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Choi JJ, Gambina K, Liu MM, Navarro MJ, Ryan K, Pandya N. Implementing briefing and debriefing during rounds. CLINICAL TEACHER 2023; 20:e13600. [PMID: 37443416 DOI: 10.1111/tct.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Justin J Choi
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Karen Gambina
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Monica M Liu
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Matthew J Navarro
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kara Ryan
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Nekee Pandya
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Huang KX, Chen CK, Pessegueiro AM, Dowling E, Dermenchyan A, Natarajan A, Krishnan D, Vangala SS, Simon WM. Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds. J Hosp Med 2023; 18:888-895. [PMID: 37584618 DOI: 10.1002/jhm.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures. OBJECTIVE This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication. DESIGNS, SETTINGS AND PARTICIPANTS Trained observers audited general medicine ward rounds at an academic medical center using a standardized tool to record physician and nurse behavior and communication in 1007 patient encounters in October 2019 to March 2020. RESULTS There were significant differences in physician and nurse interaction time among physicians with different levels of training, with attendings demonstrating higher interaction time than residents (5.4 ± 4.6 vs. 4.3 ± 3.7 min, p = .02) and interns or medical students (3.0 ± 3.2 min, p = .002). Attendings were more likely to initiate a conversation about nurse concerns (76.9%) compared to residents (67.9%) and interns or medical students (59.3%, p = .03). Early nurse participation in bedside visits was associated with increased physician and nurse interaction time (5.0 ± 4.6 vs. 1.9 ± 1.7 min, p < .001) and physician initiative to ask about nurse concerns (74.8% vs. 64.3%, p = .04). In addition, physician initiative to ask the nurse for concerns rather than waiting for the nurse to offer concerns without being prompted was associated with a subsequent conversation about those concerns (74.5% vs. 61.8%, p < .001) and the physician asking about patient or family concerns (94.2% vs. 88.4%, p = .01). CONCLUSIONS Implementing IDR structures and procedures that promote attending physician involvement, physician initiative, and early nurse participation could optimize interdisciplinary communication and quality of care.
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Affiliation(s)
- Kelly X Huang
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Caitlin K Chen
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Erin Dowling
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Anna Dermenchyan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Dhwani Krishnan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, UCLA Health, Los Angeles, California, USA
| | - Wendy M Simon
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
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Clark EH, Haltom TM, Freytag J, Hysong SJ, Dang BN, Giordano TP, Kulkarni PA. Impact of the COVID-19 Pandemic on Medical Education during Inpatient Internal Medicine Rounds. South Med J 2023; 116:690-695. [PMID: 37536697 PMCID: PMC10417251 DOI: 10.14423/smj.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Inpatient rounding is a foundational component of medical education in academic hospitals. The coronavirus 2019 (COVID-19) pandemic disrupted traditional inpatient rounding practices. The objectives of this study were to describe how Internal Medicine inpatient team rounding changed because of COVID-19-related precautions and the effect of these changes on education during rounds. METHODS During February to March 2021, we conducted four virtual focus groups with medical and physician assistant students, interns, upper-level residents, and attending physicians at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, and designed a codebook to categorize focus group commentary. RESULTS Focus groups revealed that students believed that certain physical-distancing measures in place early on during the pandemic were ineffective and significantly limited their ability to evaluate patients in person. Residents described increased stress levels related to potential severe acute respiratory-coronavirus 2 exposure and limited time at the bedside, which affected their confidence with clinical assessments. Rounding-team fragmentation precluded the entire team learning from all of the patients on the team's census. Loss of intrateam camaraderie impaired the development of comfortable learning environments. CONCLUSIONS This study evaluated Internal Medicine team member focus groups to describe how the COVID-19 pandemic affected medical education during rounds. Academic teaching programs can adapt the findings from this study to address and prevent pandemic-related gaps in medical education during rounds now and during future potential disruptions to medical education.
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Affiliation(s)
- Eva H. Clark
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Trenton M. Haltom
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine-Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Jennifer Freytag
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Sylvia J. Hysong
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine-Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Bich N. Dang
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Thomas P. Giordano
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Prathit A. Kulkarni
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
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Al Halabi A, Habas E, Farfar KL, Ghazouani H, Alfitori G, Abdulla MA, Borham AM, Khan FY. Time Spent on Medical Round Activities, Distance Walked, and Time-Motion in the General Medicine Department at Hamad General Hospital in Qatar. Cureus 2023; 15:e37935. [PMID: 37220459 PMCID: PMC10200253 DOI: 10.7759/cureus.37935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Background The daily morning round is a routine activity performed by medical teams. During the morning round, updates on the patient's clinical condition, new laboratory results, and other test results are reviewed and discussed between team members, the patient, and at times the family. Completing these tasks takes time. The design of the patient location differs between hospitals, and significant distance between patients can considerably affect round times. This study assesses physicians' time spent on clinical activities, the distance traveled, and the time they spend walking between patients during daily morning rounds to identify better reorganization methods to reduce wasted time. Methodology The survey was self-administered and had no intervention needing ethical approval. The research team's leader engaged two observers (a general practitioner from another department and a general internal medicine department case manager) to collect the data. The general practitioner was a medical graduate doctor, while the bed manager was not a medical college graduate. They observed 10 rounds over 10 non-consecutive days from July 1 to July 30, 2022. They recorded daily activities during the daily morning round, including time spent with patients, family conversations, bedside education, medication, social issues, and the time and distance required to move from patient to patient and from one location to location. The informal conversations about age, work history, and other small talk were recorded and converted into quantitative data. In each round, records were given to a statistician for rechecking. Subsequently, the records were imported into a Microsoft Excel spreadsheet for further statistical analysis. For continuous variables, the data were summarized as mean, median, and standard deviation. For categorical variables, the data were summarized as counts or proportions. Results On average, the duration of the daily morning round was 161.7 ± 17.3 minutes. The average number of patients seen by the general internal medicine round team was 14. The median patient encounter time per patient was 14 minutes (11-19 minutes), with an average of 12 minutes. An average of 8.6 employees participated in the 10-day rounds. The physician spent 41.2% of the time in direct contact with the patient during the morning round, 11.4% in maintaining electronic medical records, and 18.20% in bedside teaching. Additionally, 7.1% of the round time was spent because of interruptions by clinical and non-clinical staff other than team members or family members who were not in the room. Furthermore, a team member walked an average of 763 ± 54.5 m (667-872 m) per round, costing 35.7 minutes (22.1%) of the total round time. Conclusions The daily morning round time was significantly longer compared with the reported round times. Relocating patient beds to a common location reduced the rounding time by 22.30%. Disruption, teaching, and medical instruction must also be considered and shortened to reduce the morning round time.
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Affiliation(s)
- Anas Al Halabi
- Quality and Patient Safety, Hamad Medical Corporation, Doha, QAT
| | | | | | - Hafedh Ghazouani
- Quality and Patient Safety, Hamad Medical Corporation, Doha, QAT
| | | | - Moza A Abdulla
- Quality and Patient Safety, Hamad Medical Corporation, Doha, QAT
| | | | - Fahmi Y Khan
- Internal Medicine, Hamad General Hospital, Doha, QAT
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Noorani M. The ward round: friend or foe in postgraduate training? A grounded theory study of residents' perspectives. MEDICAL EDUCATION ONLINE 2022; 27:2101180. [PMID: 35850579 PMCID: PMC9302005 DOI: 10.1080/10872981.2022.2101180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/23/2022] [Accepted: 07/10/2022] [Indexed: 06/10/2023]
Abstract
The ward round has traditionally been a learning activity in medical education. Apart from education, ward rounds have multiple roles including patient care and communication. Some studies have described the ward round as an ideal place to learn patient management while others reported that little learning happens on rounds due to lack of time and patient volume. This study aimed to develop a deeper understanding of ward round learning from the perspective of postgraduate trainees. A constructivist grounded theory approach was used and data was collected during focus group discussions. Data were analyzed by initial coding, then grouped into focused codes and development of a theoretical framework by the process of constant comparison. Six categories evolved which contributed to the framework. Postgraduate trainees perceive the ward round as an important space where they use different learning activities to acquire knowledge, attitude and skills required of a specialist doctor. They progress from novices to experts under supervision of faculty who lead ward rounds. The round can achieve its full learning potential if planned and organized well but can become a missed opportunity if the learning environment is unfriendly. Patient- and learner-related barriers exist that hinder ward round learning. The framework explains how ward round learning occurs in postgraduate medical education from a trainee perspective. The findings can guide interventions to improve the learning experience. Studies comparing perspectives of teachers to those of learners are needed to further understand the complex learning milieu of the ward round.
