rounds

name	rounds
description	Structured walk-through of in-progress work, like morning rounds at a teaching hospital. For each "patient" (task, ticket, PR, branch), produce a one-screen summary in standard format and a numbered plan. Use to start the day, prep a standup, or sanity-check what's actually in flight.

Rounds

700. The team gathers in the hallway outside 3-East. Dr. Aisha Mwangi (Chief of Medicine) is on service this week and quotes Osler before we begin. Dr. Priya Sundaram (Chief Resident, Medicine) presents the list. Coffee is mandatory.

Rounds is not status. Rounds is the team thinking out loud, in a structured format, about every patient on the service. Same applies to in-flight tasks, branches, PRs, experiments, customer issues — whatever's "admitted."

---

Pre-round (do this first, alone)

Before you "stand outside the room":

• Pull the list (open tickets, in-flight branches, PRs, alerts).
• For each one, glance at: last update, last error, last thing you said about it.
• Sort by acuity (use /triage if it's been a while).

Show up to rounds with a clean list. Walk-up rounds with no list = chaos.

---

Per-patient presentation format

For each item, present in this order. Be brief. A whole patient takes 60–90 seconds to present.

PATIENT: <task / ticket / PR name>
HOSPITAL DAY: <how long it's been open>
ID: <one-sentence what-and-why>
HPI: <history of present issue — what's happened recently, in chronological order>
EXAM: <current state — tests passing? metrics healthy? merge conflicts? blocked on whom?>
ASSESSMENT: <what you actually think is going on>
PLAN:
  1. <next action>
  2. <action>
  3. <action / disposition>

The PLAN is numbered. Always. Numbered plans are scannable plans.

---

Common patient types and their rounds patterns

• The stable patient (PR in review, no comments) — short presentation, "continuing current management."
• The improving patient (test was flaky, now consistent) — note improvement, plan: "monitor x 24h, downgrade priority."
• The deteriorating patient (blocker just appeared) — escalate. Page senior. Consider transfer (re-assign).
• The "interesting" patient (Holloway hates this word) — there is no such thing. State the differential.
• The boarder (something stuck waiting on external review for weeks) — disposition decision needed: stay or go (close vs. push).

---

What to do at the bedside

After presenting, the team (you and Claude, or the user and Claude) decides:

• Continue the plan as-is, or
• Change the plan (and write down what changed and why), or
• Discharge (close it out — see /discharge), or
• Transfer (hand off to someone else, with SBAR).

Document the decision in the relevant ticket / PR / file. Decisions made in rounds and not documented may as well not have been made.

---

End of rounds

• Updated list, sorted by acuity.
• One-line plan per item.
• A short note: who's doing what next, by when.
• Coffee refill.

---

Anti-patterns Mwangi will call you on

• Bullet vomit. "Tried this, then this, then this, then this, then this." If your HPI is ten bullets, your patient hasn't been thought about.
• No assessment. Skipping straight from EXAM to PLAN means you haven't decided what's wrong.
• Plan without disposition. Every plan ends in a disposition: continue, change, discharge, or transfer.
• Re-presenting the same patient three days in a row with no change. Either escalate or discharge. No third option.

---

Show up clean. Present concise. Plan numbered. Move on.