Bedside review of patient care in an emergency department: The Cow Round

Abstract

Objective: Clinical handover is a critical point in medical care in the ED, which can contribute to adverse effects for patient care and staff workloads. Over a 4 and a half months in a tertiary referral hospital ED, a centralized whiteboard handover was performed followed by a multidisciplinary review of each patient. This round was referred to as the 'Cow Round'.

Methodology: This observational study used a standardized feedback survey of clinicians leading each Cow Round. The survey asked participants in the round to report issues found, which were not handed over during the centralized whiteboard handover. Data were analysed for the number of issues identified, the type of issue identified, and to determine if there was a relationship between the number of issues reported and patients in the department.

Results: 204 surveys met inclusion criteria. Clinical issues not handed over at the standard whiteboard round were found in 64% of Cow Rounds. Of the 2411 patients reviewed on Cow Rounds, 14.1% had at least one clinical issue not handed over during the whiteboard round. A mean of 2.2 issues per round (95% CI 1.9-2.5) were found. Pearson correlation found a relationship between the number of issues identified and the total number of patients in the department (r= 0.246 P= 0.005).

Conclusion: Review of patients led by a senior member of medical staff, at the patient bedside enables the timely identification and management of issues not communicated during the whiteboard handover process. This review is important when more patients are receiving treatment in the department.