Attending morning rounds take place at teaching hospitals every day. They are the primary mechanism for patient care delivery, supervision and education of trainees, and communication with patients, families, and staff. However, they are done with little standardization or widely recognized best practices. The objective of this quality improvement (QI) initiative is to evaluate the adherence to and impact of implementing standardized attending morning rounds on medicine teams at our institution. A standardized rounding intervention has been developed which includes specific guidance on completing the following activities during morning rounds: (1) Pre-rounds discretion; (2) Pre-rounds huddle; (3) Bedside registered nurse (RN) integration; (4) Patient-centered rounding; (5) Real-time order writing. This trial will randomize half of the investigators' medicine teams at University of California San Francisco to this rounding intervention whilst the other half will be randomized to continue with usual unstandardized rounding practices. The investigators will compare medicine teams randomized to undertake standardized rounding to those teams undertaking usual practice. Outcomes assessed will relate to the patient (e.g. satisfaction), providers (e.g. satisfaction), efficiency (e.g. total morning round time) as well as adherence to the intervention . The investigators' study hypotheses are that patient satisfaction scores will be higher for those patients receiving standardized bedside rounds compared to the usual care group. The investigators also hypothesize that total attending morning rounds time and interns length of workday will be shorter and that the number of consultations ordered before noon will increase for those teams undertaking standardized bedside. Further, the investigator hypothesize higher levels of nurse participation, physician and medical student satisfaction with standardized bedside rounding.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
1,200
University of California San Francisco Medical Center
San Francisco, California, United States
Patient satisfaction with morning rounds
Patient satisfaction with morning ward rounds. This inpatient assessment will occur after day one of hospitalization before the patient is discharged from hospital. This time point will ensure that patients have experienced rounds at least once before completing a patient satisfaction survey.
Time frame: Once, after day one of hospitalization and before patient is discharged.
Patient satisfaction with provider communication
Post-discharge assessment will be sent by a commercial Vendor (Press Ganey) within a month of discharge following hospitalization
Time frame: Once, within one month of hospital discharge
Interns total length of workday
The interns total length of workday will be recorded daily. Over the course of the trial the average length of workday will be determined including any duty hour violations.
Time frame: Daily during the 3-month trial
Number of consultations ordered before noon
The number of consultations ordered before noon will be recorded daily. Over the course of the trial the average number of consultations ordered before noon will be calculated.
Time frame: Daily during the 3-month trial
Resident satisfaction
Resident satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
Time frame: Once during the last week of their rotation on a given team
Attending physician satisfaction
Attending physician satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
Time frame: Once during the last week of their rotation on a given team
Medical student satisfaction
Medical student satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
Time frame: Once during the last week of their rotation on a given team
Nurse participation in morning rounds
The presence of RN during morning ward rounds will be recorded daily.
Time frame: Daily during the 3-month trial
Nurse satisfaction
Nurse satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, team work)
Time frame: Once during the last week the trial
Intern satisfaction
Intern satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
Time frame: Once during the last week of their rotation on a given team
Total morning rounding time
Total morning rounding time will be recorded daily for each team. Over the course of the trial the average length of morning rounds will be determined.
Time frame: Daily during the 3-month trial
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