Background: For the academic hospitalist, rounds are the cornerstone of teaching, learning, and patient care. At our institution, a study found that Internal Medicine (IM) residents on the wards spend an average of 3.4 hours rounding daily. However, most residents and attendings described rounds as “inefficient” and “low value.” With this information and with attention to trainee work hour regulations, our residency program leadership called for an intervention to improve rounding efficiency and value.
Purpose: To identify best practices for inpatient Internal Medicine rounds, and to design a novel intervention to implement these strategies.
Description: We convened a taskforce of hospitalist faculty and residents in Winter 2020 to identify high- and low-yield rounding practices and to design an intervention. We engaged in structured brainstorming sessions, reviewed existing literature on effective rounds and interviewed esteemed clinician educators at multiple sites in our medical system. Our taskforce identified nine strategies for efficient rounds, in three categories – Novel Rounding Strategies, Shared Expectations, and Time Management. The NET Rounding intervention included a pocket card with recommended strategies and a table to track rounding time [Figure 1]. Each wards team was instructed to select together at least one strategy from each category to use during a 10- to 14-day block. A QR-code on the pocket card displayed Frequently Asked Questions and contingency plans for common rounding challenges. NET Rounding was implemented from March-May 2021. To promote uptake, members of our taskforce introduced the intervention in residency and faculty meetings, and emailed attendings and residents at the start of their rotation. During the intervention we reached out to participants via text to answer questions and provide support. Daily attending surveys and weekly resident surveys collected self-reported rounding length. In addition, residents and attendings completed pre- and post-intervention surveys on their rounding experience.The pre-survey was completed by 39 residents and 43 attendings, and the post-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 of their rotation, while 71% (24/32) of residents and 73% (33/45) of attendings used them every day. The most frequently used strategies were also cited as the most helpful for efficiency. These included: establishing whole-team readiness for rounds, rounding with purpose, setting a daily rounding agenda, and prioritizing relevant data and problems.Feedback about NET Rounding was overwhelmingly positive, and many participants said NET Rounding would positively impact their future practice [Figure 2]. A minority of faculty expressed concerns over a shift away from bedside rounds during the intervention and we adjusted our messaging to address this.
Conclusions: A taskforce of faculty and residents successfully designed and implemented an intervention to promote efficient rounding at a large academic medical center. There was high uptake of the intervention, and NET Rounding contributed to a more positive wards experience. This innovation identified best practices for rounding efficiency that could be implemented at other teaching hospitals.