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Affiliation(s)
- Mariam Noorani
- Consultant Paediatrician and Senior Instructor Department of Paediatrics, Aga Khan University, Dar Es Salaam, Tanzania
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6
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Merriott D, Ransley G, Aziz S, Patel K, Rhodes M, Abraham D, Imansouren K, Turton D. Will clinical signs become myth? Developing structured Signs Circuits to improve medical students' exposure to and confidence examining clinical signs. MEDICAL EDUCATION ONLINE 2022; 27:2050064. [PMID: 35388743 PMCID: PMC9004494 DOI: 10.1080/10872981.2022.2050064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Correctly eliciting and interpreting physical examination (PEx) signs contributes to successful diagnosis and is fundamental to patient care. A significant decline in the time spent acquiring these skills by medical students, and the decreased ability to elicit and recognise signs is widely acknowledged. However, organising teaching to counteract this in the busy clinical environment is challenging. We evaluated the prior exposure to clinical signs, and experience of examination teaching among a cohort of final-year medical students. Following this, we assessed the utility of a structured circuit-based approach (Signs Circuits) using hospital inpatients and junior doctors to provide high-yield PEx teaching and overcome these limitations. MATERIALS AND METHODS Qualitative and quantitative survey feedback, including a standardised list of 62 clinical signs, was sought from final-year medical students during their rotations at a teaching hospital in London, UK, before and after the provision of Signs Circuits. RESULTS Prior to the course the 63 students reported limited exposure to even the most common clinical signs. For example, the murmurs of mitral and tricuspid regurgitation and the sound of lung crackles eluded 43%, 87%, and 32%, respectively. From qualitative feedback, the reasons for this included that much of their prior PEx experience had focused on the performance of appropriate examination steps and techniques in patients without pathology. During the course, students were exposed to an average of 4.4 new signs, and left with increased confidence examining and eliciting signs, and a firmer belief in their importance to diagnosis. CONCLUSION Medical students continue to have limited exposure to clinical signs in medical school. This signs-focused approach to PEx teaching is an effective and reproducible way to counter the deficiencies identified in signsexposure.
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Affiliation(s)
- Dominic Merriott
- Intensive Care Registrar, Austin Health, Melbourne, VIC, Australia
| | - George Ransley
- Internal Medicine Trainee, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shadman Aziz
- Emergency Medicine Specialty Trainee, London, UK
| | - Krushna Patel
- Foundation Doctor, King’s College Hospital NHS Foundation Trust, London, UK
| | - Molly Rhodes
- Foundation Doctor, Barts Health NHS Trust, London, UK
| | | | | | - Daniel Turton
- Anaesthetist at Barts Health and Honorary Lecturer at Queen Mary’s University of London, UK
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Chan SJ, Archibald HL, Conner SM. NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment. BMC MEDICAL EDUCATION 2022; 22:600. [PMID: 35927659 PMCID: PMC9351275 DOI: 10.1186/s12909-022-03599-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Rounds are a foundational practice in patient care and education in the inpatient healthcare environment, but increased demands on inpatient teams have led to dissatisfaction with inefficient, ineffective rounds. In this study, we describe the design, implementation, and evaluation of a novel rounding framework ("NET Rounding") that provides behaviorally-based strategies to inpatient teams to achieve efficient rounds while preserving patient safety and education. METHODS NET Rounding consists of nine recommendations divided into three categories: Novel rounding strategies, shared Expectations, and Time management. This framework was introduced as a bundled intervention at a single-site, quaternary-care, academic hospital from March-May 2021. Eighty-three residents and 64 attendings rotated on the inpatient teaching service during the intervention period. Participants were surveyed before, during, and after their rotation about rounding's contribution to educational value, patient safety, resident duty hour violations and rotation experience. Additionally, rounding duration was recorded daily by team attendings. RESULTS Thirty-two residents (38.5%) and 45 attendings (70%) completed post-intervention surveys. Rounding duration was recorded on 529/626 rounding days (80.6%) and resulted in achieving efficient rounds on 412/529 days (77.9%). Residents reported improvement in perceived patient safety (54 to 84%, p = 0.0131) and educational value of rounds (38 to 69%, p = 0.0213) due to NET Rounding; no change was observed amongst attendings in these areas (79 to 84% and 70 to 80%, p = 0.7083 and 0.4237, respectively). Overall, 29/32 residents (91%) and 33/45 attendings (73%) reported a positive impact on rotation experience. CONCLUSIONS NET Rounding enabled inpatient teaching teams to complete rounds more efficiently while preserving patient safety and education.
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Affiliation(s)
- Shirley J Chan
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA
| | - Hannah L Archibald
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA
| | - Stephanie M Conner
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA.
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Salavitabar A, Popov V, Nelson J, Benedict MD, Inniss DA, Mahajan AP, Cohen MS, Owens ST. Extended Reality International Grand Rounds: An Innovative Approach to Medical Education in the Pandemic Era. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1017-1020. [PMID: 35767409 DOI: 10.1097/acm.0000000000004636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PROBLEM While bedside training has always presented its own unique challenges, the COVID-19 pandemic era has intensified barriers to suitable provider and trainee experiences for both patient care and medical education. APPROACH This project introduced an innovative solution with the Extended Reality International Grand Rounds, a collaboration between the University of Michigan Center for Medical and Surgical Extended Reality and Imperial College London. Three complex cases were presented to trainees through a wireless, extended reality (XR) headset and augmented by holographic visual aids and expert commentary. This pilot rounding experience was performed through the first-person view of one clinician at the bedside. OUTCOMES In 2020, 140 attendees participated in XR International Grand Rounds, and 82 (59%) and 61 (44%) completed pre- and postsurveys, respectively. Survey analysis showed that the majority of respondents (65, 79.3%) had very little to no baseline experience with XR technologies and nearly all (75, 91.5%) agreed that the development and implementation of XR curricula are important in medical training, indicating an unmet need. Nearly all respondents (59, 96.7%) found value in the ability to visualize patients' clinical findings in the XR rounding experience and 60 (98.4%) found value in the ability to visualize patient-specific imaging and test findings in an XR format. Limiting exposure to high-risk patients and care team members with this innovative format was believed to be important to 79 (96.3%) respondents at baseline and that perception was unchanged following the event. NEXT STEPS This solution to a long-standing dilemma, newly stressed by a unique era in medicine, was a successful collaboration using state-of-the-art XR technology. Next steps will include introducing more advanced physical exam visualization and detection and comprehensive evaluation of the patient experience, as well as expanding the international experience in a format that is scalable to other interested institutions.
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Affiliation(s)
- Arash Salavitabar
- A. Salavitabar is assistant professor of pediatrics, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio. At the time this initiative was conducted, he was assistant professor of pediatrics, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Vitaliy Popov
- V. Popov is assistant professor of learning health sciences, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeremy Nelson
- J. Nelson is director, Extended Reality Initiative, Center for Academic Innovation, University of Michigan, Ann Arbor, Michigan
| | - Michelle D Benedict
- M.D. Benedict is a medical student, University of Michigan Medical School, Ann Arbor, Michigan
| | - Donovan A Inniss
- D.A. Inniss is a medical student, University of Michigan Medical School, Ann Arbor, Michigan
| | - Arushi P Mahajan
- A.P. Mahajan is a medical student, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark S Cohen
- M.S. Cohen is professor of surgery, pharmacology, and biomedical engineering, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sonal T Owens
- S.T. Owens is associate professor of pediatrics, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
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Kanjee Z, Tess AV. Teaching Evidence-Based Physical Diagnosis: A Workshop for Hospitalists. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11243. [PMID: 35497678 PMCID: PMC8986890 DOI: 10.15766/mep_2374-8265.11243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Teaching on physical examination, especially evidence-based physical diagnosis, is at times lacking on general medicine rounds. We created a hospitalist faculty workshop on teaching evidence-based physical diagnosis. METHODS The workshop included a systematic approach to teaching evidence-based physical diagnosis, multiple teaching resources, and observed peer teaching. A long-term follow-up session was offered several months after the workshop. Participants completed questionnaires before and after the workshop as well as after the long-term follow-up session. RESULTS Four workshops were conducted and attended by 28 unique participants. Five hospitalists attended long-term follow-up sessions. Due to the COVID-19 pandemic, repeat sessions and long-term follow-up were limited. In paired analyses compared to preworkshop, respondents after the workshop reported a higher rate of prioritizing ( p = .008), having a systematic approach to ( p < .001), and confidence in ( p = .001) teaching evidence-based physical diagnosis. Compared to before the workshop, participants after the workshop were able to name more resources to inform teaching of evidence-based physical diagnosis ( p < .001). Informal feedback was positive. Respondents noted that the workshop could be improved by allowing more practice of the actual physical exam maneuvers and more observed teaching. DISCUSSION We created and implemented a workshop to train hospitalists in teaching evidence-based physical diagnosis. This workshop led to improvements in faculty attitudes and teaching skills. Long-term outcomes were limited by low participation due in part to the COVID-19 pandemic.
