Hospitalization Clinical Trial
Official title:
Back to Bedside: A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
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.
Status | Completed |
Enrollment | 1200 |
Est. completion date | December 2014 |
Est. primary completion date | February 2014 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
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: |
Allocation: Randomized, Intervention Model: Single Group Assignment, Masking: Single Blind (Subject), Primary Purpose: Health Services Research
Country | Name | City | State |
---|---|---|---|
United States | University of California San Francisco Medical Center | San Francisco | California |
Lead Sponsor | Collaborator |
---|---|
University of California, San Francisco |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Number of discharges before noon | Daily during the 3-month trial | No | |
Other | Cost of care per patient | Average cost of care per patients for each group for entire 3-month study period | For entire 3 month study period | No |
Other | Length of stay | Average length of stay for each group for entire 3-month study period | For entire 3 month study period | No |
Other | 30-day readmission rate | Average readmission rate for each group for entire 3-month study period | For entire 3 month study period | No |
Other | Adherence to the intervention | Adherence to the standardized intervention will be recorded throughout the trial to determine the uptake of this intervention in everyday practice. | Daily during the 3-month trial | No |
Primary | Patient satisfaction with morning rounds | 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. | Once, after day one of hospitalization and before patient is discharged. | No |
Primary | Patient satisfaction with provider communication | Post-discharge assessment will be sent by a commercial Vendor (Press Ganey) within a month of discharge following hospitalization | Once, within one month of hospital discharge | No |
Secondary | Interns total length of workday | 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. | Daily during the 3-month trial | No |
Secondary | Number of consultations ordered before noon | 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. | Daily during the 3-month trial | No |
Secondary | Resident satisfaction | Resident satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value) | Once during the last week of their rotation on a given team | No |
Secondary | Attending physician satisfaction | Attending physician satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value) | Once during the last week of their rotation on a given team | No |
Secondary | Medical student satisfaction | Medical student satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value) | Once during the last week of their rotation on a given team | No |
Secondary | Nurse participation in morning rounds | The presence of RN during morning ward rounds will be recorded daily. | Daily during the 3-month trial | No |
Secondary | Nurse satisfaction | Nurse satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, team work) | Once during the last week the trial | No |
Secondary | Intern satisfaction | Intern satisfaction and perceptions of with morning rounds (e.g. efficiency, organization, educational value) | Once during the last week of their rotation on a given team | No |
Secondary | Total morning rounding time | 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. | Daily during the 3-month trial | No |
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