Healthcare staff on a hospital ward: how to conduct bedside rounds

The patient as a participant in the conversation

For the patient, rounds begin before anyone mentions a diagnosis: several people gather around the bed, and the patient may not know their roles. It helps to introduce each person, explain why the team is there and ask for the patient’s agreement to discuss their care at the bedside, in line with usual practice. Rather than referring to the patient solely by bed number, the person leading rounds might say, “We’ll discuss your treatment plan together today. What matters most to you before the team starts?” This gives the patient a chance to raise an urgent need before staff turn to their own assessment. Even a brief answer helps start a conversation with the person at the bedside, not just about their illness.

How patients lose their voice

Discussing the illness is necessary during rounds, but it can take over the entire conversation. A conceptual article on dehumanization in medicine helps describe what happens when a patient is no longer treated as someone to talk with; it also considers the possible purposes of that distance. It is not, however, an experiment proving that one approach to rounds works, and the concept does not mean that all clinical shorthand is harmful. Imagine a team talking only about a bed number and an affected organ while the patient tries to ask about pain or what happens next. This illustrates how the language of a case can crowd out questions for the person, not harm measured in a particular study. It is worth noticing that moment and turning back to the patient.

During a procedure

During an examination or procedure, the team’s conversation can easily shift to the task at hand, leaving the patient unsure what is happening. Before each step, it helps to briefly explain what staff will do and what the patient can expect. The patient also needs a straightforward way to report pain, so they do not have to interrupt a conversation taking place over their head. Comments about the patient’s body that are unnecessary for the conversation or the team’s work are best left unsaid. When clinical discussion is needed, staff can communicate in professional terms, but that should not replace an explanation addressed to the person being examined. This way, the patient knows how to speak up during the procedure.

Uncertainty and differences of opinion

Different assessments of a patient’s condition may emerge at the bedside. The team need not pretend to be more certain than it is, but a detailed professional debate that is not intended for the patient is better held away from the bed. The team should then return with one clear explanation: what is known, what remains uncertain and what the next step is. If clinicians give conflicting instructions or make different promises in front of the patient, the patient may not know what to expect. A shared message does not mean concealing differences of opinion. It means agreeing on how to present them honestly without making the patient carry the burden of a professional debate. After the explanation, leave time for the patient to ask what the decisions mean for them.

Patients whose voices are harder to hear

A patient who cannot speak freely should still have a chance to take part in rounds. Gestures, a communication board and extra time may help someone with aphasia or a tube; before turning to family members, staff should check what the patient can communicate themselves. The aim is not to exclude loved ones, but to avoid automatically letting them speak for the patient. A randomized study of staff training in conversations with people with aphasia examined observed communication skills, not recovery of speech. A quasi-experimental study of the SPEACS program, meanwhile, included 89 intubated patients. These specific contexts support paying attention to communication barriers, but they do not prove that any particular tool is superior in every intensive care unit.

The limits of clinical shorthand

Staff need technical terms to share information about illness, results and possible decisions efficiently. The line is crossed when that shorthand becomes the only language used during rounds, or when a description of a condition turns into a judgment of the person. After specialists have exchanged information, it helps to return to the patient and explain in plain language what has been decided and what will happen next. Rather than simply asking whether everything is clear, staff can ask how the patient understands the next step. If there is a misunderstanding, the team can clarify the plan before leaving the bedside. Moving from clinical language to a conversation with the patient does not require sacrificing precision.

What to assess after rounds

After rounds, it is worth checking not only whether the team communicated the plan, but also what the patient took away from the conversation. Staff can ask whether the patient knew who was at the bedside and why they had come, who makes decisions about their treatment, and what will happen next. It is also worth noting whether the patient had time to ask a question and receive an answer before the team left. These questions help assess a particular conversation and identify anything that needs clarification. A conceptual article on dehumanization should not, however, be used to derive mortality figures or claimed as proof that this approach works. It provides a framework for reflection, not experimental results about rounds.

Introducing the team, asking the patient a question and clearly explaining the plan help make bedside rounds a conversation with the patient, not just about them.

Using Empatyzer to prepare for patient-inclusive rounds

Before rounds, the lead clinician can work with Em on a brief introduction for the people who will gather at the bedside, along with an explanation of the conversation’s purpose and the immediate plan. In team mode, it helps to agree who will introduce everyone and who will answer the patient’s questions; the team view helps organize these roles before entering the room. The lead clinician can practise with Em how to open by addressing the patient directly and asking what matters to them. The “About me” section may help them recognize a tendency to rush and move too quickly into technical terms. Micro-lessons support the habit of directing questions to the patient, even when several people are at the bedside. After preparing, the team must still listen carefully to the patient’s answers and adapt the conversation to whether and how the patient can take part in rounds.