Role of physician-nurse-patient hospital rounds on patient safety and quality of care: a review of community hospital experience
Brief Report

Role of physician-nurse-patient hospital rounds on patient safety and quality of care: a review of community hospital experience

Tarik Wasfie1,2,3, Autumm Heeter1

1College of Medicine, Central Michigan University, Mount Pleasant, MI, USA; 2College of Medicine, Michigan State University, East Lansing, MI, USA; 3Department of Surgery, Henry Ford Genesys Hospital, Grand Blanc, MI, USA

Correspondence to: Tarik Wasfie, MD, FACS. Clinical Professor of Surgery, College of Medicine, Central Michigan University, Mount Pleasant, MI, USA; Clinical Professor of Surgery, College of Medicine, Michigan State University, East Lansing, MI, USA; Department of Surgery, Henry Ford Genesys Hospital, 1 Genesys Pkwy, Grand Blanc, MI 48438, USA. Email: twasfie@gmail.com.

Abstract: Physician-nurse-patient rounds remain one of the cornerstones of patient care and satisfaction. However, with the introduction of electronic medical records (EMR), this essential practice was pushed aside and reduced to minimal resulting in care fragmentation and unsatisfied patients. While rounding with medical student residents and allied healthcare workers focused primarily on teaching and education of the individual rounding with, it had unintentional consequences of improvement in patient satisfaction and overall care. As we continuously strive to improve patient outcome and care, perception of the patient—of the care they received during hospitalization is greatly influenced by personal attention from the first-hand caretakers, meaning physician and nurses; therefore, daily physician-nurses-patient rounding are the cornerstones of patient care and further solidified the belief we hold that personal care of our patients is worthwhile and not impossible to adapt. We carried between 2016 and 2017 a daily physician-nurse patient daily round with the aim to identify any gaps in patient care and patient perceptions of his care. Subsequent survey evaluation by the insurance institute calculated post-discharge, the patient recorded his satisfaction as high, medium, low, or none. These results were shared with the hospital. The results revealed a significant improvement in patient satisfaction post rounds. We concluded that in the day of computerized patient care, personal attention, and the physician-nurse approach to the patient care are one of the most important factors in patient satisfaction.

Keywords: Physician-nurse round; patient satisfaction; rounding

Received: 27 January 2025; Accepted: 27 June 2025; Published online: 03 September 2025.

doi: 10.21037/jhmhp-25-13

In the current climate of electronic medical records (EMR), and the vast amount of information collected and stored about the patient, physicians and nurses had to keep pace with storing, analyzing, and evaluating that wealth of information. This time-consuming effort will undoubtedly take a sizeable slice of time from both physicians and nurses which is allocated to patient care, and thus daily physician-nurse rounds become the first victim.

At our community hospital, we carried out a project of rounding with our nurses during 2016/2017 and measured our patient satisfaction post-discharge. The patient received a survey from Medicare/Medicaid post-discharge. It had multiple sections related to the patient’s satisfaction of his overall care during hospitalization (high, medium, low, none). These surveys were collected by the insurance institutes and sent later to the hospital as an indicator of how the patients rate their experience during hospitalization.

Genesys Hospital was positioned well to conduct this study:

  • Non-profit organization with a high value for patient care, safety, and well-being.
  • A prior wellness program in Genesys Hospital for more than 10 years, reflecting the dedication and commitment of the institute as well as the individual personnel involved in it to improve patient-nurse-physician relationships with the ultimate aim of safe and successful patient outcomes.
  • The principal investigator (T.W.) has already established himself as an effective, reliable leader, educator, and researcher, having worked for more than 7 years with individual residents in collecting the data personally and participating actively in nursing education and communications. He worked closely with the institute in implementing and improving patient satisfaction with the nurses’ collaboration.
  • The institute had a strong commitment to nurses’ well-being as they annually celebrate Nurses Week, encourage physician-nurse-patient relationships, and recommend nurses for an award and recognition.
  • Advocate for physician-nurse communication regarding patient care and safety and removing any barriers between them.
  • Genesys had seven accredited residency programs in the following categories:
    • Internal medicine: 39 residents;
    • General surgery: 18 residents;
    • Orthopedics: 16 residents;
    • Family medicine: 37 residents;
    • Podiatry: 6 residents;
    • Obstetrics and gynecology: 12 residents;
    • Pulmonary medicine, cardiology, oncology, and gastroenterology: 20 fellows.

