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Background Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. Methods A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. Results A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. Conclusions  These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.

AimThis study aimed to evaluate the effect of a team training program to support shared mental model (SMM) development in interprofessional rounds.Design and ParticipantsA three-arm randomized controlled trial study was conducted for interprofessional teams of 207 health profession learners who were randomized into three groups.Program DescriptionThe full team training program included a didactic training part on cognitive tools and a virtual simulation to support clinical teamwork in interprofessional round. Group 1 was assigned to the full program, group 2 to the didactic part, and group 3 (control group) with no intervention. The main outcome measure was team performance in full scale simulation. Secondary outcome was interprofessional attitudes.Program EvaluationTeamwork performance and interprofessional attitude scores of the full intervention group were significantly higher (P < 0.05) than those of the control group. The two intervention groups had significantly higher (P < 0.05) attitude scores on interprofessional teamwork compared with the control group.DiscussionOur study indicates the need of both cognitive tools and experiential learning modalities to foster SMM development for the delivery of optimal clinical teamwork performances. Given its scalability and practicality, we anticipate a greater role for virtual simulations to support interprofessional team training.

ImportanceThough interprofessional bedside rounds have been promoted to enhance patient-centred care for hospitalised patients, few studies have been conducted in adult hospital settings and evidence of impact is lacking.ObjectiveTo evaluate the effect of patient-centred bedside rounds (PCBRs) on measures of patient-centred care.Design and settingCluster randomised controlled trial involving four similar non-teaching hospitalist service units in a large urban hospital.ParticipantsHospitalised general medical patients.InterventionWe assembled working groups on two intervention units, consisting of professionals and patient/family members, to determine the optimal timing, duration and format for PCBR. Nurses and hospitalists rounded together in PCBR using a communication tool to provide a framework for discussion and unit leaders joined PCBR to provide coaching during initial weeks of implementation.Main outcomesUsing patient interviews, we assessed preferred and experienced roles in medical decision-making using the Control Preferences Scale, activation using the Short Form of the Patient Activation Measure, and satisfaction. We also compared postdischarge patient satisfaction survey items related to teamwork, involvement in decisions and overall care. We assessed nurses’, physicians’ and advanced practice providers’ (APP) perceptions of PCBR using a survey developed for this study.ResultsOverall, 650 patients were approached for structured interview during hospitalisation: 284 were excluded because of disorientation, 54 were excluded because of non-English language, 72 declined to participate and 4 withdrew from the study after enrolment. Interview data were available for 236 (122 control and 114 intervention unit) patients, and postdischarge satisfaction survey data were available for 493 (274 control and 219 intervention unit) patients. We found no significant differences in patients’ perceptions of shared decision-making, activation or satisfaction with care. Results were similar in analyses based on whether PCBR had been performed (ie, per protocol). We also found no difference in postdischarge patient satisfaction items. Results were similar in multivariate analyses controlling for patient characteristics and clustering of patients within study units. A majority of nurses (78.6%), but only about half of hospitalist physicians and APPs felt that PCBR improved communication with patients (47.4%). A minority of nurses (46.4%) and physicians and APPs (36.8%) agreed that PCBR had improved the efficiency of their workday.ConclusionsPCBR had no impact on patients’ perceptions of shared decision-making, activation or satisfaction with care. Additional research is needed to identify optimal approaches that can be reliably implemented in hospital settings to improve patient-centred care.

