Pre-rounding in hospital medicine: a narrative review

Pre-rounding in hospital medicine is the practice of having junior physicians in the medical team come to work early to pre-clerk new and existing patients in advance, in order to formulate preliminary management plans, draft rounding notes and prepare for ward round presentations when the attending consultant and senior members of the team arrive. While pre-rounding is part of a long-standing tradition in the United States hospital-based practice, its adoption has been highly heterogeneous across the world, due to controversy over its purported benefits in patient care and post-graduate training. In this article, we sought to review the relevant literature on pre-rounding in hospital medicine and examine its current role in postgraduate training and practice, specifically evaluating its clinical and pedagogical utility. From our analyses and discussion, we propose a simple "PRE-ROUND" (Prioritise/pre-select patients for physical review, Review of electronic medical record charts/documentations, Escalation of urgent clinical cases, Rounding notes drafting, Organise the sequence of ward rounds, Understand and synthesise pertinent medical issues to practise clinical reasoning, Narrative, structured ward round presentation, Developing a healthy institutional pre-round culture) model that practically encapsulates the key principles required for effective pre-rounds in hospital-based practice that can contribute meaningfully to patient care and post-graduate training, whilst avoiding excessive burden and clinical redundancy on junior physicians.