The Earlier the Longer: Disproportionate Time Allocated to Patients Discussed Early in Attending Physician Handoff Sessions

Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study

“…These selections are based on patient criticality (eg, the sickest patient first), time of admission (ie, LOS in the unit), bed order, or costeffectiveness ratio [37]. For example, Cohen et al [18] suggested that the sickest, newest, or patient’s requiring further discussions should be seen first during rounds. However, there are other external constraints that play into the decisions regarding the priority order of patient presentation that can accelerate the disposition of patients in a unit.…”

“…Our assumption was that, given the unpredictability of patient arrivals or discharges and similar resource availability for all patients, the order of patient discussion was effectively randomized, making any of the patient, unit, or external variables unrelated to the discussion order (a similar claim was made by Cohen et al [18] regarding randomization and discussion order).…”

“…Given the exploratory nature of this study, and limited previous research results, our purpose was to compare our results with the results reported in other published research articles [18]. There was no control condition (ie, a “no tool” condition), and the comparisons were made only between the 2 considered rounding tools.…”

“…A negative Kendall τ between the order of presentation and time spent shows lesser time for patients presented later, zero correlation shows that relatively equal time was spent across all patients, and a positive correlation shows more time spent for patients presented later. Given that the data were collected across 8 sessions (4 sessions per tool), similar to Cohen et al [18], we computed the Kendall τ per session and averaged across all sessions per tool.…”

“…Recent research has illustrated that verbal discussions during rounds were vulnerable to unequal time allocation––a phenomenon that has been described as a “portfolio problem” or “end of round time compression” [18-20]. For example, Cohen et al [18] examined video-recordings of 23 end-of-week handoff sessions in a 21-bed intensive care unit (ICU) and found that patients discussed earlier received about 50% more time than the patients discussed later in the same session, regardless of their severity or complexity of illness. Similarly, Kannampallil et al, [20] reported an average decrease of 54 seconds for every additional patient discussion during morning rounds in a Cardiothoracic ICU.…”