Rounds @ Austin Health
The TRAMS team do formal rounds every Monday and Thursday, the format is as follows:
In the morning on those days, some of the team will meet and discuss the current list of trache patients. Most commonly this will be all the team except the physicians. A list is printed by the nurses consisting of:
Patients identifying factors, location, PMH/SHx, Diagnosis, current admission, Recommendations and current plan. (SBAR format)
It will also document at the top who is going to attend the ward round at 3pm.
In the morning the smaller team will discuss all the trache patients and any potential step downs identified from ICU. They will go through the patients one by one with the aim of identifying which patients will need to be on the ward round. It is not just this meeting that will decide this, the wards looking after the patents can request a ward round on their patent if they are struggling with something in particular. They will then decide in which order to see the patients so they can let all of the rounding team know where to meet at 3pm.
Finally the team discusses any patients attending clinic for review of trache changes.
In my time at TRAMS I was able to attend 2 ward rounds. The rounding team consisted of, a Respiratory Consultant and Registrar, Clinical Nurse Consultants, Physiotherapist, Speech Pathologist and on each ward the attending physio and nurse would join the round. = Medical model of a ward round.
Before seeing each patient the team discuss their current progress and problems, making a tentative plan for what they want to assess and what changes may need to be made.
The whole team then go to review the patient, often lead by the consultant. The ward team will get the patient into their best functioning state for this round, e.g. sat out with a speaking valve in situ. This way the patient can interact with the team easier.
The patient is then reviewed and plans made for their continuing care. This is documented by the registrar or junior doctor on round.
After a collaborative decision is made on the patients care the rest of the ward team are informed. The ward team then continue to progress the patient as able. Because this is a consulting service and coordination team, the treating team are still in control of the patients care. Having this team however allows a greater skill set to tackle more challenging cases, which can act upon its recommendations quicker with the links and experience they have.
The TRAMS team appears very well thought of and accepted within Austin Health.
This review process and management has shown great outcomes for patients and staff (see the TRAMS site under the ‘Trache Links’ section), and is particularly of note for those patients who have been challenging to wean.
Occasionally the team will review an out-patient in clinic whilst on rounds, as was the case on Thursday. Once again this was a difficult case of a patient with long term neurological conditions and a compromised airway. The patient had a Montgomery Cannula in situ, and the decision was being made if the patient would manage without it long term.
Once again because all members of the MDT where present, the patient benefited from a full specialist assessment and analysis, where they could also voice their own informed wishes on their care.
The team were able to give the patient a full plan by the end of his consult, consisting of the need for an ENT review, pending ABG results, aiming decanulation in a day case setting which will be organised by the team.
My personal and brief experience of this ward round was that the ward team and the patient were very grateful for this specialist review and support. The team also gives great opportunities for staff interaction and learning.