COVID-19 has disrupted the 2020–2021 residency application cycle with the cancellation of away rotations and in-person interviews. This study seeks to investigate the feasibility and utility of video conferencing technology (VCT) as an opportunity for applicants to interact with faculty from outside programs. 18 prospective urology applicants were randomized to 6 urology programs to give a virtual grand rounds (VGR) talk. Presentations were recorded and analyzed to determine audience engagement. Students were surveyed regarding perceived utility of VGR. Faculty were surveyed to determine system usability of VCT and ability to evaluate the applicant. 17 students completed the survey, reporting a 100% satisfaction rate with VGR. A majority felt this was a useful way to learn about outside programs. 85 physicians completed the faculty survey, with nearly half feeling confident in their ability to evaluate the applicant. Video transcription data shows sessions were interactive with minimal distractions. VGR can be a useful means for medical students to express interest in programs as well as an additional marker for faculty to evaluate applicants. •Prospective applicants were highly satisfied with virtual grand rounds (VGR).•82% of applicants felt VGR was a useful way to learn about other programs.•Nearly half of faculty felt confident evaluating the applicant after VGR.•70% of faculty and residents were able to determine likelihood of interview invite.•VGR sessions were generally interactive with minimal distractions.

[...]these restrictions have accelerated the adoption, adaptation and application of modern internet-based technologies to all professional meetings including grand rounds. On login after registration, all attendees are automatically muted with capability to turn on their video. Because we use the pre-registration function, our Department does not utilize the Waiting Room feature of Zoom, which provides another option for security by requiring a host/co-host to allow entry of every participant into the session. [...]the test session is a good time for the co-host to get to know the presenter and review the speaker’s biography and curriculum vitae (CV). [...]there is an economic advantage to having virtual grand rounds.

Family participation in intensive care unit (ICU) rounds is a recommended care practice by critical care professional societies. However, system and individual-level barriers may prevent families from attending rounds in person. This study aimed to assess the feasibility of virtual family participation in ICU rounds. This multicenter prospective cohort study included family members of ICU patients who participated via videoconference in daily multidisciplinary team rounds in five adult ICUs in Montreal, Canada, between June 2023 and August 2024. Feasibility metrics included recruitment rate, intervention uptake, technical issues, and follow-up rate. Family-centered outcomes included care engagement (FAMily Engagement; FAME), satisfaction (Family Satisfaction in the ICU-24R), and mental health (Hospital Anxiety and Depression Scale). A total of 72 family members participated in at least one virtual round (out of 84 enrolled; 85.7 % uptake). No technical issues were experienced in 113/132 (85.7 %) virtual rounds. Follow-up data were available for 56/72 (77.7 %) participants. From baseline to post-intervention, overall family engagement scores (FAME) increased (64.5 ± 20.5 to 69.8 ± 15.2; p = 0.045) with improvements in the perception of engagement (63.0 ± 22.3 to 70.8 ± 16.5; p = 0.04) and family-centered care (75.7 ± 16.9 to 82.1 ± 14.0; p = 0.04) domains. Overall mean family satisfaction was high (75.8 ± 17.2). Anxiety and depression symptoms were reported by 42.8 % and 23.2 % of participants, respectively. Virtual participation by family members in ICU rounds was feasible and was associated with improved family engagement scores and high satisfaction scores. These results support the need for a multicenter trial to evaluate the effectiveness of virtual rounds in improving process and experience-related outcomes. •This pilot trial found that a virtual family ICU rounding intervention was feasible.•Most ICU clinicians agreed to include families in virtual rounds.•Family engagement scores improved following the intervention.•This study will inform the design of a planned multicenter effectiveness trial.

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings (PEACE rounds) to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer (MDT) scores fluctuated. \"Clinical situations\" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised (MDS-R), were lower for respondents in all categories (non-significant), and on three specific items (significant). Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS (4.94 control vs 3.37 PEACE, p = 0.015), a statistically significant increase in both code status changes DNR (11 % control, 28 % PEACE, p = 0.013), and in-hospital death (9 % control, 25 % PEACE, p = 0.015), with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients.