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Affiliation(s)
- Zahir Kanjee
- Hospitalist, Department of Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School
| | - Anjala V. Tess
- Hospitalist and Associate Vice Chair for Education, Department of Medicine, Beth Israel Deaconess Medical Center; Associate Professor of Medicine, Harvard Medical School
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Yann Foo Y, Tan K, Rao J, Lim WS, Xin X, Cheng Q, Lum E, Tan NC. Viewing interprofessional collaboration through the lens of networked ecological systems theory. J Interprof Care 2022; 36:777-785. [PMID: 35015602 DOI: 10.1080/13561820.2021.2007864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Interprofessional collaboration (IPC) is key to ensuring safe quality care for patients. However, IPC intervention outcomes are variable, leading to calls for systems theories to understand complex interactions in healthcare. Using networked ecological systems theory (NEST), we aimed to uncover facilitators and barriers impacting the interactions between nurses and physicians in a specialty healthcare center. A qualitative study involving 55 non-participant observations and 17 individual semi-structured interviews was conducted at the National Neuroscience Institute of Singapore from April 2019 to March 2021. Template analysis was used to analyze the data. The most important IPC facilitators were exosystemic institutional support and physicians' willingness to engage in IPC in the microsystems that together enabled the establishment of disease-based outpatient programs fostering patient-centered interactions among different healthcare professionals (HCP). We also found that patient-, disease-, and systems-related knowledge played an important role in facilitating IPC. Macrosystemic entrenchments such as intraprofessional composition of ward rounds emerged as a significant barrier. However, microsystemic efforts such as chat groups connecting all HCP involved in the care of the patients in the wards have fostered IPC. Although still preliminary, these findings suggest NEST can be useful to inform systematic interventions to improve IPC.
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Affiliation(s)
- Yang Yann Foo
- Academic Medicine Education Institute, Duke-NUS Medical School, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Jai Rao
- Duke-NUS Medical School, Singapore.,Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Qianhui Cheng
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Elaine Lum
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Nigel Ck Tan
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS Medical School, Singapore
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A Quality Improvement Approach to Early Patient Discharge. Pediatr Qual Saf 2021; 6:e497. [PMID: 34934880 PMCID: PMC8677894 DOI: 10.1097/pq9.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/21/2021] [Indexed: 11/26/2022] Open
Abstract
Lack of bed availability is a common problem in our pediatric unit, as in many hospitals. To address this issue, we instituted a quality improvement (QI) initiative involving collaborative nurse-physician rounding. This intervention has been shown to expedite discharge, improve patient care, and increase bed availability in other settings. Methods By utilizing PDCA (Plan, Do, Check, Act) processes, we created two improvement initiatives, "Increasing Patient Discharge Before 12 pm" and "Midnight Rounds with Discharge Focus." Senior resident and faculty physicians rounded on discharge-ready patients before teaching rounds, and by 10 am, placed discharge orders to allow for a 12 pm discharge. A night team consisting of senior residents and nurses conducted "Midnight Rounds" and identified potential discharges for the morning team. The project aimed to increase patient discharges before 12 pm from a June-November 2018 baseline of 15%-20% by June 2019. Results Patient discharge percentage before 12 pm increased from 15% to 21% (P < 0.01) by June 2019, and as a result, bed availability increased by 16% (P < 0.01). Conclusions QI methodology clarified the root causes of limited bed availability. Understanding the existing discharge process allowed for QI initiatives to develop a consistent and sustainable discharge process. Patient discharge percentages before 12 pm increased by 40%, and bed availability increased by 16% after QI implementations.
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Dongmo Fotsing LN, Pang EM, Shieh L. How is mobile health technology transforming physician-nurse collaboration? Intern Med J 2021; 51:1522-1525. [PMID: 34541771 PMCID: PMC9293215 DOI: 10.1111/imj.15484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/13/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
The integration of mobile health technologies in medical practice has the potential to promote in-person, high-quality care. We examine the impact of Voalte, a healthcare-specific mobile application, on bedside rounding and care coordination. A cross-sectional survey was conducted on 71 medical ward-based nurses from a quaternary-care academic centre, capturing 183 rounding events. The frequency of physician-nurse overlap at the bedside was 50.3%, representing a >20% increase when compared with the 2018 baseline before Voalte's introduction. Our results show that mobile health technologies can strengthen inpatient medicine workflows and interdisciplinary collaboration when implemented successfully.
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Affiliation(s)
- Laurena N Dongmo Fotsing
- Department of Internal Medicine, Division of Hospital Medicine, Stanford University, Stanford, California, USA
| | - Emily M Pang
- School of Medicine, Stanford University, Stanford, California, USA
| | - Lisa Shieh
- Department of Internal Medicine, Division of Hospital Medicine, Stanford University, Stanford, California, USA
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Van Blarcom J, Chevalier A, Drum B, Eyberg S, Vukin E, Good B. The recent evolution of patient care rounds in pediatric teaching hospitals in the United States and Canada. Hosp Pract (1995) 2021; 49:431-436. [PMID: 34488528 DOI: 10.1080/21548331.2021.1977561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: National trends toward empowering and enabling patients and families to take a bigger role in their own medical care and enhanced collaboration between rounding stakeholders have effectuated a new rounding model in the pediatric inpatient setting known as 'Patient- and Family-Centered Rounds/I-PASS,' which has shown to decrease safety events and to improve stakeholders' experience with rounding. Other enhancements to the new model, such as the use of whiteboards, rounding checklists, and facecards, have all been applied to the new model to good effect. Another major enhancement to rounding of late has been the application of a schedule to rounds, which has increased the presence of the nurse and the family during rounds and has improved rounding efficiency without a negative effect on teaching.Objective: We provide a review of the literature regarding this new rounding model and its effects in the pediatric inpatient setting, as well as a review of the enhancements that have been applied to the new model, the recognized barriers to the implementation of these rounding alterations and the ways in which those barriers have been overcome. Conclusions: In the pediatric inpatient setting, the 'Patient and Family-Centered Rounds/IPASS' rounding model, as well as enhancements to this new model such as rounding schedules, whiteboards, checklists and facecards, have had a positive effect on stakeholders' experience with rounding, increased patient safety and improved rounding efficiency. Given these positive effects, these alterations to rounding should be promoted and sustained.PLAIN LANGUAGE SUMMARYRounding is when a medical care provider, or a team of providers, visits patients in the hospital in order to determine a plan of care and discuss that care with the patient and the patient's family. In teaching hospitals, this involves staff physicians, medical trainees and advanced practice providers. Rounding has changed in the recent past as evolving pressures have increasingly led these teams of providers to talk and make decisions about patients outside the patient's room, which lessens the patient's ability to contribute to decision-making. This also lessens the ability of the patient's nurse to contribute. The recognition of this problem has led to big changes in rounding in children's teaching hospitals, the biggest of which is called 'family-centered rounding.' This involves performing the entirety of rounds in the patients' rooms, directing the discussion toward them in language that they understand, with the active participation of everyone present, including the patient's nurse. Other changes in rounding, designed to improve patients' experiences and decrease medical errors, have made this new rounding model even better. Structured communication during rounds, communication aids such as whiteboards and checklists, and planned times for rounding on each patient ('scheduled rounding') have all successfully been used to improve patients' care and experience in the hospital. This article aims to inform the reader about family-centered rounds and other recent rounding transformations that have proven to increase patient safety and improve their experience while in the hospital, also noting barriers to these changes and how they have been overcome.
