Background: Bedside rounds (BR) have been proposed as an ideal method to promote patient-centered hospital care. However, their effect on patient-centered outcomes is unclear. Our objective was to determine whether BR, when compared to other forms of hospital ward rounds, improve patient-centered outcomes. To accomplish this aim, we conducted a systematic review and meta-analysis of controlled studies measuring the effect of BR on patient-centered outcomes.
Methods: Data sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through July 28, 2017, along with review of reference lists from included articles. We included randomized and non-randomized experimental studies comparing BR to another form of rounds in a hospital-based setting (i.e., medical/surgical unit, emergency medicine unit, intensive care unit). Studies reporting a quantitative comparison of a patient-reported or objectively-measured clinical outcome were included. Eligibility was assessed independently and in duplicate, with disagreements resolved by consensus.
Patient-centered outcomes were categorized into one of four domains: patient knowledge (e.g., comprehension, understanding of information), patient experience (e.g., satisfaction, clinician-patient communication), use of services and costs (e.g., hospital length of stay, readmission rates, cost) and health behavior and health status (e.g., mortality, adverse event rates). We used random-effects models to calculate pooled Cohen’s d effect size estimates for the patient knowledge and patient experience outcome domains.
Results: Twenty-nine studies (21,447 patients) met inclusion criteria, including eight randomized controlled trials (2,310 patients). The majority of studies (n=23, 79.3%) were conducted in the United States, and general medical wards were the most frequent study setting (n=10, 34.5%). Bedside rounds were most often interprofessional (n=22, 75.9%) and involved health professions trainees (n=26, 89.7%).
We found a statistically significant improvement in patient experience with BR (24 studies, 9,110 patients, summary Cohen’s d = 0.09, 95% CI 0.04-0.14, p<0.001, I2=56%). The association between BR and patient knowledge was not statistically significant (10 studies, 2,789 patients, Cohen’s d = 0.21, 95% CI -0.004-0.43, p=0.054, I2=92%). Seven studies (15,717 patients) reported the effect of bedside rounds on use of services and costs, and four studies (11,978 patients) reported the effect on health behavior and health status. Outcomes in the use of services and costs, and health behavior and health status domains were more diverse and not felt amenable to quantitative pooling. For example, outcomes in the use of services and costs domain ranged from 30-day readmission to the proportion of patients discharged during the first nursing shift.
Heterogeneity among included studies was high, and not explained by differences in study design, setting, interprofessional participation, or whether BR were implemented as part of a bundled intervention. The overall strength of evidence was graded as low-to-moderate because of variable risk of bias and unexplained heterogeneity across studies.
Conclusions: In hospital-based settings, BR were associated with a small improvement in patient experience, but not other patient-centered outcomes. Additional research is needed to understand and measure patient-centered care at the bedside.