Managing the Discussion at Rounds
The purpose of WCPR is to work collaboratively to review the current goals of care, discuss any difficult physical or biopsychosocial/spiritual presenting symptoms, and make recommendations about care management approaches and care plan revisions. These recommendations should aim to improve quality of care and decrease suffering in alignment with the patient’s goals of care.
This practice change involves selecting a facilitator for the rounds. A WCPR facilitator prepares for the rounds and guides participants through the rounds. The individual facilitates focused clinical conversations, open discussion, sharing of expertise, exploration of options and decision-making for patients referred to the rounds.
What Does A Facilitator Do?
A WCPR facilitator ensures the discussion runs smoothly and that clear recommendations and actions are identified. The facilitator manages the communication process during the rounds. Below is a more detailed description of the duties of a WCPR facilitator.
Preparing for the Rounds
1. Review and document referrals to the WCPR
Keep a weekly tracking record.
2. Identify which referrals will be discussed at the rounds
Make sure referrals are complete with all relevant information and prioritize patient referrals based on need.
3. Decide who will attend the rounds
Participants will vary depending upon the patient’s circle of care and referral situation.
Attendance may change from week to week, depending on patient case needs.
4. Set and share the agenda
5. Prioritize the referrals to be discussed during the rounds
Prioritize the referrals based on patient needs and urgency.
Consider mixing straightforward and complex referrals.
Plan referrals based on participants’ availability and time.
During the Rounds
1. Manage time
Schedule the rounds to be 60 to 90 minutes.
Allow 5 to 10 minutes per case.
Start and end the rounds on time.
2. Ensure all participants know the purpose and goal of rounds
Discuss and address immediate palliative pain and symptom needs.
3. Facilitate discussion
Ask each health care provider for a succinct report introducing the case.
Lead a solution-based, inter-professional discussion.
Guide conversations, support consensus and support team members in identifying recommendations and actions.
After the Rounds
1. Ensure documentation is completed
The referring clinician is responsible for documenting the details and actions for their patient.
2. Ensure that follow-up occurs
Providing timely communication back to most responsible provider and/or primary health providers (if not in attendance during rounds) is essential.
The referring clinician is responsible for reporting back to the most responsible provider, the other care team members, the patient and their family members.