Teamwork on Rounds on an Inpatient Ward Team: An Ethnographic Study

Falco, Carla; Balmer, Dorene F.

doi:10.1542/hpeds.2017-0158

Cited by 6 publications

(2 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the potential value of ward rounds in teaching trainees to generate diagnostic hypotheses and differential diagnoses, to select investigations and treatments and to make decisions regarding patient care, 10 it has been suggested that more time is devoted to developing care plans than to discussing diagnoses during team discussions 11 . Prior studies on ward rounds in teaching hospitals have examined the extent to which rounds are dedicated to presenting patients and discussing patient care 12–19 . However, how clinical (diagnostic) reasoning occurs in team discussions is not well understood, such as the communication processes among team members and factors that influence them (e.g., team composition and hierarchy, environmental factors and location of discussions and contextual factors such as time and external pressures).…”

Section: Introductionmentioning

confidence: 99%

“…11 Prior studies on ward rounds in teaching hospitals have examined the extent to which rounds are dedicated to presenting patients and discussing patient care. [12][13][14][15][16][17][18][19] However, how clinical (diagnostic) reasoning occurs in team discussions is not well understood, such as the communication processes among team members and factors that influence them (e.g., team composition and hierarchy, environmental factors and location of discussions and contextual factors such as time and external pressures). Given the potential value of ward rounds for learning about team clinical reasoning, it is important to understand how teams communicate clinical reasoning in this complex learning environment to develop strategies that may enhance the teaching and learning of clinical reasoning.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How team clinical reasoning occurs on ward rounds: Implications for learning

Choi

Contractor

Patel

et al. 2023

The Clinical Teacher

View full text Add to dashboard Cite

Background: Ward rounds offer a rich environment for learning about team clinical reasoning. We aimed to assess how team clinical reasoning occurs on ward rounds to inform efforts to enhance the teaching of clinical reasoning. Methods:We performed focused ethnography of ward rounds over a 6-week period, during which we observed five different teams. Each day team comprised one senior physician, one senior resident, one junior resident, two interns and one medical student. Twelve 'night-float' residents who discussed new patients with the day team were also included. Field notes were analysed using content analysis.Findings: We analysed 41 new patient presentations and discussions on 23 different ward rounds. The median duration of case presentations and discussions was 13.0 minutes (IQR, 10.0-18.0 minutes). More time was devoted to information sharing (median 5.5 minutes; IQR, 4.0-7.0 minutes) than any other activity, followed by discussion of management plans (median 4.0 minutes; IQR, 3.0-7.8 minutes).Nineteen (46%) cases did not include discussion of a differential diagnosis for the chief concern. We identified two themes relevant to learning: (1) linear versus iterative approaches to team-based diagnosis and (2) the influence of hierarchy on participation in clinical reasoning discussions. Conclusion:The ward teams we observed spent far less time discussing differential diagnoses compared with information sharing. Junior learners such as medical students and interns contributed less frequently to team clinical reasoning discussions.In order to maximise student learning, strategies to engage junior learners in team clinical reasoning discussions on ward rounds may be needed.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How team clinical reasoning occurs on ward rounds: Implications for learning

Choi

Contractor

Patel

et al. 2023

The Clinical Teacher

View full text Add to dashboard Cite

show abstract

Defining Supervision Preferences and Roles Within a New Subspecialty: Pediatric Hospital Medicine

O'Hara

Tseng

Moss

et al. 2022

Academic Pediatrics

View full text Add to dashboard Cite

Pediatric Chronic Critical Illness: Gaps in Inpatient Intrateam Communication*

Hirschfeld¹,

Barone²,

Johnson³

et al. 2019

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objectives: The number of children with medical complexity and prolonged hospitalizations is rising. Strategies to adapt acute care approaches for this population are falling behind clinical demand. This study aimed to identify how inpatient team communication practices match the needs of teams caring for these patients and families, and to identify priority areas for improvement. Design: Cross-sectional mixed methods survey. Setting: Academic children’s hospital. Subjects: Interdisciplinary healthcare professionals: physicians, nurse practitioners, nurses, resident and fellow trainees, respiratory therapists, clinical pharmacists, occupational therapists, physical therapists, social workers, and child life specialists. Interventions: None. Measurements and Main Results: Four-hundred eight interdisciplinary healthcare professionals participated (33% response rate). Half (53%) worked in ICUs and 37% had greater than 10 years clinical experience. Three overarching themes emerged regarding communication during care of children with prolonged hospitalizations are as follows: 1) Dysfunctional team collaboration: the many involved healthcare providers for these children have inconsistent team meetings and few platforms for reaching clinical consensus; 2) Continuity gaps: time-limited clinician rotations and no designated longitudinal clinical leaders undermine relationships with families and key elements of shared decision-making; and 3) Inadequate communication skills and tools: healthcare professionals have inadequate training to address complex conversations and big picture concerns, and often default to daily management conversations. Nearly half (40%) perceived intra-team conflict to occur more commonly during care of these children compared with those with short hospitalizations, and many feel unskilled to address these conflicts. Healthcare providers working in ICUs were more likely than other healthcare providers to find care of children with chronic critical illness stressful “most of the time” (ICU 46%; 60/131 vs non-ICU 25%; 21/84; p = 0.02). Conclusions: Acute care inpatient communication practices require modification to meet the needs of healthcare professionals who provide longitudinal care to children with repeated and prolonged hospitalizations. Improvement strategies should prioritize building collaboration, continuity, and communication skills among healthcare professionals.

show abstract

Teamwork on Rounds on an Inpatient Ward Team: An Ethnographic Study

Cited by 6 publications

References 37 publications

How team clinical reasoning occurs on ward rounds: Implications for learning

How team clinical reasoning occurs on ward rounds: Implications for learning

Defining Supervision Preferences and Roles Within a New Subspecialty: Pediatric Hospital Medicine

Pediatric Chronic Critical Illness: Gaps in Inpatient Intrateam Communication*

Contact Info

Product

Resources

About