Standardized attending rounds to improve the patient experience: A pragmatic cluster randomized controlled trial
Background
At academic medical centers, attending rounds (AR) serve to coordinate patient care and educate trainees, yet variably involve patients.
Objective
To determine the impact of standardized bedside AR on patient satisfaction with rounds.
Design
Cluster randomized controlled trial.
Setting
500-bed urban, quaternary care hospital.
Patients
1200 patients admitted to the medicine service.
Intervention
Teams in the intervention arm received training to adhere to 5 AR practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; 5) whiteboard updates. Control arm teams continued usual rounding practices.
Measurements
Trained observers audited rounds to assess adherence to recommended AR practices and surveyed patients following AR. The primary outcome was patient satisfaction with AR. Secondary outcomes were perceived and actual AR duration, and attending and trainee satisfaction.
Results
We observed 241 (70.1%) and 264 (76.7%) AR in the intervention and control arms, respectively, which included 1855 and 1903 patient rounding encounters. Using a 5-point Likert scale, patients in the intervention arm reported increased satisfaction with AR (4.49 vs. 4.25; P = 0.01) and felt more cared for by their medicine team (4.54 vs. 4.36; P = 0.03). Although the intervention shortened the duration of AR by 8 minutes on average (143 vs. 151 minutes; P = 0.052), trainees perceived intervention AR as lasting longer and reported lower satisfaction with intervention AR.
Conclusions
Medicine teams can adopt a standardized, patient-centered, time-saving rounding model that leads to increased patient satisfaction with AR and the perception that patients are more cared for by their medicine team. Journal of Hospital Medicine 2017;12:143-149. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
We would like to thank all patients, providers, and trainees who participated in this study. We would also like to acknowledge the following volunteer auditors who observed teams daily: Arianna Abundo, Elahhe Afkhamnejad, Yolanda Banuelos, Laila Fozoun, Soe Yupar Khin, Tam Thien Le, Wing Sum Li, Yaqiao Li, Mengyao Liu, Tzyy-Harn Lo, Shynh-Herng Lo, David Lowe, Danoush Paborji, Sa Nan Park, Urmila Powale, Redha Fouad Qabazard, Monique Quiroz, John-Luke Marcelo Rivera, Manfred Roy Luna Salvador, Tobias Gowen Squier-Roper, Flora Yan Ting, Francesca Natasha T. Tizon, Emily Claire Trautner, Stephen Weiner, Alice Wilson, Kimberly Woo, Bingling J Wu, Johnny Wu, Brenda Yee. Statistical expertise was provided by Joan Hilton from the UCSF Clinical and Translational Science Institute (CTSI), which is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Thanks also to Oralia Schatzman, Andrea Mazzini, and Erika Huie for their administrative support, and John Hillman for data-related support. Special thanks to Kirsten Kangelaris and Andrew Auerbach for their valuable feedback throughout, and to Maria Novelero and Robert Wachter for their divisional support of this project.
Disclosure
The authors report no financial conflicts of interest.
