Finding the most effective structure for inpatient clinical rounds can be tricky.

Many hospitals have turned to geographic rounding — the grouping of patients in designated hospital areas (typically a unit or a set of beds) based on specified criteria — for inpatient rounds in an attempt to be more efficient while still delivering quality care. As a 2025 study noted, this approach, sometimes also called geographic cohorting, can provide a number of benefits, such as improved workflow and productivity, but implementation can also create challenges, such as increased interruptions.

But that’s not the only approach to hospital clinical rounds that might be worth considering. Another approach is dividing the inpatient team in two: one team to handle admissions and a second team to make rounds. Some hospitals have even blended the two.

Some hospitalists like the advantages conferred by the split team approach. “That’s been our approach for many years,” said Andrew Dunn, MD, chief of the Division of Hospital Medicine for the Mount Sinai Health System in New York City, which has separate admitting teams. “We feel it is very effective. Everyone gets to focus on their primary task.”

However, Christopher Migliore, MD, an attending physician and assistant professor of medicine at Columbia University Irving Medical Center in New York City, isn’t quite as convinced. He prefers mixed rounding teams, saying “I think it allows for better continuity.”

To Split or Not to Split

According to Dunn, creating a team devoted solely to admissions has been well received at Mount Sinai. Physician assistants serve on the dedicated admitting team during the day, whereas nocturnists fill the role at night.

“That saves our rounding teams from having to run down and disrupt their workflow with their panel of patients, so they can focus on their work upstairs,” Dunn said. “They can concentrate fully on patients who have been admitted, without having to worry about getting an admission and have to run down to the emergency department.”

Meanwhile, the admissions team can fully focus on their work, too.

The approach also supports the geographic cohort approach, he added. The admitting team can admit a patient to a particular unit, and the geographic team that rounds on that unit can pick up that patient. “That allows for more efficient care of patients, more coordination with nurses and case management,” he said.

The University of Nebraska Medical Center in Omaha moved to a model with a geographic focus in 2018. But that approach also created some challenges, too, according to Tabatha Matthias, DO, MBA, associate division chief of clinical operations in the Division of Hospital Medicine.

The medical center does not have one single dedicated space for hospital medicine. Patients admitted to that service can be scattered throughout the hospital, which has four large towers. That could mean a lot of walking for the rounding physician who needs to see patients on multiple floors of multiple towers.

So the hospital medicine team has incorporated the split approach into the geographic model to make it easier on clinicians and their patients. A separate admitting team handles the initial admissions. When a patient gets admitted, they’re assigned to one of four towers, each of which has its own geographic rounding team, according to Matthias.

“We also try to balance census among all the rounders,” said Matthias. “It’s very important to us that people feel that the workload is equitable each day.”

Migliore acknowledged that the split approach can have advantages, such as advantages for scheduling.

“There is some stability that comes with that system,” he said. “It removes some of the unknown.”

‘A Complex Puzzle’ for Teaching Programs

Splitting teams for inpatient clinical rounds might be less feasible for teaching programs, as academic medical centers have an additional challenge to consider when deciding how to structure clinical rounds.

Teaching team priorities do not always align perfectly with hospital priorities, especially when it comes to factors such as workflow and efficiency metrics, noted Jeremy Schwartz, MD, a chief on one of the general medicine inpatient teaching services at Yale New Haven Hospital and an associate professor at Yale School of Medicine and Yale School of Public Health in New Haven, Connecticut.

“Teaching programs are inherently not efficient structures. You have to teach, you have to learn, that’s the whole point,” he said.

And while having one team devoted solely to admissions could help remove some of the burden of being interrupted and pulled away from rounding on patients to do admitting work, there’s a downside there, too.

“It’s very important for learners to get experience of doing fresh admissions,” Schwartz said.

“And the learning is amplified on mixed rounding teams because you see the end result of your decisions,” added Migliore.

Plus, teaching programs still have to fit within the organization’s larger context. “It’s a very complex puzzle,” Schwartz said.

Trying a New Approach to Rounding

Ultimately, every hospital or system determines the approach that best suits their current needs and work on implementation. “What works in one context might not work in another,” said Schwartz.

Matthias agreed, noting that it’s important to also understand the hospital’s bed planning strategy. “You still have to maintain a ton of flexibility,” she added. “And you have to think about what your principles for continuity of care for the patient are.”

Plus, it may take some trial and error.

For example, the implementation of the standardized, team-based intervention known as Structured Interdisciplinary Bedside Rounds in an inpatient medicine teaching unit yielded some encouraging early success, according to Schwartz, who co-authored a study about the effort in the Journal of Interprofessional Care. This intervention, which was developed as part of the Accountable Care Unit model, requires bringing together a multidisciplinary team to conduct a structured beside encounter with a patient.

“Turns out, that’s a lot more easily said than done,” Schwartz said. “It’s really challenging.”

With team members all pulled in different directions throughout the day, they eventually concluded it wasn’t sustainable.

But that kind of information can be useful. Migliore suggested that hospitals should be willing to consider what they could improve and be open to new ideas that could help — instead of getting stuck.

“Those systems that do the best are continually willing to reevaluate whatever system they have in place and then really be willing to enact change, even if painful, for the next step,” Migliore said.

No reported disclosures.