A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
Study Details
Study Description
Brief Summary
Attending morning rounds take place at teaching hospitals every day. They are the primary mechanism for patient care delivery, supervision and education of trainees, and communication with patients, families, and staff. However, they are done with little standardization or widely recognized best practices.
The objective of this quality improvement (QI) initiative is to evaluate the adherence to and impact of implementing standardized attending morning rounds on medicine teams at our institution. A standardized rounding intervention has been developed which includes specific guidance on completing the following activities during morning rounds: (1) Pre-rounds discretion; (2) Pre-rounds huddle; (3) Bedside registered nurse (RN) integration; (4) Patient-centered rounding; (5) Real-time order writing.
This trial will randomize half of the investigators' medicine teams at University of California San Francisco to this rounding intervention whilst the other half will be randomized to continue with usual unstandardized rounding practices.
The investigators will compare medicine teams randomized to undertake standardized rounding to those teams undertaking usual practice. Outcomes assessed will relate to the patient (e.g. satisfaction), providers (e.g. satisfaction), efficiency (e.g. total morning round time) as well as adherence to the intervention .
The investigators' study hypotheses are that patient satisfaction scores will be higher for those patients receiving standardized bedside rounds compared to the usual care group. The investigators also hypothesize that total attending morning rounds time and interns length of workday will be shorter and that the number of consultations ordered before noon will increase for those teams undertaking standardized bedside. Further, the investigator hypothesize higher levels of nurse participation, physician and medical student satisfaction with standardized bedside rounding.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Standardized attending morning rounds Pre-rounds discretion Pre-rounds huddle Bedside RN integration Patient-centered rounding Real-time order writing |
Other: Standardized attending morning rounds
|
| No Intervention: Usual rounding practice Usual rounding practice (as defined by each clinical team) |
Outcome Measures
Primary Outcome Measures
- Patient satisfaction with morning rounds [Once, after day one of hospitalization and before patient is discharged.]
Patient satisfaction with morning ward rounds. This inpatient assessment will occur after day one of hospitalization before the patient is discharged from hospital. This time point will ensure that patients have experienced rounds at least once before completing a patient satisfaction survey.
- Patient satisfaction with provider communication [Once, within one month of hospital discharge]
Post-discharge assessment will be sent by a commercial Vendor (Press Ganey) within a month of discharge following hospitalization
Secondary Outcome Measures
- Interns total length of workday [Daily during the 3-month trial]
The interns total length of workday will be recorded daily. Over the course of the trial the average length of workday will be determined including any duty hour violations.
- Number of consultations ordered before noon [Daily during the 3-month trial]
The number of consultations ordered before noon will be recorded daily. Over the course of the trial the average number of consultations ordered before noon will be calculated.
- Resident satisfaction [Once during the last week of their rotation on a given team]
Resident satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
- Attending physician satisfaction [Once during the last week of their rotation on a given team]
Attending physician satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
- Medical student satisfaction [Once during the last week of their rotation on a given team]
Medical student satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
- Nurse participation in morning rounds [Daily during the 3-month trial]
The presence of RN during morning ward rounds will be recorded daily.
- Nurse satisfaction [Once during the last week the trial]
Nurse satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, team work)
- Intern satisfaction [Once during the last week of their rotation on a given team]
Intern satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value)
- Total morning rounding time [Daily during the 3-month trial]
Total morning rounding time will be recorded daily for each team. Over the course of the trial the average length of morning rounds will be determined.
Other Outcome Measures
- Number of discharges before noon [Daily during the 3-month trial]
- Cost of care per patient [For entire 3 month study period]
Average cost of care per patients for each group for entire 3-month study period
- Length of stay [For entire 3 month study period]
Average length of stay for each group for entire 3-month study period
- 30-day readmission rate [For entire 3 month study period]
Average readmission rate for each group for entire 3-month study period
- Adherence to the intervention [Daily during the 3-month trial]
Adherence to the standardized intervention will be recorded throughout the trial to determine the uptake of this intervention in everyday practice.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
All attending physicians, residents, interns and medical students of Medicine teams A through H
-
All patients admitted to Medicine teams A through H
-
All nurses on the Medicine floors
Exclusion Criteria:
- None
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of California San Francisco Medical Center | San Francisco | California | United States | 94143 |
Sponsors and Collaborators
- University of California, San Francisco
Investigators
- Principal Investigator: Brad Monash, MD, University of California, San Francisco
- Principal Investigator: Nader Najafi, MD, University of California, San Francisco
- Principal Investigator: James D Harrison, PhD, University of California, San Francisco
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- RoundingUCSF