A real-time locating system observes physician time-motion patterns during walk-rounds: a pilot study

Abstract

BackgroundWalk-rounds, a common component of medical education, usually consist of a combination of teaching outside the patient room as well as in the presence of the patient, known as bedside teaching. The proportion of time dedicated to bedside teaching has been declining despite research demonstrating its benefits. Increasing complexities of patient care and perceived impediments to workflow are cited as reasons for this declining use. Research using real-time locating systems (RTLS) has been purported to improve workflow through monitoring of patients and equipment. We used RTLS technology to observe and track patterns of movement of attending physicians during a mandatory once-weekly medical teaching team patient care rounding session endorsed as a walk-rounds format.MethodsDuring a project to assess the efficacy of RTLS technology to track equipment and patients in a clinical setting, we conducted a small-scale pilot study to observe attending physician walk-round patterns during a mandatory once-weekly team rounding session. A consecutive sample of attending physicians on the unit was targeted, eight agreed to participate. Data collected using the RTLS were pictorially represented as linked points overlaying a floor plan of the unit to represent each physician’s motion through time. Visual analysis of time-motion was independently performed by two researchers and disagreement resolved through consensus. Rounding events were described as a sequence of approximate proportions of time engaged within or outside patient rooms.ResultsThe patient care rounds varied in duration from 60 to 425 minutes. Median duration of rounds within patient rooms was approximately 33% of total time (range approximately 20-50%). Three general time-motion rounding patterns were observed: a first pattern that predominantly involved rounding in ward hallways and little time in patient rooms; a second pattern that predominantly involved time in a ward conference room; and a third balanced pattern characterized by equal proportions of time in patient rooms and in ward hallways.ConclusionsObservation using RTLS technology identified distinct time-motion rounding patterns that hint at differing rounding styles across physicians. Future studies using this technology could examine how the division of time during walk-rounds impacts outcomes such as patient satisfaction, learner satisfaction, and physician workflow.

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

“…The MIRs we observed were consistent with the existing literature in that physical examinations and direct interactions with patients were rare (Miller et al 1992;Ward et al Interprofessional rhetoric and operational realities: an… 2014), and their nature and frequency varied greatly based on the preferences of the leading attending physician (Ward et al 2014). …”

“…ventilator, balloon pump) at the bedside, although these practices were once again highly dependent on the preferences of each attending physician, a phenomenon noted elsewhere (Ward et al 2014). Many attending physicians saw MIRs as a space for the discussion of exclusively medical issues.…”

“…Key concerns include the declining art of bedside teaching and physical examination (Ramani et al 2003;Verghese 2008;Wachter 2015), rarefied time spent at the bedside (Miller et al 1992;Ward et al 2014), and the use of ''depersonalizing'' language during case presentations (Anspach 1988;Fox 1993). These are all aspects of the well-known and much decried phenomenon of patient objectivation in medical education and care (Mizrahi 1985).…”

Physician experiences of patient-centered and team- based ward rounding – an interview based case-study

“…A high-quality ward round, following the Caldwell considerate checklist, took 12 minutes per patient, with considerable variation [38] . Large variation between physicians time-motion patterns during walking rounds was also reported using real-time location systems [39] . Research showed that single-room rounding took longer time compared to rounding four-bedded rooms [13] .…”

“…An observational study of general medicine rounds found great heterogeneity in the composition of rounding participants, the number of patients discussed during rounds and the activities performed [37] . Large time variations between physicians rounding the same ward may indicate distinct rounding styles [39] . Healthcare has a unique and complex relationship to the autonomy of its individual actors where human virtue is seen as the basis for safety and human incompetence as the source of risk [41] .…”