Medical rounds in the Pediatric Intensive Care Unit (PICU) took about four hours each day to complete. The length of rounds was affecting the advancement of care of the patients, the engagement of sub-specialty providers who needed to be present on other rounds, and the engagement of the PICU faculty and staff due to overburdening waste created by the long duration of rounds. Specific interventions were identified aimed at reducing the duration of rounds each day, increasing engagement of the rounding team and satisfying the needs of the patients and families. Post-improvement results were that rounding times were reduced to two hours each day and were pre-scheduled for families, the burden of excess work was lifted for attending physicians, and the presentation expectations during rounds were specified by role. Quality and safety were improved through standard work and auditing.