IntroductionAccurate and timely documentation during surgical ward rounds is critical for ensuring patient safety, effective multidisciplinary communication and continuity of care. In high-demand surgical settings, resident doctors often experience delays in completing documentation due to competing clinical priorities. This quality improvement project aimed to assess whether an artificial intelligence (AI) transcription tool, Heidi, could reduce documentation time in a busy ear, nose and throat (ENT) department within a tertiary centre.MethodsBaseline data on time taken to complete conventional ward round documentation were collected over a 4-day period. The Heidi AI tool was then implemented to transcribe real-time discussions during ward rounds and automatically format the information using a structured template adapted from the SHINE Surgical Ward Round Toolkit. Documentation times using the AI system were recorded over a subsequent 4-day period.ResultsThe implementation of Heidi led to a statistically significant reduction in documentation time compared with conventional methods.ConclusionsUsing AI tools can not only improve timeliness of clinical records but also free resident doctors from scribing duties, allowing greater participation in patient care and enhancing educational opportunities. This intervention demonstrated the potential of AI-assisted documentation to improve workflow efficiency and patient flow while supporting resident doctor training and reducing administrative burden in a surgical setting.

Background: In line with the patient- and family-centered care concept, no care plan is complete without considering the voice and will of patients and their relatives. Involving families in medical rounds offers opportunities for collaboration, enhanced communication with the medical team, updates on the patient’s condition, and joint decision-making. Objective: This mixed-method systematic review aimed to provide evidence on family experiences regarding participation in medical rounds—specifically benefits, barriers, and suggestions—in adult ICUs. Methods: A mixed-method systematic review was conducted. Four databases were searched. Studies published in between 2014 and 2025 were included. Results: A total of 14 studies met the inclusion criteria. The reported experiences were categorized into three groups: benefits, barriers, and suggestions. Family presence on rounds was associated with improved medical staff family relationship, increased family satisfaction with care, improved the mental condition of the FM and increased knowledge of the patient’s condition and clinical plan. Organizational barriers as well as barriers associated with medical staff were identified. Clear policies, inviting the family to participate in the rounds and improving the communication skills among medical staff are important to improve this intervention. Conclusion: Family participation in ICU rounds has a positive impact on family mental health and improves perceptions of the quality of patient care. ICUs should consider integrating family participation into routine practice. Implications for clinical practice: Improve communication skills among staff, both within the team and with patients and their families. Educate medical staff on how to conduct rounds with families and highlight the associated benefits. Use mnemonic tools for family communication. Provide orientation tools to help families understand the rounds. Schedule rounds to enable family participation. Consider telemedicine as an alternative when in-person meetings are not feasible.

BackgroundWard rounds are an essential activity occurring in hospital settings. Despite their fundamental role in guiding patient care, they have no standardised approach. Implementation of structured interventions during ward rounds was shown to improve outcomes such as efficiency, documentation and communication. Whether these improvements have an impact on clinical outcomes is unclear. Our systematic review assessed whether structured interventions to guide ward rounds affect patient outcomes.MethodsA systematic search was carried out in May 2023 on Embase, Medline, CINAHL, ERIC, Web of Science Core Collection, the Cochrane Library (Wiley) and Google Scholar, and a backward and forward citation search in January 2024. We included peer-reviewed, original studies assessing the use of structured interventions during bedside ward rounds (BWRs) on clinical outcomes. All inpatient hospital settings where BWRs are performed were included. We excluded papers looking at board, teaching or medication rounds.ResultsOur search strategy yielded 29 studies. Two were randomised controlled trials (RCTs) and 27 were quasi-experimental interventional studies. The majority (79%) were conducted in intensive care units. The main clinical outcomes reported were mortality, infectious complications, length of stay (LOS) and duration of mechanical ventilation (DoMV). Mortality, LOS and rates of urinary tract and central-line associated bloodstream infections did not seem to be affected, positively or negatively, by interventions structuring BWRs, while evidence was conflicting regarding their effects on rates of ventilator-associated pneumonia and DoMV, with a signal towards improved outcomes. Studies were generally of low-to-moderate quality.ConclusionThe impact of structured interventions during BWRs on clinical outcomes remains inconclusive. Higher quality research focusing on multicentric RCTs or on prospective pre–post trials with concurrent cohorts, matched for key characteristics, is needed.PROSPERO registration numberCRD42023412637.