Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size

OBJECTIVE: Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds. METHODS AND PARTICIPANTS: Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census. RESULTS: Results presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (-2.77 adjusted bedside minutes; 95% CI -4.61 to -0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02). CONCLUSIONS: Pediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities

Relationships of the location and content of rounds to specialty, institution, patient-census, and team size.

ObjectiveExisting observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds.Methods and participantsBetween December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census.ResultsResults presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p&lt;.001; 11.9 vs. 2.4 non-physicians, p&lt;.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p&lt;.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (-2.77 adjusted bedside minutes; 95% CI -4.61 to -0.93; p&lt;.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = &lt;.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p&lt;.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02).ConclusionsPediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities

Generalized Estimating Equation for Association of Observed Characteristics of Rounds with Adjusted Bedside Minutes per Patient^a.

a<p>Adjusted Bedside Minutes = √(bedside minutes/patient census), intercept 0.87.</p>b<p>ß = Slope of the regression line adjusted for each variable and adjusted bedside minutes, expressed per unit of each variable.</p>c<p>when compared to internal medicine.</p>d<p>when compared to “Institution A”.</p><p><b>Bold text</b> indicates significance of .05 or less.</p

Definitions of Categories Used to Record the Location and Content of Rounds.

<p>Definitions of Categories Used to Record the Location and Content of Rounds.</p

Mean Values for Team Composition, Patient load, and Duration of Location and Activities Observed on Rounds Vary by Specialty.

a<p>Unadjusted p-values calculated from a two group t-test.</p>b<p>adjusted p-values represent the Holm correction for multiple comparisons. All p-values are two-sided.</p><p><b>Bold text</b> indicates significance of .05 or less.</p><p>Grey box indicates no significance test was performed.</p

Characteristics of Observations at the Four Participating Hospitals.

<p>Characteristics of Observations at the Four Participating Hospitals.</p

Comparison of Historical Data on Rounds to Medicine and Pediatrics Observations.

<p>*Category defined by <i>Elliot et al.</i> as “discussion of diseases not directly related to patient care” and <i>Miller et al.</i> as “topic presentations”.</p