Wards rounds: for one or all?

Hodgson et al (Psychiatric Bulletin, May 2005, 29,171-173) point out that little is known about ward round practice, and White & Karim (Psychiatric Bulletin, June 2005, 29, 207-209) found that 46 out of 100 patients experienced anxiety in relation to ward rounds.

Some years ago in Milton Keynes we tried a communal ward round, which all available staff and all the team’s inpatients (usually between six and ten) attended. After words of welcome and introducing the staff, the patients were told that if they wished to see the team on their own, they could do so at the end of the round, and could either stay until then or come back later (very few patients requested this). Then we went round the patients in turn, and their key worker would report on the week’s progress, discuss medication, level of observation, leave arrangements and plans for discharge.

There were several advantages. There was saving of time, as the welcoming and introduction of staff only had to be done once. Explanations of drug actions, side-effects and other matters, which often affected more than one patient, could be done once for all. Patients had less anxiety, because no one had to go in and confront the team alone, and no one was left wondering when, and even if, he or she would be summoned. An unexpected benefit was the sometimes powerful intervention of fellow patients, for instance if one wanted leave or was reluctant to take medication, sometimes the other patients would try to set them right, saying, for instance, ‘Do you remember what happened yesterday? That shows you are not ready for leave yet’. This social pressure from peers was often more effective than advice from the team.

There were some disadvantages. New patients could not be presented in detail because of confidentiality, so they were dealt with at a separate meeting. It was not appropriate for spouses and family members to attend, and they were seen separately.

Most patients preferred the communal meeting, but this may have been because the unit was run on group lines, and, for instance, had a ward meeting every morning so the patients were accustomed to groups. In another type of setting it might have been less acceptable.

Personally I found these group ward rounds more efficient and also more enjoyable than seeing patients one by one. My regret is that we did no formal audit. Perhaps someone else might try it.