The quality of communication between physicians and nurses plays an important role in patient safety and provider job satisfaction. Efforts to improve the effectiveness of MD-RN communication have traditionally disseminated new programs such as staff training or communication tools, rather than improve established routines such as morning rounds. Having MDs and RNs round together has many tangible benefits including clearer discussion of plans, reduced guesswork and error, fewer pages, improved sense of teamwork, and higher patient satisfaction. However, in busy academic hospitals, MDs do not routinely take the time to find RNs during rounds due to time constraints, and RNs do not reliably know when MDs come by for rounds.
The purpose of our project was to utilize existing hospital technologies to accurately and quantitatively assess MD and RN rounding habits. Based on our focus groups, time/workload constraints and coordination challenges are the main drivers of poor MD-RN overlap during morning rounds. By studying MD and RN rounding habits precisely, we will be able to design specific, targeted interventions to improve MD-RN face time.
Hospitalist physicians and nurses at our academic institution were given small, portable locator devices to wear. These devices turn on a specific colored light (white for nurses and green for physicians) when the wearer enters the room. In addition, our information technologists are able to precisely and automatically record when each locator device enters and leaves a specific patient room, thereby generating a temporal-spatial map of both MD and RN activity. We recorded and analyzed the rounding habits of MDs and RNs in three separate in-patient wards over a period of 90 consecutive days.
This approach has successfully generated precise, quantitative data on MD and RN rounding habits that have been previously unattainable. Over the 90-day period, 739 MD rounding events were captured. The average MD rounding time was 7.3 minutes (±0.35 min, range 1 to 41 min). Importantly, of these rounding events, 42.1% occurred with an RN at bedside. The average length of MD-RN face time overlap was 4.1 minutes. Interestingly, the distance from the nursing station (located at the center of each linear ward) to the individual patient rooms did not have a noticeable effect on the frequency of RNs rounding together with the MDs (p = 0.37, 0.23, 0.48 for each ward). In addition, the length of rounds in which an RN was present (8.0±0.29 min) was longer than rounds with MDs only (6.2±0.22 min) (p < 0.0001), although this difference is likely associative rather than causal. Altogether, these novel data directly contribute to our understanding of MD-RN rounding and overlap habits, and can be used to both guide future quality improvement projects as well as quantitatively measure their impact.