Background: Interprofessional bedside rounds have been promoted as a strategy to enhance patient engagement; prior studies have been limited by their use of nonvalidated measures and lack of patient and/or family involvement in design of the intervention.
Methods: In collaboration with our hospital’s Patient and Family Advisory Council (PFAC), we developed Patient Centered Bedside Rounds (PCBR)–interprofessional work rounds at the bedside in which the patient shares in the control of the management plan. We evaluated PCBR using a cluster randomized controlled trial involving four similar hospitalist service units; 2 intervention and 2 control units. The unit medical director and nurse manager for each intervention unit assembled a working group to design PCBR. Working groups included nurses, hospitalists, pharmacists, social workers and Patient/Family Advisors and met weekly for 6 weeks prior to, and 6 weeks after implementation of PCBR. Working groups developed a framework for PCBR discussion and, based on the recommendation of our PFAC to limit the number of team members present, decided that PCBR would include only the patient’s hospitalist and nurse. Unit medical directors and nurse managers attended PCBR during the first month to provide coaching and ensure adherence. We conducted structured interviews with randomly selected patients to assess the impact of PCBR. We assessed preferred and experienced roles in medical decision making using the Degner Control Preferences Scale. We assessed activation using the Short Form of the Patient Activation Measure (PAM-SF) and satisfaction by asking patients to rate how often nurses and doctors worked as team and the quality of their overall hospital care on a scale from 0-10. As done in prior research, we compared “top box” responses.
Results: Overall, 103 intervention and 113 control unit patients were interviewed. Intervention and control unit patients were similar in age, sex, race, admssion source, education level, MS-DRG weight, Elixhasuer combordibty score, and length of stay. PCBR occurred as intended for 72.3% of intervention unit patients. Patients’ experienced role in decision making (36.9% active role on the intervention unit vs. 38.0% on the control unit; p=0.85) and the concordance between their preferred and experienced role was not significanly different (87.4% vs. 88.5%;p=0.80). The PAM-SF was higher among intervention patients, but the result was not statistically significant (64.3± 18.1 vs. 63.1± 16.1; p=0.62). A higher percentage of intervention unit patients indicated nurses and doctors worked as a team (74.5% vs. 69.0%; p=0.36), and gave high ratings to overall hospital care (58.3% vs. 57.5%; p=0.91), but results were not statisticaly significant.
Conclusions: PCBR did not significantly improve patients’ role in decision making, activation, or satisfaction with care. Larger studies are needed to determine whether small differences in patient experience might achieve statistical significance.