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A Night in the Bunker

In 1889, Canadian-born physician Sir William Osler became the first physician-in-chief of the new Johns Hopkins Hospital in Baltimore, Maryland.1 He was often called "the father of modern medicine."2 Bedside teaching was so much a part of his style of clinician training3 that he is sometimes credited with coining the word rounding. The story is hard to verify, but it sounds really good, particularly if you are a resident in training hearing it for the first time from one of the staff. During Sir William's tenure, the famous Johns Hopkins dome was still a part of the hospital, so when he guided his team of young physicians from patient to patient, they followed the circular hospital hallway all the way around the base of the dome. Because there were multiple members of the team, they were said to be making their "rounds."

Whether the story is true or not, making rounds is an established and important part of any clinician's life in a hospital setting, contributing to care team cohesion, an improved teamwork dynamic across disciplines (particularly when nurses are included), and more concise communication.4 Also, it's just a good idea to keep an eye on your patients, especially the ones who are really sick, such as those in an intensive care unit (ICU).

It was a fairly large ICU patient population that Jorge Guzman, MD, was watching over on a cold February night in 2014. Though he presently serves as the vice president of Cleveland Clinic's Regional Medical Operations, on this particular evening he was, as director of Cleveland Clinic's Medical Intensive Care Unit, performing the duties of a critical care clinician who specializes in acute lung injury, acute respiratory distress syndrome, and sepsis. The ICU patient population that was under his watchful eye numbered 78, and they were located in four different hospitals, separated by as much as 45 miles. Instead of rounding on them all, he decided that, for his eleven o'clock rounds, he would only look in on the 12 who needed his closest attention, starting with a gentleman who, though not a "red box," had arrived within the past hour.

"Are we ready?" Dr. Guzman asked, and the two nurses who occupied the workstations located to his right and left stepped in closer to where he was standing at the center of Cleveland Clinic's eHospital technology array, which was located on the anesthesia floor of the main campus's P Building, in a room known as the bunker.

Inside, there were three large tables arranged end-to-end, positioned against the left wall, running lengthwise from the door. The tables were sophisticated devices that could be raised or lowered with the touch of a button. Each supported an identical arrangement of five flat-screen monitors: one large one on the left, by itself, and four smaller ones arranged in ...

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