How Much Time are Physicians and Nurses Spending Together at the Patient Bedside?
BACKGROUND: Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician–nurse (MD–RN) overlap at the patient bedside are lacking.
OBJECTIVE: This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency.
DESIGN: This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology.
SETTING: Single-institution academic hospital.
MEASUREMENTS: The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD–RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station.
RESULTS: A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD–RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD–RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD–RN overlap (Pearson’s r = –0.67, P < .05).
CONCLUSION: RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.
© 2019 Society of Hospital Medicine
CONCLUSION
RFID technology is a high-throughput method of generating precise, quantitative, and objective data on physician and nurse rounding habits. This tool can be widely applied to generate baseline rounding and overlap data for a variety of wards and settings, especially for institutions that are interested in comparing their metrics and performance to other peer wards or hospitals. Furthermore, this method can generate the necessary pre- and postintervention data for countless quality improvement endeavors, including efforts to enhance bedside interdisciplinary rounding.
Acknowledgments
The authors would like to thank the attending hospitalists who piloted wearing the RFID tags. This study would not be possible without your participation. The authors also wish to extend their appreciation to Gretchen Brown, MSN RN NEA-BC, for her support. Finally, the authors would like to thank Dr. Laurence Katznelson, Thi Dinh La, and the Resident Safety Council at Stanford, as well as the Stanford GME Office.
Disclosures
The authors have nothing to disclose.
