To: Hospital Executive Leadership, Medical Executive Committee, and Department of Medicine Leadership
From: Attending Physicians and Advanced Practice Providers
Subject: Request to Implement Patient Census Caps During Daily Rounds
Date: [Insert Date]
Purpose
We, the undersigned physicians, respectfully submit this petition to request the formal establishment of patient census caps during daily rounding to ensure high-quality, safe, and sustainable patient care.
Background
Over recent months, many clinicians have experienced consistently elevated patient volumes during rounds, often exceeding levels that allow for thorough clinical assessment, effective communication, and timely documentation. While we remain deeply committed to patient care and organizational goals, current rounding expectations increasingly place physicians in situations that compromise:
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Clinical decision-making quality
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Patient safety and satisfaction
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Teaching effectiveness (where applicable)
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Physician well-being and retention
Extensive evidence links excessive patient loads with increased medical errors, burnout, depersonalization, and turnover—all of which directly impact institutional quality metrics and financial performance.
Rationale for Capped Rounding
Implementing a defined census cap during rounds would:
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Enhance Patient Safety
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Allow adequate time for history review, bedside assessment, and care coordination
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Reduce cognitive overload and error risk
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Improve Quality of Care and Patient Experience
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Support meaningful patient and family communication
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Improve compliance with best practices, documentation accuracy, and discharge planning
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Support Physician Well-Being and Workforce Stability
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Reduce burnout and moral injury
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Improve job satisfaction, retention, and recruitment
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Align with Organizational Quality and Risk Management Goals
Proposed Request
We respectfully request that leadership:
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Establish a clearly defined maximum patient census per rounding physician, adjusted for:
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Implement overflow or surge protocols when census exceeds safe rounding thresholds
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Reassess caps periodically based on quality metrics, physician feedback, and patient outcomes
(Suggested example: a maximum of ___ patients per rounding physician, with defined escalation pathways when exceeded.)
Commitment to Collaboration
We emphasize that this petition is not adversarial in nature. We seek collaborative dialogue and partnership with leadership to develop solutions that balance operational demands with safe, patient-centered care. We are eager to participate in workgroups, pilots, or quality initiatives to support successful implementation.
Conclusion
Capping patient census during rounds is a proactive, evidence-based measure that supports patient safety, physician sustainability, and organizational excellence. We respectfully request leadership’s consideration and timely response to this proposal.
Thank you for your attention and continued commitment to high-quality care.
