds in hospitals are the primary form of communication between clinical teams, patients, and their families. In its current form, the goal of rounding is an exchange of information along with the collaborative establishment of a plan of care for patients. Physicians may take rounding for granted as a normal part of work life. However, medical rounds are a relatively new process in medicine.

Objective: To explore the history of medical rounding along with current and future rounding approaches.

Design/Methods: This abstract will present a chronological historical review of medical rounding and explore the impact on current practices. Historical records, medical literature, and media sources were reviewed to produce the past, present, and future timeline of medical rounding.

Results: We will trace the history of medical rounding starting with Dutch physician Franciscus De La Boe Sylvius in the 1600s. Sylvius ensured that his students directly interacted with patients in the public hospitals in Leiden, the Netherlands. In the 1850s, Florence Nightingale’s work during the Crimean War defined nursing rounds through her nighttime care provided to her patients, wounded British soldiers. Sir William Osler, at Johns Hopkins Hospital in the 1880s, developed innovative bedside rounds. Instead of conducting patient evaluations in an amphitheater surrounded by medical trainees and attendings, Osler led his team to the patient’s bedside, allowing the patient to participate in their assessments and be present for the analysis of their medical condition.

As the volume of individual patient data and clinical complexity increased in the 20th century, clinical teams retreated from patient-observed medical deliberations espoused by Osler. This led to decreased utilization of bedside rounds. Rounds moved from the bedside to the conference room. In the early 2000s, Steven Meuthing and colleagues at Cincinnati Children’s Hospital brought the advent of patient and family centered rounds. The patients and their families became key players in the decision-making process and full members of the care team. Technology, including artificial intelligence, will impact medical rounding in the future. Thus far, the use of technology has not removed the person-centered focus of rounds.

Conclusion(s): The current best practice for medical rounding centers on the patient and family. Use of technology will likely transform rounding in the future. However, it is important for physicians and medical teams to reflect upon their past to ensure that patients remain the focus of future rounding models.