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Affiliation(s)
- Jeffrey Van Blarcom
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrew Chevalier
- Department of Internal Medicine, Department of Pediatrics, Internal Medicine/Pediatrics Resident, Med-Peds Residency Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin Drum
- Department of Internal Medicine, Department of Pediatrics, Internal Medicine/Pediatrics Resident, Med-Peds Residency Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sarah Eyberg
- Department of Internal Medicine, Department of Pediatrics, Internal Medicine/Pediatrics Resident, Med-Peds Residency Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elizabeth Vukin
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brian Good
- Associate Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Becker C, Gamp M, Schuetz P, Beck K, Vincent A, Hochstrasser S, Metzger K, Widmer M, Thommen E, Mueller B, Fux CA, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Effect of Bedside Compared With Outside the Room Patient Case Presentation on Patients' Knowledge About Their Medical Care : A Randomized, Controlled, Multicenter Trial. Ann Intern Med 2021; 174:1282-1292. [PMID: 34181449 DOI: 10.7326/m21-0909] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although bedside case presentation contributes to patient-centered care through active patient participation in medical discussions, the complexity of medical information and jargon-induced confusion may cause misunderstandings and patient discomfort. OBJECTIVE To compare bedside versus outside the room patient case presentation regarding patients' knowledge about their medical care. DESIGN Randomized, controlled, parallel-group trial. (ClinicalTrials.gov: NCT03210987). SETTING 3 Swiss teaching hospitals. PATIENTS Adult medical patients who were hospitalized. INTERVENTION Patients were randomly assigned to bedside or outside the room case presentation. MEASUREMENTS The primary endpoint was patients' average knowledge of 3 dimensions of their medical care (each rated on a visual analogue scale from 0 to 100): understanding their disease, the therapeutic approach being used, and further plans for care. RESULTS Compared with patients in the outside the room group (n = 443), those in the bedside presentation group (n = 476) reported similar knowledge about their medical care (mean, 79.5 points [SD, 21.6] vs. 79.4 points [SD, 19.8]; adjusted difference, 0.09 points [95% CI, -2.58 to 2.76 points]; P = 0.95). Also, an objective rating of patient knowledge by the study team was similar for the 2 groups, but the bedside presentation group had higher ratings of confusion about medical jargon and uncertainty caused by team discussions. Bedside ward rounds were more efficient (mean, 11.89 minutes per patient [SD, 4.92] vs. 14.14 minutes per patient [SD, 5.65]; adjusted difference, -2.31 minutes [CI, -2.98 to -1.63 minutes]; P < 0.001). LIMITATION Only Swiss hospitals and medical patients were included. CONCLUSION Compared with outside the room case presentation, bedside case presentation was shorter and resulted in similar patient knowledge, but sensitive topics were more often avoided and patient confusion was higher. Physicians presenting at the bedside need to be skilled in the use of medical language to avoid confusion and misunderstandings. PRIMARY FUNDING SOURCE Swiss National Foundation (10531C_ 182422).
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Affiliation(s)
- Christoph Becker
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Martina Gamp
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Philipp Schuetz
- University of Basel, Basel, and Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M., C.A.F.)
| | - Katharina Beck
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Alessia Vincent
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Seraina Hochstrasser
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Kerstin Metzger
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Madlaina Widmer
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Emanuel Thommen
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Beat Mueller
- University of Basel, Basel, and Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M., C.A.F.)
| | - Christoph A Fux
- University of Basel, Basel, and Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M., C.A.F.)
| | - Jörg D Leuppi
- University of Basel, Basel, and University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland (J.D.L.)
| | - Rainer Schaefert
- University Hospital Basel and University of Basel, Basel, Switzerland (R.S., W.L., S.H.)
| | - Wolf Langewitz
- University Hospital Basel and University of Basel, Basel, Switzerland (R.S., W.L., S.H.)
| | - Marten Trendelenburg
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Tobias Breidthardt
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Jens Eckstein
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Michael Osthoff
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Stefano Bassetti
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Sabina Hunziker
- University Hospital Basel and University of Basel, Basel, Switzerland (R.S., W.L., S.H.)
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Temsah MH, Alhboob A, Abouammoh N, Al-Eyadhy A, Aljamaan F, Alsohime F, Alabdulhafid M, Ashry A, Bukhari A, ElTahir O, Jamal A, Halwani R, Alhasan K, Alherbish A, Temsah R, Al-Tawfiq JA, Barry M. Pediatric Intensive Care Hybrid-Style Clinical Round During COVID-19 Pandemic: A Pilot Study. Front Pediatr 2021; 9:720203. [PMID: 34490169 PMCID: PMC8417365 DOI: 10.3389/fped.2021.720203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/21/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: With the evolving COVID-19 pandemic and the emphasis on social distancing to decrease the spread of SARS-CoV-2 among healthcare workers (HCWs), our pediatric intensive care unit (PICU) piloted the integration of Zoom meetings into clinical rounds. We aimed to explore the feasibility of these hybrid virtual and physical clinical rounds for PICU patients. Design: Mixed quantitative and qualitative deductive thematic content analysis of narrative responses. Setting: PICU, single tertiary-care academic center. Participants: Multidisciplinary PICU HCWs. Interventions: Integration of Zoom meeting into clinical daily PICU rounds. Measurements: For the quantitative part, we gathered the details of daily PICU hybrid rounds in terms of times, number of HCWs, and type of files shared through Zoom. For the qualitative part, open-ended questions were used. Main Results: The physical round took statistically significantly less time (34.68 ± 14.842 min) as compared with the Zoom round (72.45 ± 22.59 min), p < 0.001. The most shared component in the virtual round was chest X-rays (93.5%). Thirty-one HCWs participated in focus group discussions and were included in the analysis. Some of the HCWs' perceived advantages of the hybrid rounds were enabling multidisciplinary discussions, fewer round interruptions, and practicality of virtual discussions. The perceived challenges were the difficulty of the bedside nurse attending the virtual round, decreased teaching opportunities for the trainees, and decreased interactions among the team members, especially if video streaming was not utilized. Conclusions: Multidisciplinary hybrid virtual and physical clinical rounds in the PICU were perceived as feasible by HCWs. The virtual rounds decreased the physical contact between the HCWs, which could decrease the possibility of SARS-CoV-2 spread among the treating team. Still, several components of the hybrid round should be optimized to facilitate the virtual team-members' interactions and enhance the teaching experience.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alhboob
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad Alsohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Ashry
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Bukhari
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Omer ElTahir
- Department of Medicine and Clinical Pharmacology, University of Medical Sciences and Technology (UMST), Khartoum, Sudan
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
- Evidence-Based Health Care and Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Adi Alherbish
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Reem Temsah
- College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mazin Barry
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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16
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Bavare AC, Goldman JR, Musick MA, Sembera KA, Sardual AA, Lam AK, Tume SC, Thammasitboon SX, Williams EA. Virtual Communication Embedded Bedside ICU Rounds: A Hybrid Rounds Practice Adapted to the Coronavirus Pandemic. Pediatr Crit Care Med 2021; 22:e427-e436. [PMID: 33653995 DOI: 10.1097/pcc.0000000000002704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Coronavirus disease 2019 containment strategies created challenges with patient-centered ICU rounds. We examined how hybrid rounds with virtual communication added to in-person rounds could facilitate social distancing while maintaining patient-centered care. DESIGN Continuous quality improvement. SETTING Quaternary care referral pediatric hospital. PATIENTS Daytime rounds conducted on PICU patients. INTERVENTIONS Following a needs assessment survey and pilot trials, multiple technological solutions were implemented in a series of plan-do-study-act cycles. Hybrid rounds model was deployed where a videoconference platform was used to establish communication between the bedside personnel (nurse, patient/family, and partial ICU team) with remotely located remaining ICU team, ancillary, and consultant providers. Floor labels marking 6-feet distance were placed for rounders. MEASUREMENTS AND MAIN RESULTS Outcome metrics included compliance with social distancing, mixed methods analysis of surveys, direct interviews of providers and families, and reports of safety concerns. The clinicians adopted hybrid rounds readily. Compliance with social distancing and use of floor labels needed reminders. One-hundred fourteen providers completed the feedback survey. Twenty-five providers and 11 families were interviewed. Feedback about hybrid rounds included inability to teach effectively, suboptimal audio-video quality, loss of situational awareness of patient/unit acuity, alarm interference, and inability to socially distance during other ICU interactions. Benefits noted were improved ancillary input, fewer interruptions, improved efficiency, opportunity to integrate with data platforms, and engage remote consultants and families. Nurses and families appreciated the efforts to ensure safety but wanted the ICU attending/fellow supervising the team to participate at bedside, during rounds. Clinicians appreciated the multidisciplinary input but felt that teaching was difficult. CONCLUSIONS Hybrid rounds employed during pandemic facilitated social distancing while retaining patient-centered multidisciplinary ICU rounds but compromised teaching during rounds. A change to ingrained rounding habits needs team commitment and ongoing optimization. The hybrid rounds model has potential for generalizability to other settings.
