Relationships Between Time-at-Bedside During Hospital Ward Rounds, Clinician–Patient Agreement, and Patient Experience

Abstract

Hospital medicine ward rounds are often conducted away from patients’ bedsides, but it is unknown if more time-at-bedside is associated with improved patient outcomes. Our objective is to measure the association between “time-at-bedside,” patient experience, and patient–clinician care agreement during ward rounds. Research assistants directly observed medicine services to quantify the amount of time spent discussing each patient’s care inside versus outside the patient’s room. “Time-at-bedside” was defined as the proportion of time spent discussing a patient’s care in his or her room. Patient experience and patient–clinician care agreement both were measured immediately after ward rounds. Results demonstrated that the majority of patient and physicians completely agreement on planned tests (66.3%), planned procedures (79.7%), medication changes (50.6%), and discharge location (66.9%), but had no agreement on the patient’s main concern (74.4%) and discharge date (50.6%). Time-at-bedside was not correlated with care agreement or patient experience ( P > .05 for all comparisons). This study demonstrates that spending more time at the bedside during ward rounds, alone, is insufficient to improve patient experience.

Reduced time spent with patients and decreased satisfaction in work during COVID-19 pandemic

“…A study at Mayo Clinic conducted on internal medicine inpatient teaching services had similar findings; there was no relationship between time spent in patients' room, level of agreement of between patient and physician care plan, and patient experience. 11 Our study has several limitations. We limited our study to internal medicine physicians.…”

Using participatory research to identify actionable facilitators and barriers to effective inpatient interdisciplinary communication

“…Interestingly, some patients and family members felt that bedside rounds instead illustrated Concept VII: Culture of Healthcare item 73, “Culture of residents is not patient‐centered, focused on education rather than the patient.” Within our context, the current implementation of bedside rounding was seen as a communication barrier (six items in Concept VI: Barriers to Communication). The mixed literature on the purpose and effects of bedside rounds reflect these sentiments 6–8,29–34 . Tools like interdisciplinary rounds only improve outcomes if contextual factors like system complexity (e.g., presence of medical trainees) and resources (e.g., staffing) are effectively addressed with implementation 2,9 .…”

Dismissal disagreement and discharge delays: Associations of patient–clinician plan of care agreement with discharge outcomes

“…[19][20][21] Ward rounds serve as the primary means for discussing future dismissal by educating patients about their clinical condition and treatment plan and ensuring that the patients' goals, questions, and concerns are addressed. Effective communication during ward rounds may facilitate the formation of a shared mental model between patient and physician 22 and, theoretically, increase the likelihood of a successful discharge. However, the relationship between patient-clinician plan of care agreement following ward rounds and patient readiness for discharge is unknown.…”