Census, rounding sheet, list, rounds report, these are all names we have for the list that we print out every morning with all of our patients on it. Each hospital and each service within a hospital has a different way of managing that list. Some hospitals list nothing but room number, patient name and diagnosis. Others are much more extensive. My hospital prides itself on our list. We like to think of ourselves as pioneers in this one bit of data recording. Our list contains not just the basics, but what meds they are on, their vitals, ins and outs and diet for the last 24 hours auto populates every time you print a new list. Additionally you can add in any procedures they have had or that are planned for. You can type up a plan, put in notes for the cross-cover intern. You can stick in random details about the patient that you don't want forgotten.
Basically, my hospital has a pretty sweet set up when it comes to the patient list. But that doesn't change the number one goal of any intern . . . KEEP THE LIST SHORT. Now, we have absolutely no say in who gets added on to our list. Ultimately that decision is for our Attending. And we can't discharge anyone that is still sick. But their are plenty of people who sit in hospitals for days, weeks, even months because that perfect storm to get them out just hasn't come together. Well, here is the checklist we go through before we send someone out.
1. Are they off of IV pain meds?
2. Have they been cleared by physical, speech and occupational therapy?
3. Can they continue their baseline activities of daily living?
That seems easy enough. But what about the chronic pain patient whose appendix we just took? Should we wait for days for them to get their pain under control or send them on their way? And patient with osteomyelitis who needs 6 weeks of antibiotics? Or the child with Leukemia who is going to need chemo every few weeks? Should these people just sit around the hospital? And how about the little old lady who just had a stroke and can no longer live alone? How do you get these people out?
I've worked at hospitals where these people will just sit in the hospital forever. Most of my fourth year rotations were about a month long. And I would start with a couple of patients who were in one of these awful situations and they would always be there when it was time for me to leave. I never really appreciated the art of getting someone OTD (out the door) until I started on Vascular Surgery.
For the last 2 weeks we've had a list hovering right around 20. Most of these patients were sick, 5 or 6 were ICU status we had another 7-9 that were intermediate level of care and the rest were floor patients. About half of whom were in the "just can't leave" column. So, rounding in the morning and being on the floor during the day has been a nightmare. It's even harder for the poor intern that's been cross covering for the last few nights.
And even though my co-intern and I were discharging anywhere from 3-6 patients a day we could not get the list below 17. And then, a break through! We finally, finally started discharging more patients then we were admitting. And by the time I left on Friday night we had 7 patients. SEVEN. We literally just made history for our service in the hospital.
Basically, this whole entry was just to brag about our superb discharging skills. Suck it vascular surgery!
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