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Affiliation(s)
- Aarti C Bavare
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jordana R Goldman
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Matthew A Musick
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kerry A Sembera
- Pediatric Critical Care Unit, Texas Children's Hospital, Houston, TX
| | - Alex A Sardual
- Pediatric Critical Care Unit, Texas Children's Hospital, Houston, TX
| | - Anne K Lam
- Pediatric Critical Care Unit, Texas Children's Hospital, Houston, TX
| | - Sebastian C Tume
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Satid X Thammasitboon
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Eric A Williams
- Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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17
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Zurca AD, Krawiec C, McKeone D, Solaiman AZ, Smith BM, Ceneviva GD. PICU Passport: Pilot study of a handheld resident curriculum. BMC MEDICAL EDUCATION 2021; 21:281. [PMID: 34001109 PMCID: PMC8130359 DOI: 10.1186/s12909-021-02705-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND To explore the impact of an educational tool designed to streamline resident learning during their pediatric intensive care (PICU) rotations. METHODS Topics and procedures were chosen for inclusion based on national requirements for pediatric residents. Residents received a PICU Passport at the beginning of their rotations. PICU faculty were provided learning objectives for each topic. Residents and faculty were surveyed before and after starting use of the Passport. RESULTS Twenty-two residents pre-Passport and 38 residents post-Passport were compared. Residents were more satisfied with their educational experiences (27 % vs. 79 %; P < 0.001), more likely to report faculty targeted teaching towards knowledge gaps (5 % vs. 63 %; P < 0.001) and felt more empowered to ask faculty to discuss specific topics (27 % vs. 76 %; P = 0.002). The median number of teaching sessions increased from 3 to 10 (Z = 4.2; P < 0.001). Most residents (73 %) felt the Passport helped them keep track of their learning and identify gaps in their knowledge. CONCLUSIONS The PICU Passport helps residents keep track of their learning and identify gaps in their knowledge. Passport use increases resident satisfaction with education during their PICU rotation and empowers residents to ask PICU faculty to address specific knowledge gaps.
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Affiliation(s)
- Adrian D Zurca
- Department of Pediatrics, Penn State Hershey Children's Hospital, P.O. Box 850, 500 University Drive, Mail Code H085, PA, 17033, Hershey, USA.
| | - Conrad Krawiec
- Department of Pediatrics, Penn State Hershey Children's Hospital, P.O. Box 850, 500 University Drive, Mail Code H085, PA, 17033, Hershey, USA
| | - Daniel McKeone
- Department of Pediatrics, Penn State Hershey Children's Hospital, P.O. Box 850, 500 University Drive, Mail Code H085, PA, 17033, Hershey, USA
| | - Adil Z Solaiman
- Department of Pediatrics, Penn State Hershey Children's Hospital, P.O. Box 850, 500 University Drive, Mail Code H085, PA, 17033, Hershey, USA
- Division of General Academic Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Hershey, USA
| | - Brandon M Smith
- Department of Pediatrics, Penn State Hershey Children's Hospital, P.O. Box 850, 500 University Drive, Mail Code H085, PA, 17033, Hershey, USA
| | - Gary D Ceneviva
- Department of Pediatrics, Penn State Hershey Children's Hospital, P.O. Box 850, 500 University Drive, Mail Code H085, PA, 17033, Hershey, USA
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18
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Ratelle JT, Herberts M, Miller D, Kumbamu A, Lawson D, Polley E, Beckman TJ. Relationships Between Time-at-Bedside During Hospital Ward Rounds, Clinician-Patient Agreement, and Patient Experience. J Patient Exp 2021; 8:23743735211008303. [PMID: 34179432 PMCID: PMC8205390 DOI: 10.1177/23743735211008303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hospital medicine ward rounds are often conducted away from patients’ bedsides,
but it is unknown if more time-at-bedside is associated with improved patient
outcomes. Our objective is to measure the association between “time-at-bedside,”
patient experience, and patient–clinician care agreement during ward rounds.
Research assistants directly observed medicine services to quantify the amount
of time spent discussing each patient’s care inside versus outside the patient’s
room. “Time-at-bedside” was defined as the proportion of time spent discussing a
patient’s care in his or her room. Patient experience and patient–clinician care
agreement both were measured immediately after ward rounds. Results demonstrated
that the majority of patient and physicians completely agreement on planned
tests (66.3%), planned procedures (79.7%), medication changes (50.6%), and
discharge location (66.9%), but had no agreement on the patient’s main concern
(74.4%) and discharge date (50.6%). Time-at-bedside was not correlated with care
agreement or patient experience (P > .05 for all
comparisons). This study demonstrates that spending more time at the bedside
during ward rounds, alone, is insufficient to improve patient experience.
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Affiliation(s)
- John T Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
- John Ratelle, Division of Hospital Internal
Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Michelle Herberts
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Donna Miller
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ashok Kumbamu
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of
Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Donna Lawson
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Polley
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Armendariz J, Tamayo C, Slade J, Belitskaya-Lévy I, Gray C, Allaudeen N. Interruptions to Attending Physician Rounds and Their Effect on Resident Education. J Grad Med Educ 2021; 13:266-275. [PMID: 33897961 PMCID: PMC8054601 DOI: 10.4300/jgme-d-20-00698.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/15/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Daily attending rounds (AR) are a cornerstone of teaching and patient care in academic health centers. Interruptions in health care are common and can cause increased risk of errors, incomplete work, and decreased decision-making accuracy. Interruptions to AR may diminish a trainee's capacity to learn and retain information. OBJECTIVE We characterized and quantified interruptions that occur during AR. METHODS We used a mixed-methods design combining a prospective observational study with a qualitative study. AR were observed January to March 2020 to characterize interruptions, followed by semi-structured interviews with the observed physicians to elucidate the effect of interruptions on workflow and the educational value of rounds. RESULTS There were 378 observed interruptions over the course of 30 AR sessions, averaging 12.6 (range 1-22, median 13) interruptions per rounding session. Bedside nursing staff was the most common source of interruptions (25%) and consultant recommendations was the most common topic of interruption (21%). Most interruptions occurred during patient presentations (76%), and the most common method of interaction was text message (24%). Most team members described negative effects of interruptions, including loss of focus and missing critical clinical information; some also reported that certain interruptions had positive effects on education and clinical care. Interns were more likely to report negative emotional reactions to interruptions. CONCLUSIONS AR are frequently interrupted for non-urgent topics by a variety of methods and sources. Negative effects included loss of focus, missed information, and increased stress. Proactive communication, particularly between physicians and nurses, was suggested to reduce interruptions.
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Affiliation(s)
- Julia Armendariz
- At the time of research, Julia Armendariz, MD, was an Internal Medicine Resident, Department of Medicine, Stanford University, and is now an Internal Medicine Physician, Veterans Affairs Palo Alto Health Care System
| | - Carla Tamayo
- At the time of research, Carla Tamayo, MD, was an Internal Medicine Resident, Department of Medicine, Stanford University, and is now an Internal Medicine Physician, San Juan, Puerto Rico
| | - Justin Slade
- At the time of research, Justin Slade, MD, was Physician Scholar in Quality and Patient Safety, Medical Service, Veterans Affairs Palo Alto Health Care System, and is now a Cardiology Fellow, Department of Cardiology, The Permanente Medical Group, San Francisco
| | - Ilana Belitskaya-Lévy
- Ilana Belitskaya-Lévy, PhD, is a Biostatistician, Cooperative Studies Program Coordinating Center, Veterans Affairs Palo Alto Health Care System
| | - Caroline Gray
- Caroline Gray, PhD, is Research Sociologist, Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System
| | - Nazima Allaudeen
- Nazima Allaudeen, MD, is Assistant Professor (Affiliated), Stanford School of Medicine, and Director of Quality Improvement, Inpatient Medicine, Veterans Affairs Palo Alto Health Care System
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20
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van Dam M, Ramani S, Ten Cate O. An EPA for better Bedside Teaching. CLINICAL TEACHER 2021; 18:398-403. [PMID: 33763984 PMCID: PMC8451813 DOI: 10.1111/tct.13346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/25/2021] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
Background Bedside teaching (BST), a time‐honoured tradition of clinical teaching which integrates theoretical knowledge and clinical practice, has declined steeply over the last decade. Moreover, many clinician teachers today are not specifically trained in and/or comfortable in delivering effective BST. Resucitating this valuable educational format may require a new approach to preparing teachers and setting the stage for effective BST. Framing BST as an entrustable professional activity (EPA) for teachers may be one strategy to enhance its application and quality. Methods We aimed to redefine, describe essential features and effective practices for high‐quality BST, based on clinical teacher participant perspectives through a focus group discussion and open‐ended questionnaires via e‐mail, supplemented by insights from literature. Results Based on data collected, we generated a definition of BST and a list of suggested strategies to optimise BST, for example, preparation, safe learning environment, flexible teaching and patient's benefits. A structured EPA description was created based on this definition. Conclusion Effective BST requires skilled clinical teachers who are comfortable and confident in this mode of teaching; framing BST as a teaching EPA could guide faculty development and clinical teacher certification.
