A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine

Hospitalization Clinical Trial

Official title:

Back to Bedside: A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01931553
• Other study ID #: RoundingUCSF
• Status: Completed
• Phase: N/A
• First received: August 16, 2013
• Last updated: May 14, 2015
• Start date: September 2013
• Est. completion date: December 2014

Study information

• Verified date: May 2015
• Source: University of California, San Francisco
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• 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:

Study Design

Allocation: Randomized, Intervention Model: Single Group Assignment, Masking: Single Blind (Subject), Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Hospitalization
• Inpatients
• Morning Rounds
• Quality Improvement
• Teaching Rounds

Intervention

Other:
• Standardized attending morning rounds

Locations

Country	Name	City	State
United States	University of California San Francisco Medical Center	San Francisco	California

Sponsors (1)

Lead Sponsor	Collaborator
University of California, San Francisco

Country where clinical trial is conducted

United States, 

Outcome

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