%0 Journal Article
%T Multiprofessional Ward Rounds for Inpatients With Advanced Cancers: Too Big to Succeed?
%A Carol Ann Huff
%A Peter J. Pronovost
%A William G. Nelson
%J General Information | Journal of Oncology Practice
%D 2018
%R https://doi.org/10.1200/JOP.18.00100
%X Cancer care is becoming more complex, particularly for solid organ cancers. A diverse collection of specialists now contributes to cancer screening, detection, diagnosis, staging, and treatment. Emerging therapeutic approaches, ranging from minimally invasive surgery, to proton beam radiation, to molecularly targeted drugs, and to immune response-modulating agents, provide a confusing array of options and decisions for patients with cancer and their families. An unplanned hospitalization further stresses physician-patient relationships. Communication, now monitored by Hospital Consumer Assessment of Healthcare Providers and Systems surveys, can become a casualty of such complex multispecialty care. To promote better communication for hospitalized patients with solid organ cancer, we propose that the longstanding practice of inpatient ward rounds, once conducted principally for teaching purposes, be altered in such a way as to have responsible physicians and nurses deliver unified information and handle questions at the bedside, while multidisciplinary care coordination is accomplished elsewhere. The practice of making a complete circuit (a round) likely dates back to the late 16th century; at Johns Hopkins, a tradition of beside teaching rounds, along with amphitheater teaching rounds (grand rounds), originated with William Osler in 1889. As inpatient care has increased in pace and complexity in both academic and nonacademic settings, ward rounds (also called work rounds) conducted for bedside teaching have progressively become ward rounds undertaken for care coordination.1 Invasive procedures, intensive monitoring and support, and uncontrolled symptoms such as pain comprise the most common causes of hospitalization for solid organ cancers. Admission to an acute care hospital is frequently unexpected, undermining the coordination of services established as part of outpatient cancer care. Ward rounds serve to ensure responsiveness to patient symptoms and concerns, to engage consulting specialists, and to expedite radiologic technologies, laboratory tests, and invasive procedures. Ward rounds also tend to serve as a major means for physician-to-physician handoffs, an increasingly critical element in hospital safety and quality.2 To help coordinate complex cancer care, ward rounds teams have progressively expanded to incorporate social workers, pharmacists, nutritionists, psychologists, home care personnel, and palliative care experts, along with responsible physicians, nurses, and advanced practice providers. However, ward rounds teams have now grown too
%U http://ascopubs.org/doi/full/10.1200/JOP.18.00100