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Affiliation(s)
- Marjel van Dam
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Subha Ramani
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands and adjunct professor, Department of Medicine University of California, San Francisco, San Francisco, California, USA
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Cunningham JM, Adams JE. Recovering Critical Curriculum: Hypothesis-Driven Physical Examination as a Method to Increase Clinical Skills Teaching When Bedside Teaching Remains Limited. South Med J 2021; 114:126-127. [PMID: 33537796 PMCID: PMC8055093 DOI: 10.14423/smj.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- John M Cunningham
- From the Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Jennifer E Adams
- From the Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora
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22
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Han SM, Parkes P, Wang S. Assessing "How to Ask Questions" - Response to: Is Asking Questions on Rounds a Teachable Skill? [Letter]. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:93-94. [PMID: 33519253 PMCID: PMC7837590 DOI: 10.2147/amep.s299732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Seung Min Han
- Faculty of Medicine, Imperial College London, London, UK
| | - Pylin Parkes
- Faculty of Medicine, Imperial College London, London, UK
| | - Susannah Wang
- Faculty of Medicine, Imperial College London, London, UK
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23
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Vanderberg R, Nikiforova T, Hamm M, Spagnoletti C, McNeil M. Outpatient Exam Room Presentations in Resident Continuity Clinics: a Qualitative Report. MEDICAL SCIENCE EDUCATOR 2020; 30:1445-1457. [PMID: 34457812 PMCID: PMC8368740 DOI: 10.1007/s40670-020-01092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Outpatient exam room presentations (OERPs) in resident continuity clinics could address several current challenges in graduate medical education including increasing patient satisfaction, enhancing patient-centered care, and operationalizing competency-based education through direct observation. The authors' aim of this study was to explore the positive and negative aspects of OERPs as a precepting model in resident continuity clinics and to develop a list of best practices for medical educators to utilize when conducting OERPs. MATERIALS AND METHODS The authors defined an OERP as a case presentation and subsequent discussion taking place inside the exam room with the attending physician, resident physician, and patient present. Following a 1-month pilot period of conducting OERPs in internal medicine resident continuity clinics, the authors conducted individual phone interviews and focus groups with internal medicine attendings and residents, respectively. The authors analyzed transcripts using thematic analysis and the constant comparative method. Sixteen attendings participated in individual phone interviews and four resident focus groups averaged five participants per group. RESULTS Four main topics emerged: (1) effect of OERPs on patient care, (2) effect of OERPs on medical education, (3) barriers to OERPs, and (4) OERP best practices. CONCLUSION Participants noted both positive and negative effects of OERPs on patient care and medical education. Best practices suggested to maximize these benefits and minimize drawbacks included targeting OERPs to certain types of clinical encounters and employing strategies to preserve the resident physician-patient relationship and resident autonomy.
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Affiliation(s)
- Rachel Vanderberg
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Megan Hamm
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
- Qualitative, Evaluation and Stakeholder Engagement (Qual EASE) Research Core, University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, PA USA
| | - Carla Spagnoletti
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Melissa McNeil
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
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24
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Shields HM, Honan JP, Goldsmith JD, Madan R, Pelletier SR, Roy CL, Wu LC. Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings' Asking Questions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:921-929. [PMID: 33299375 PMCID: PMC7720889 DOI: 10.2147/amep.s277008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Morning bedside rounds remain an essential part of Internal Medicine residency education, but rounds vary widely in terms of educational value and learner engagement. OBJECTIVE To evaluate the efficacy of an intervention to increase the number and variety of questions asked by attendings at the bedside and assess its impact. DESIGN We conducted a randomized, controlled trial to evaluate the efficacy of our intervention. PARTICIPANTS Hospitalist attendings on the general medicine service were invited to participate. Twelve hospitalists were randomized to the experimental group and ten hospitalists to the control group. INTERVENTION A one-hour interactive session which teaches and models the method of asking questions using a non-medical case, followed by practice using role plays with medical cases. MAIN MEASURES Our primary outcome was the number of questions asked by attendings during rounds. We used audio-video recordings of rounds evaluated by blinded reviewers to quantify the number of questions asked, and we also recorded the type of question and the person asked. We assessed whether learners found rounds worthwhile using anonymous surveys of residents, patients, and nurses. KEY RESULTS Blinded analysis of the audio-video recordings demonstrated significantly more questions asked by attendings in the experimental group compared to the control group (mean number of questions 23.5 versus 10.8, p< 0.001) with significantly more questions asked of the residents (p<0.003). Residents rated morning bedside rounds with the experimental attendings as significantly more worthwhile compared to rounds with the control group attendings (p=0.009). CONCLUSION Our study findings highlight the benefits of a one-hour intervention to teach faculty a method of asking questions during bedside rounds. This educational strategy had the positive outcome of including significantly more resident voices at the bedside. Residents who rounded with attendings in the experimental group were more likely to "strongly agree" that bedside rounds were "worthwhile".
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Affiliation(s)
- Helen M Shields
- Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - James P Honan
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Jeffrey D Goldsmith
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachna Madan
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen R Pelletier
- Office of Educational Quality Improvement, Harvard Medical School, Boston, MA, USA
| | - Christopher L Roy
- Division of Hospitalist Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Lindsey C Wu
- Division of Hospitalist Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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25
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Freed JA, Hale AJ, Rangachari D, Ricotta DN. Twelve tips for teaching oncology to non-oncologists. MEDICAL TEACHER 2020; 42:987-992. [PMID: 31663798 DOI: 10.1080/0142159x.2019.1682534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Teaching subspecialty care to trainees who are not pursuing that subspecialty poses many challenges. These challenges are amplified in the teaching of oncology to non-oncologists because there are more new therapies emerging in oncology than in any other discipline, and there are few oncologic issues managed by generalists without consultation. Concurrently, there is an increasing need for generalists to manage many aspects of care for patients with cancer.Aim: To provide 12 tips for oncologists to use to educate trainees on their oncology rotations.Method: The tips provided are based upon the available literature and the authors' own experience.Results: The 12 tips presented offer specific strategies for oncologists to enhance their teaching by selection of appropriate content and enhancing delivery. Focus is placed on aspects of oncology that trainees are likely to encounter as a generalist or non-cancer subspecialist. While oncology is used as the case study, these strategies are adaptable to any subspecialty area.Conclusion: Oncologists and other subspecialists can be core medical educators.
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Affiliation(s)
- Jason A Freed
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew J Hale
- Division of Infectious Disease, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Deepa Rangachari
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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26
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Liaw SY, Wu LT, Soh SLH, Ringsted C, Lau TC, Lim WS. Virtual Reality Simulation in Interprofessional Round Training for Health Care Students: A Qualitative Evaluation Study. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Levine D, Gadivemula J, Kutaimy R, Kamatam S, Sarvadevabatla N, Lohia P. Analysis of patient safety messages delivered and received during clinical rounds. BMJ Open Qual 2020; 9:bmjoq-2019-000869. [PMID: 32719084 PMCID: PMC7388879 DOI: 10.1136/bmjoq-2019-000869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/28/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Multiple modalities are available to introduce patient safety training to healthcare professionals. In internal medicine, clinical rounds have always played an important role in education; however, the patient safety content taught at the point of care is not well studied. We studied, both quantitatively and qualitatively, the number and nature of patient safety messages delivered by attending physicians to determine what is taught at the point of care and how well this is recognised and recalled by attending physicians, residents and medical students. Methods This prospective mixed methods study was conducted on the medicine teaching service. Clinical rounds were audio-recorded. Immediately after rounds, attending physicians, residents and students completed a short survey card identifying the number and type of educational messages they immediately recalled teaching or hearing. Independent t-test was used to compare differences in the number of messages delivered by attendings and recalled by trainees. One-way analysis of variance was used to compare differences in messages delivered by attending physicians compared with trainees. Recordings were transcribed and analysed qualitatively for patient safety content. Results Trainees recalled more educational messages than attendings recalled teaching in all educational domains. Safety messages comprised 17.5% of educational messages. The average number of patient safety messages recalled per session was 1.08 per attending physicians, 1.84 per resident and 2.50 per student. Residents recalled 56.4% of safety messages delivered; students recalled 76.7% of safety messages. Conclusion Patient safety is a focus of teaching during clinical rounds and provides meaningful opportunities to train students and residents to practice safe patient care.
