System ergonomic analysis of the morning ward round in an intensive care unit.
OBJECTIVE
Our objective was to find out what is discussed during a bedside morning ward round (MWR), whether there are any weak points, and if a standard work process structure can be recommended.


METHODS
An intensive care unit (ICU) consultant recorded in a predefined form the topics that were discussed in 225 bedside discussions.


RESULTS
The median length of discussions was 5 min. In more than 60% of the discussions, items were considered related to the respiratory, neurological, and cardiovascular systems, as well as to surgical and nursing problems. Specific variables relating to organ system conditions were seldom used (e.g., inspired O2 concentration, 35%; temperature, 28%; ventilation mode, 25%). We recorded two interruptions per MWR; only 17% of them were related to urgent decisions. Information that could not be found in the patient's file usually concerned microbiology findings (10%) or surgical procedures (6%).


CONCLUSIONS
We recommend the following structure: (1) Addressing the patient by saying "hello"; (2) presentation of information related to case history, acute status (findings and strategy) (including the function of the main organ systems), infection status, and nursing problems; (3) patient-related discussion; and (4) discussion of general treatment rules, triggered by individual patient condition.
ATV Section, University Clinic for Anaesthesiology, University of Ulm, Germany.
W
W
Friesdorf
S
S
Konichezky
F
F
Gross-Alltag
G
G
Federolf
B
B
Schwilk
H
H
Wiedeck
D003142:Communication; D003266:Continuity of Patient Care; D003422:Critical Care; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D010348:Patient Care Team; D013597:Systems Analysis