Background: Ward rounds at our hospital traditionally have been performed by a team of physicians and medical students outside of patients’ rooms, with minimal involvement of nursing staff and limited time spent with patients. As part of a care redesign initiative that included regionalization of clinicians and staff to unit-based care teams in June 2013, the general medical service at an academic medical center instituted bedside rounds. We hypothesized that this care redesign initiative would improve opportunities for interdisciplinary communication as well as patient and family engagement.
Methods: Time-motion analysis of general medical team rounds was conducted 16 times on four different teams from April to June 2013, and again performed 24 times on five different teams after implementation of care redesign, from April to June 2014. Trained medical students used a tablet device linked to a customized Microsoft Access database form to dynamically track the amount of time spent on rounds per patient, location of rounds, and all the participants present. The main outcome measures included percentage of time the nurse was present on rounds and the percentage of time spent at patients’ bedsides. Secondary outcomes included duration of rounds and time spent rounding per patient. Data were analyzed using Fisher exact test for dichotomous outcomes and t-test for continuous outcomes.
Results: Prior to implementation, nurses were present on rounds for 52% of patients. After implementation, nursing presence rose to 89% of patients (p < 0.001). Total rounding time spent at patients’ bedsides increased from 39% before care redesign to 56% afterwards (p < 0.001). Meanwhile, the duration of rounds decreased from a mean of 3.0 hours prior to redesign to a mean of 2.4 hours afterwards (p = 0.02; Table 1).
Conclusions: Care redesign on the general medical service with implementation of interdisciplinary bedside rounding resulted in an increased percentage of total rounding time spent with patients as well as an increased percentage of time that nurses were present on rounds. This did not result in lengthened rounding time but rather was associated with a significant decrease in duration of rounds, driven mainly by a decrease in rounding time on newly-admitted patients. This was made possible in part by a commitment from hospitalists to review admission notes prior to rounds as part of care redesign. Overall, these changes create the conditions for improved patient- and family-centeredness and enhanced teamwork and communication between physicians and nurses; further research is needed to determine whether these benefits have been realized.