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Affiliation(s)
- Diane Levine
- Internal Medicine, Wayne State University, Detroit, Michigan, USA .,Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Jaya Gadivemula
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Raya Kutaimy
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Srinivasa Kamatam
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | | | - Prateek Lohia
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Beaird G, Baernholdt M, Byon HD, White KR. Interprofessional rounding design features and associations with collaboration and team effectiveness. J Interprof Care 2020; 35:343-351. [PMID: 32530333 DOI: 10.1080/13561820.2020.1768058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple models of interprofessional rounding (IPR) exist. However, researchers find mixed effects for the impact of IPR, pointing to the possibility that variations in design may influence the effectiveness of the practice. We explored whether IPR design variations (location, use of script, and role of the leader) are associated with team collaboration (partnership and cooperation) and team effectiveness as perceived by practitioners and patients (i.e., patient inclusion). A cross-sectional, survey-based method design was used targeting practitioners on 15 different hospital units at two academic health centers. Routinely collected Hospital Consumer Assessment of Healthcare Practitioners and Systems scores were used to capture patients' perceptions. Statistical methods included multilevel modeling with moderation analysis. There were several significant relationships among design, team collaboration, and team effectiveness. For the design, role of the leader and use of a script had a significant positive association with cooperation. Practitioners' perceptions of team effectiveness were associated with use of script, and cooperation moderated the relationships between practitioners' perceptions of team effectiveness and location, as well as the role of the leader. There was a significant inverse relationship between cooperation and patient inclusion. Results can inform organizations that are exploring, implementing, or improving IPR as well as considering alternative ways to evaluate their practices.
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Affiliation(s)
- Genevieve Beaird
- Department of Family and Community Health, Virginia Commonwealth University School of Nursing
| | | | - Ha Do Byon
- University of Virginia School of Nursing, USA
| | - Kenneth R White
- Office of the Dean, Strategic Partnerships & Innovation, University of Virginia School of Nursing
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29
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Walton V, Hogden A, Long JC, Johnson J, Greenfield D. Clinicians' perceptions of rounding processes and effectiveness of clinical communication. J Eval Clin Pract 2020; 26:801-811. [PMID: 31385440 DOI: 10.1111/jep.13248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/30/2019] [Accepted: 07/20/2019] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Ward rounds present opportunities for medical officers, nurses, allied health clinicians, and patients to interact and plan patient care. A recent literature review found eight types of rounding processes. Different purposes, varying levels of representation from clinical professions, and understanding of each others' roles revealed a complex activity. A shared understanding of rounding processes facilitates positive teamwork and improves patient care. We examined how clinicians perceive the nature of rounding processes they undertake within their practice, multidisciplinary team attendance at rounds, and the effectiveness of team communication. METHODS We surveyed frontline professionals in two acute care and two rehabilitation wards from a metropolitan teaching hospital. There were 77 participants representing medical officers, nurses, and allied health clinicians. Participants selected the type of rounding processes undertaken on their ward from a list of six defined types, then answered questions about who participated in the rounds and their perceptions of the effectiveness of multidisciplinary communication. Survey findings were analysed using descriptive statistics and comparison. RESULTS Overall, professionals were inconsistent in the identification of number and types of rounds. Participants nominated processes more consistently within individual clinical disciplines than by clinical speciality. Medical officers identified rounds most consistently, while some nurses were unable to identify any rounding processes undertaken. The perceptions clinicians had of their own attendance at rounds differed from that of their colleagues. Despite variation in perceptions about rounds, professionals reported effective multidisciplinary communication patterns overall. CONCLUSION Rounds are a common yet complex activity. Rounds are revealed to be a taken-for-granted organizational activity with diversity in function, attendance, and participation, yet rounding processes are perceived and experienced differently between health professions. These differences impact on multidisciplinary attendance at rounds amongst peers. Making and communicating explicit round expectations and roles for clinicians supports coordinated teamwork and care planning.
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Affiliation(s)
- Victoria Walton
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Julie Johnson
- Centre for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
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30
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Wickersham A, Zavodnick J, Thum A, Robertson B, Ackermann L. Making Room at the Bedside: Improving Communication Alongside Medical Education Through Interdisciplinary Rounds. Am J Med Qual 2020; 36:42-48. [PMID: 32126794 DOI: 10.1177/1062860620908058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interdisciplinary rounding has been shown to improve patient safety and provider engagement. Many models for interdisciplinary rounding have been proposed but few focus on preserving bedside medical education. The authors changed the interdisciplinary bedside rounding model to accommodate more time for medical education. The objective was to assess perceptions of communication, care coordination, and teamwork surrounding this change. Resident and attending physicians and unit-based nursing staff completed an anonymous online survey prior to and following the rounding intervention. Length of stay on medical units also was monitored prior to and following the rounding intervention. Following the intervention, there were perceived improvements in interdisciplinary communication, care coordination, and teamwork, and there were no significant changes in length of stay.
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Affiliation(s)
- Alexis Wickersham
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA Thomas Jefferson University Hospital, Philadelphia, PA
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31
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Ragsdale JW, Habashy C, Warrier S. Developing Physical Exam Skills in Residency: Comparing the Perspectives of Residents and Faculty About Values, Barriers, and Teaching Methods. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520972675. [PMID: 33294620 PMCID: PMC7705809 DOI: 10.1177/2382120520972675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The physical examination (PE) skills of residents are often not improved since medical school. Unfortunately, how residents learn PE is not well understood. There is a paucity of research on the factors involved and the differences between resident and faculty perspectives. The authors sought to determine resident and faculty perceptions about the value of PE, the major barriers to learning PE, and the most effective teaching methods. METHODS Based on a rigorous process of literature review and semi-structured interviews, the authors developed an online survey which was sent to 406 internal medicine residents and 93 faculty at 3 institutions. Residents and faculty answered questions about both their own opinions and about their perception of the other group's opinions. RESULTS About 283 residents (70%) and 61 faculty (66%) completed the survey. Both residents and faculty rated the importance of PE similarly. Residents rated being too busy, followed by a lack of feedback, as the most significant barriers to learning PE. Faculty rated a lack of feedback, followed by a lack of resident accountability, as the most significant barriers. Both groups rated the availability of abnormal findings as the least significant barrier. Both groups agreed that faculty demonstration at the bedside was the most effective teaching method. CONCLUSION This survey can serve as a needs assessment for educational interventions to improve the PE skills of residents by focusing on areas of agreement between residents and faculty, specifically faculty demonstration at the bedside combined with feedback about residents' skills.
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Affiliation(s)
| | | | - Sarita Warrier
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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32
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Vanderberg R, Rothenberger SD, Spagnoletti C, McNeil M. Internal Medicine Attendings' Perception of Barriers to Outpatient Exam Room Presentations in Resident Continuity Clinic. MEDICAL SCIENCE EDUCATOR 2019; 29:929-934. [PMID: 34457568 PMCID: PMC8368682 DOI: 10.1007/s40670-019-00773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Outpatient exam room presentations (OERPs) in resident continuity clinic (RCC) can operationalize competency-based medical education and enhance patient satisfaction. We aimed to assess current OERP use and OERP barriers by surveying internal medicine attendings prior to and following a 4-week pilot of OERPs in RCC. Twenty-six out of an eligible 35 attendings completed the pre-pilot survey. Twenty attendings participated in the pilot and completed the post-pilot surveys. On the pre-pilot survey, 65% (17/26) of participants reported never using OERPs. Attendings' perception of learner discomfort with OERPs as somewhat of or a significant barrier significantly decreased from pre-pilot to post-pilot (96% (25/26) v. 65% (13/20), p = 0.03). Time, feedback, and sensitive topics were frequently rated as barriers on both the pre-pilot and post-pilot surveys. On the post-pilot survey, most participants reported patient discomfort with OERPs, attending physician discomfort with OERPs, difficulty writing attestations during OERPs, and difficulty teaching during OERPs were not barriers. Additionally, 45% (9/20) reported planning to use OERPs in the future. Despite benefits of OERPs, there are several barriers to OERPs that need to be addressed prior to more routine implementation in resident continuity clinic. Further research should focus on strategies for overcoming barriers and maximizing benefits of OERPs as well as developing a set of OERP best practices to support routine implementation in RCC.
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Affiliation(s)
- Rachel Vanderberg
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
| | - Scott D. Rothenberger
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
- Center for Research on Health Care Data Center, University of Pittsburgh, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Carla Spagnoletti
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
| | - Melissa McNeil
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
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Harrod M, Petersen L, Weston LE, Gregory L, Mayer J, Samore MH, Drews FA, Krein SL. Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles. Clin Infect Dis 2019; 69:S185-S191. [DOI: 10.1093/cid/ciz527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices.
Methods
From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles.
Results
Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them.
Conclusions
Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.
