How to Round a Case Without Losing the Patient in Translation

Dr. Erika Sikina

Okay so, cage four, the brown one? He had a day. There is a thing with his fluids, and the doctor said to watch him. Also, someone should probably call someone about the bloodwork at some point? Anyway, my ride is here. You got this!

Claire Brooks

And that is how a perfectly good patient becomes the brown one with a thing.

Dr. Erika Sikina

I would like the record to show that was a dramatization. Mostly.

Claire Brooks

Welcome to the AVS Veterinary Team Training Podcast. I am Claire Brooks, and today we are talking about how to round a case so nothing and nobody gets lost in translation. I am joined by veterinary emergency and critical care specialist Dr. Erika Sikina. Dr. Sikina, welcome.

Dr. Erika Sikina

Thanks, Claire. Glad to be here. In the next few minutes, we are going to cover how to lead a solid case handoff every single shift.

Dr. Erika Sikina

Real talk first: nobody gives a handoff like that because they do not care. Our techs care so much. The problem is that at shift change, everything you know about a patient lives in exactly one place, your head. And your head is about to drive home.

Claire Brooks

Human hospitals studied this. When they gave teams a structured handoff with the same steps in the same order every time, serious errors dropped by about twenty three percent. Not by hiring geniuses, and not by making rounds longer. Just structure.

Dr. Erika Sikina

Structure is a checklist doing the remembering so your tired brain does not have to. Like a preflight checklist, but the plane is a Chihuahua.

Claire Brooks

So here is the AVS standard: every shift change, every hospitalized patient, cage side, treatment sheet open, sickest patients first. Two to three minutes per patient, following six simple steps.

Dr. Erika Sikina

Step one: WHO. Name, age, sex, spayed or neutered, breed. Bella, six year old female spayed Lab. Five seconds. If your handoff starts with the brown one, we are already in trouble.

Claire Brooks

Step two: PRESENTING PROBLEM. Why are they here? One sentence. Came in yesterday for hemoabdomen, had a splenectomy. Not the director cut. One sentence.

Dr. Erika Sikina

Step three: A LITTLE HISTORY. Key word: little. Relevant past stuff, meds at home, the things the next tech genuinely needs. This is not the moment to mention that Bella once ate a sock in 2022.

Claire Brooks

Unless the sock is why she is here.

Dr. Erika Sikina

Then the sock gets top billing, obviously.

Claire Brooks

Step four: BLOODWORK AND FINDINGS. Labs, imaging, exam findings, abnormals first, plus the important normals. PCV stable at thirty two, lactate normal, incision clean. Trends beat single numbers. Stable at thirty two tells me more than thirty two.

Dr. Erika Sikina

Step five: PLAN. What is running, what is due next, what results we are still waiting on, and the doctor call parameters. This is the step people skip, and it is the one that saves patients at two in the morning.

Claire Brooks

Say it with me: Call the doctor if. If the rounds sheet does not have call parameters, ask the DVM and write them down. Future You, at two in the morning, staring at a blood pressure of eighty five, will want a number, not a vibe.

Dr. Erika Sikina

Step six: WHAT HAPPENED. How was your shift with them? Eating? Peeing? Brighter? Quieter? She has been quiet but ate a little, and she stood up for the first time at four p.m. That is gold. You are the only person on earth who knows that.

Claire Brooks

And then the close, arguably the most important five words in this whole episode: What questions do you have? The oncoming tech says the case back in their own words. The handoff is not done until they do.

Dr. Erika Sikina

Say back is not a pop quiz. It is how we catch the dropped thing before it hits the floor. Asking questions is a strength move. The techs I trust most ask the most questions.

Claire Brooks

Let us hear the difference. Dr. Sikina, give me the bad version of Bella.

Dr. Erika Sikina

Bella is fine. Well, fine ish. She got her meds, I think. The doctor came by and seemed happy? Happy adjacent. Anyway there is pudding in the break room.

Claire Brooks

Incredible. Zero out of six steps, but strong pudding intel. Now the real version.

Dr. Erika Sikina

Bella, six year old female spayed Lab, watch closely. Post op splenectomy for hemoabdomen, CPR on the cage. No big prior history, no meds at home. PCV stable at thirty two, lactate normal, incision clean. Plan: continue fluids, pain score every four hours, CBC recheck at two p.m. Call Dr. Sikina if PCV drops below twenty five or heart rate goes over one hundred forty. Overnight she was quiet but ate a little and stood at four a.m. What questions do you have?

Claire Brooks

Forty five seconds. Nothing lost. Patient safe. That is the job.

Dr. Erika Sikina

Surgery techs, when you round a post op patient over to ER, add four things to your Plan step: the procedure and how recovery went, what the incision or bandage should look like and when to check it, the pain plan and restrictions, like e collar, activity, and food timing, and the surgeon overnight call parameters. What to call about, and who to call.

Claire Brooks

Because just call the surgeon at three in the morning with no parameters is how ER docs develop eye twitches.

Dr. Erika Sikina

Quick fumble round. Fumble one: rounding from the desk instead of the cage. Go look at the patient together, that is half the information.

Claire Brooks

Fumble two: the drive by handoff while putting your coat on. If your car keys are in your hand, it is not rounds, it is a getaway.

Dr. Erika Sikina

Fumble three: skipping code status. Never assume. Say CPR or DNR out loud, every patient, every time. Not funny, just true.

Claire Brooks

And fumble four: no say back. The case is not handed off because you said words near a coworker. It is handed off when they say it back.

Claire Brooks

So: cage side, sheet open, criticals first. Who, problem, history, bloodwork and findings, plan with call parameters, and what happened. Close with What questions do you have? and hear it said back.

Dr. Erika Sikina

Grab the laminated Quick Reference off the treatment board, the steps are all there. Use it every round until it is muscle memory, and then keep using it, because tired brains love a checklist.

Claire Brooks

This is CARES in action: compassion for the patient, respect for the teammate inheriting them, and the kind of service our primary veterinarians and owners can feel. Round like the next tech knows nothing, and like the patient is yours either way. Because they are.

Dr. Erika Sikina

Now go forth and never say the brown one again.