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Table 1 Scheduled interprofessional interactions

From: Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards

1 [The doctor reports on the patient]. The patient’s main issue is urological, and has had a consult, and needs home care. The dietician queries the patient’s diabetes – he might need education. The dietician requests from [resident] “can you refer him to the diabetes clinic?” Resident replies, “Sure. Can he be taught about blood sugar monitoring here?” The dietician says, “The bedside nurse can do that.” A nurse discusses with the dietician the possibility of them both going in together to see the patient for education of blood sugar monitoring (observation, interprofessional round).
2 The resident reports that they are still actively investigating the patient 11. No comments are made. The resident reports that patient 12 is going home today; “it’s all written up and ready to go.” The resident reports that patient 13 aspirated last night and is now in the step up unit. No comments made. The resident reports that patient 14 is also in step up [round continues] (observation, interprofessional round).
3 The charge nurse calls out the patient name but the resident does most of the talking. She asks the allied health staff for information and clarification, they speak up when she asks them something directly (observation, interprofessional round).
4 The physician says to the nurse “should we start?” The nurse replies: “I don’t know where…” The social worker prompts her, and the nurse gets in two sentences before the doctor interrupts and asks the physiotherapist for information. The physician then says “get her out of here,” meaning ‘discharge the patient’ (observation, interprofessional round).
5 The attending physician asks the nurse if there is any news of patient C. “No,” she says. The occupational therapist at the back of the room says quietly, twice, “can we go back to Mr. B?” No one else looks at her or responds, and no one alerts the physician to what she has clearly said too quietly for the attending physician to hear (observation, interprofessional round).
6 “It is intimidating [to speak up at bullet rounds] because everything happens so quickly. The medical team wants a quick discharge and medicine is the focus here because this is acute care. They have pressures on them to discharge. But sometimes, as a result, we don’t get heard in terms of our recommendations for patient care” (interview, occupational therapist).
7 “Bullet rounds have no depth to them. They are too superficial” (interview, nurse).
8 “From the medical perspective, [the problem is that] the information that is shared at bullet rounds is not always useful, like what the functional ability of a patient is” (interview, physician).
9 As they are waiting, the advanced practice nurse enters and comments about the medical staff, “They’re rounding before the round.” Physiotherapist replies, “I guess they want to go over the medical stuff,” but she is clearly a little annoyed with waiting (observation, interprofessional round).