A Time-Motion Study of Inpatient Rounds Using a Family-Centered Rounds Model

Abstract

OBJECTIVE:Family-centered rounds (FCR) have become increasingly prevalent in pediatric hospital settings. The objective of our study was to describe time use and discrete events during pediatric inpatient rounds by using a FCR model. METHODS:We conducted a prospective observational study at Children's National Medical Center between September 2010 and February 2011. Investigators directly observed rounds on hospitalist and neurology services. Events were timed, and key features were recorded by using a Microsoft Access-based program. Associations with increased time spent during rounds were determined by using regression analyses. RESULTS:One hundred fi fty-nine rounding encounters were observed. Rounds lasted 7.9 minutes on average per patient. An average of 1.3 minutes was spent between patients during rounds. Eighty-six (54%) encounters occurred outside the patient's room, 3% of the time because of the family's request. Infectious isolation was associated with rounds occurring outside the room (P < .0001). Participation of the parent, location of rounds inside or outside the patient's room, most teaching behaviors, and interruptions were not signifi cantly associated with increased time spent during rounds. Teaching physical examination techniques by allowing multiple trainees to examine the patient was associated with increased rounding time (P = .02). CONCLUSIONS:The majority of rounds occurred outside the patient's room, yet rarely at the parent's request. Patients on infectious isolation were more likely to have rounds occur outside the patient's room. Neither parental participation nor most teaching behaviors were associated with increased time spent on rounds. These fi ndings will enrich the evidence base needed to establish FCR best practices.

Observing bedside rounds for faculty development

“…Other groups have examined various characteristics of internal medicine rounds, but to our knowledge, none have addressed attending physician and learner perceptions of the quality of rounds or of the attending physicians’ role or performance. We found only one study that examined the frequency and impact of interruptions on rounds: this was achieved in a setting of in‐patient paediatrics ward rounds, and did not show decreased rounding efficiency as a result of interruptions . The unique interactions between providers, parents and paediatric patients render paediatric ward rounds markedly different from internal medicine ward rounds; these findings may not be applicable to our setting.…”

Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial

“…36,38,39 The intervention reduced the average time spent on AR and time spent per patient. Studies examining the relationship between bedside rounding and duration of rounds have yielded mixed results: some have demonstrated no effect of bedside rounds on rounding time, 28,40 while others report longer rounding times. 37 The pre-rounds huddle and real-time order writing may have enhanced workflow efficiency.…”

Interprofessional collaborative care characteristics and the occurrence of bedside interprofessional rounds: a cross-sectional analysis

“…Numerous studies have investigated physician-based bedside rounds in several specialties, including pediatrics, internal medicine, and surgery [14, 26]. These studies highlight that bedside rounds occur at an incidence of <50 % of all encounters, and <20 % of total rounding time [16, 17, 27–29]. However, integration of nurses or healthcare professionals with physicians at the bedside is less studied.…”