    • A total of 30 medical students from Michigan State University, Central Michigan University, and Kirksville College of Osteopathic Medicine (Kansas City, Kansas) had Genesys as their base hospital.

  • Hospital statistics for fiscal year 2023 (FY-2023) as follows:
    • Associates: 2,217;
    • Physicians: 677;
    • Licensed beds: 400;
    • Discharges: 16,778;
    • Emergency visits: 51,429;
    • Outpatient clinics: 3,153;
    • Births: 1,385.

Patients were asked following discharge to evaluate their experience and were compared to data collected previously and it was an eye-opening experience when spending as little as 10 minutes with the nurse and patient at bedside would improve patient satisfaction and ultimately their care.

The positive result of the project came in the following areas:

  • Strengthen the physician-nurse-patient relationship as physicians become more accessible to nurses and patients, answering their concerns and questions and laying out the plan of action (short- and long-term).
  • The nurses as a primary caretaker of the patient during their shift and time will be informed firsthand of patient progress, line of care, and will be given time to have all their questions answered.
  • The patient and the family had the opportunity to discuss the patient’s well-being and the plan of care, which will improve patient satisfaction and reduce length of stay (1).
  • Strengthen the bond between the physician and nurses and make it easier for the nurses to call and talk to the physician at a later time, without feeling intimidated.
  • The nurses will be able to answer patients’ questions and communicate with them in line with their physician’s plan of action.
  • It will add great teaching opportunities to the residents, medical and nursing students, and enhance their firsthand knowledge of the patient condition as well as patient perceived notion that they are being treated compassionately by the medical team (2). Furthermore, bedside teaching as compared to non-bedside teaching is valuable (2).

Ward rounds are an essential component of surgical and perioperative care (3). They allow doctors to communicate with patients, assess their progress, and develop a treatment and management plan (3). The quality of ward rounds may directly impact patient outcomes (4,5) with documentation being a key method of communication between clinicians (6,7).

Regulatory bodies have provided a standard of communication documents in doctor consult sheet (8). Multiple studies have found that documentation during surgical ward rounds consistently fail to achieve these standards (4,5). Hospitals developed additional rounds mainly for education, interdisciplinary, unit manager round safety and quality rounds.

The question here is to construct a standardized physician-nurse round, and at the same time embrace government/hospital regulations by implementing EMR systems into the rounds. Use of software incorporated into the EMR system during the physician-nurses-patient round where the questions and answers are directly recorded at the same time as live discussion is critical for effective communication—it will embrace the EMR administrative requirements and, at the same, it will encompass the human-side of patient care by the physician, and, nurses, as well as other healthcare workers present. Therefore, the recommendation that an EMR program is developed and structured to fit into the daily rounds, where emphasis will be on the clinical changes in the patient condition, with the justification for the recommendations of the rounding physician, are all recorded on the spot in an efficient implementation.

The answer will rest on the individual physician with the support of hospital administration to develop a successful model for physician-nurse rounds by implementing the following:

  • Always allocate a specific time for rounds acceptable to both the physicians and nurses.
  • Consider rounding as a part of an educational session for physicians, residents, medical students, nurses, and nursing students.
  • Physicians should familiarize themselves with the nurses taking care of their patients and vice-versa. This will allow more comfortable and casual conversations between them in regard to patient care.
  • Hospitals, medical-government agencies, and third-party payers should consider patient care and welfare as the primary goal rather than the computerized paperwork.

The limitations of the study: first, it relays on patient’s response exclusively on their satisfaction of the care they received from their care taker. It does not directly address the clinical outcome of their medical condition.

Acknowledgments

None.

Footnote

Peer Review File: Available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-25-13/prf

Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-25-13/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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doi: 10.21037/jhmhp-25-13
Cite this article as: Wasfie T, Heeter A. Role of physician-nurse-patient hospital rounds on patient safety and quality of care: a review of community hospital experience. J Hosp Manag Health Policy 2025;9:32.

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