Background: For the academic hospitalist, rounds are the cornerstone of teaching, learning, and patient care. At our institution, a study found that internal medicine residents on the inpatient wards spent an average of 3.4 hours rounding daily. However, most residents and attendings described rounds as “inefficient” and “low value.” With the importance of ACGME work hour compliance, it is critical to optimize residents’ time at work. It is also important to train residents in effective inpatient workflows. The primary goal of this intervention was to reduce rounding time from 3.4 hours to < 2.5 hours. The secondary aims were to reduce resident work hour violations, preserve resident learning, and avoid patient harm.
Methods: This rounding intervention was implemented at an 800-bed, urban, academic medical center. A taskforce of hospitalist faculty and residents identified nine strategies for efficient rounding, in three categories – Novel rounding strategies, shared Expectations, and Time management (Figure 1). Each inpatient teaching team was instructed to select at least one strategy from each category to use during a 10-to-14 day block. The pilot was implemented from March-May 2021. Daily attending surveys and weekly resident surveys assessed self-reported rounding length and patient safety events. In addition, residents and attendings completed pre- and post-intervention surveys which were compared using chi-square analysis.
Results: The pre-intervention survey was completed by 39 residents and 43 attendings, and the post-intervention survey was completed by 32 residents and 45 attendings. All (32/32) residents and 93% (42/45) of attendings reported using NET Rounding strategies at least half the days. NET Rounding successfully reduced perceived rounding time. Pre-intervention, 79% of residents and 84% of attendings reported rounds on average lasted longer than 2.5 hours, while post-intervention this reduced to 9% (p< 0.0001) and 18% (p < 0.0001) respectively. This was mirrored in a decreased frequency of resident-reported work hour violations from 72% to 22% (p< 0.0001).Overall, 91% (29/32) of residents and 73% (33/45) of attendings perceived NET rounding had a positive impact on their wards experience. Compared to pre-intervention, more residents viewed rounds post-intervention as being very or extremely valuable to their learning, and residents perceived they more often had a safe plan for patients by the end of rounds (Figure 2). There were no major patient safety events reported as a result of NET Rounding.
Conclusions: An intervention to promote efficient rounding successfully reduced rounding length and resident-reported work hour violations, without compromising learning or patient safety. NET Rounding contributed to a more positive overall wards experience for attendings and residents. We identified effective rounding strategies that could be implemented at other academic hospitals to teach efficient workflows and to optimize attendings’ and residents’ time at work.