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Affiliation(s)
- Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Laura Petersen
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lauren E Weston
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lynn Gregory
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Jeanmarie Mayer
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
| | - Matthew H Samore
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Frank A Drews
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Sarah L Krein
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Gray AZ, Modak M, Connell T, Enright H. Structuring ward rounds to enhance education. CLINICAL TEACHER 2019; 17:286-291. [DOI: 10.1111/tct.13086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amy Z Gray
- Department of PaediatricsThe University of Melbourne Melbourne Australia
- Department of General MedicineRoyal Children's Hospital Melbourne Australia
- Murdoch Children's Research Institute Melbourne Australia
| | - Maitreyi Modak
- Department of General MedicineRoyal Children's Hospital Melbourne Australia
| | - Tom Connell
- Department of PaediatricsThe University of Melbourne Melbourne Australia
- Department of General MedicineRoyal Children's Hospital Melbourne Australia
- Murdoch Children's Research Institute Melbourne Australia
| | - Helen Enright
- Department of PaediatricsThe University of Melbourne Melbourne Australia
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35
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Plesac MA, Olson AP. Quantity, Quality, or Neither-Measuring the Effectiveness of Rounds. J Hosp Med 2019; 14:510-511. [PMID: 31386619 DOI: 10.12788/jhm.3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/03/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Melissa A Plesac
- Department of Medicine University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew Pj Olson
- Department of Medicine University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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36
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Sang AX, Tisdale RL, Nielsen D, Loica-Mersa S, Miller T, Chong I, Shieh L. How Much Time are Physicians and Nurses Spending Together at the Patient Bedside? J Hosp Med 2019; 14:468-473. [PMID: 31112496 DOI: 10.12788/jhm.3204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician-nurse (MD-RN) overlap at the patient bedside are lacking. OBJECTIVE This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency. DESIGN This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology. SETTING Single-institution academic hospital. MEASUREMENTS The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD-RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station. RESULTS A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD-RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD-RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD-RN overlap (Pearson's r = -0.67, P < .05). CONCLUSION RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.
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Affiliation(s)
- Adam X Sang
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Rebecca L Tisdale
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Derek Nielsen
- Clinical Technology, Stanford Hospital and Clinics, Stanford, California
| | - Silvia Loica-Mersa
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Travis Miller
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ian Chong
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Lisa Shieh
- Medical Director for Quality, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Abstract
Bedside rounds have evolved concurrently with hospitalist medicine and patient-centered care. Family-centered rounds are the foundation of effective communication in the in-patient pediatric setting. Participant perspectives (family members, patients, nurses, faculty, and trainees) on family-centered rounds differ and goals may not always align. Further, the practical components of how rounds are conducted varies and have continued opportunities for improvement. This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward.
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Affiliation(s)
- Lauren A Destino
- Stanford University, Lucile Packard Children's Hospital, 300 Pasteur MC 5776, Palo Alto, CA 94034, USA.
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue ML 9016, Cincinnati, OH 45229, USA
| | - Brian Good
- University of Utah, Primary Children's Hospital, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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Manojlovich M, Ameling JM, Forman J, Judkins S, Quinn M, Meddings J. Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use. Am J Crit Care 2019; 28:290-298. [PMID: 31263012 DOI: 10.4037/ajcc2019372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. OBJECTIVES To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. METHODS Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity. RESULTS Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity. CONCLUSIONS Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
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Affiliation(s)
- Milisa Manojlovich
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.
| | - Jessica M Ameling
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Jane Forman
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Samantha Judkins
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Martha Quinn
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Jennifer Meddings
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
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Mazzella AJ, Tiller R, Bynum D. Try It, You'll Like It: Changing Resident Culture to Embrace Bedside Rounding. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:301. [PMID: 30817341 DOI: 10.1097/acm.0000000000002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Anthony J Mazzella
- Chief resident, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ; ORCID: https://orcid.org/0000-0003-2036-9254. Chief resident, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Associate professor and residency program director, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sammann A, Chehab L, Patel D, Liao J. Why So Glum? Understanding the Challenges in Meeting User's Needs on Trauma Surgical Rounds. J Surg Res 2019; 235:367-372. [PMID: 30691818 DOI: 10.1016/j.jss.2018.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/31/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Trauma patient rounds are complex, with a high volume of complicated patients in a dynamic environment with competing priorities and workflows. This presents challenges to quality improvement as single-method research approaches fail to comprehensively understand these complex systems. We used a mixed-methods approach to understand factors contributing to system inefficiency and user dissatisfaction on daily patient rounds at a safety-net teaching hospital and level 1 trauma center. MATERIALS AND METHODS A human-centered design uses ethnographic observations and in-depth interviews to understand the challenges and needs facing users of a system. We performed in-context observations and 22 in-depth interviews with a cross-section of care team members, patients, and families. Using the lean methodology, we performed time observations of 15 rounds, tracking activities related to flow, and classified them as 'value added' and 'non-value added.' RESULTS Lean time observations revealed that 34.2% of time was spent on 'non-value-added' activities. Qualitative interviews revealed that all users reported perceived inefficiency as their greatest challenge on rounds. Among these users, there were three distinct user groups: connectors, learners, and doers, and each group had a different set of needs and priorities for rounds which were not being met. CONCLUSIONS To adequately address complex environments, we need to understand the strains on both the system and its users so that we can create sustainable quality-improvement programs. By mixing methods using lean and human-centered design processes, we were able to gain a more comprehensive understanding of the system- and human-centered factors affecting rounds on a trauma surgical service.
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Affiliation(s)
| | - Lara Chehab
- University of California, San Francisco, California.
| | - Devika Patel
- University of California, San Francisco, California
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41
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Chew BH, Tang CJ, Lim WS, Yap JKY, Zhou W, Liaw SY. Interprofessional bedside rounds: Nurse-physician collaboration and perceived barriers in an Asian hospital. J Interprof Care 2019; 33:820-822. [DOI: 10.1080/13561820.2019.1566218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Wee Shiong Lim
- Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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42
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Hahn TW, D'Agata C, Edgoose J, Mastrocola J, Zakletskaia L, White M. TEACH Cards: Teaching Evidence-Based Medicine and Clinical Topics in the Hospital. PRIMER (LEAWOOD, KAN.) 2018; 2:25. [PMID: 32818197 PMCID: PMC7426113 DOI: 10.22454/primer.2018.479320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Inpatient training and evidence-based medicine (EBM) curricula are fundamental components of medical education. Teaching EBM And Clinical topics in the Hospital (TEACH) Cards is an inpatient curricular tool developed to help guide efficient, discussion-based teaching sessions. TEACH Cards aims to increase frequency of inpatient teaching, improve exposure to the breadth of inpatient topics, advance EBM skills, and improve efficiency in answering clinical questions. METHODS TEACH Cards is a set of 25 topic-based cards, each addressing an adult inpatient medicine topic by asking background questions and encouraging learners to write and answer foreground questions. Residents and faculty from a family medicine residency rotating on an adult inpatient medicine service during the 6-month study period were invited to complete a prerotation survey, use the TEACH Cards, and then complete a postrotation survey. RESULTS Out of 54 potential participants, 35% completed both the pre- and postrotation surveys. Respondents used TEACH Cards on average three times per week, reporting significantly stronger agreement that they were both learning (P=0.034) and teaching (P=0.006) core inpatient topics. Respondents reported greater confidence in using EBM resources ( P=0.006) and significantly shorter time to find an evidence-based answer to a clinical question (pretest median=6-10 minutes vs posttest median=2-5 minutes, P=0.002). CONCLUSION Use of TEACH Cards increased self-reported exposure to the breadth of core inpatient topics, confidence with EBM skills, and efficiency in finding answers to clinical questions.
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Affiliation(s)
- Thomas W Hahn
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health
| | - Caitlin D'Agata
- Department of Family Medicine, Tufts University School of Medicine
| | - Jennifer Edgoose
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health
| | | | - Larissa Zakletskaia
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health
| | - Mattie White
- Department of Family and Community Medicine, Saint Louis University School of Medicine
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43
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Abstract
Ward rounds are a highly important forum for collaborative medical reasoning. Despite being prevalent for over a century, they are under-researched. In particular, no clear and comprehensive statement of the purpose of ward rounds exists in the literature. This letter provides such a statement. Having the purpose of ward rounds clearly described helps to provide a foundation for evaluating the effectiveness of rounds and suggesting ways in which rounds can be improved.
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Affiliation(s)
- Paul Perversi
- Deakin University, Burwood Campus, Melbourne, Australia.
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44
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Ratelle JT, Sawatsky AP, Kashiwagi DT, Schouten WM, Erwin PJ, Gonzalo JD, Beckman TJ, West CP. Implementing bedside rounds to improve patient-centred outcomes: a systematic review. BMJ Qual Saf 2018; 28:317-326. [PMID: 30224407 DOI: 10.1136/bmjqs-2017-007778] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Bedside rounds (BR) have been proposed as an ideal method to promote patient-centred hospital care, but there is substantial variation in their implementation and effects. Our objectives were to describe the implementation of BR in hospital settings and determine their effect on patient-centred outcomes. METHODS Data sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through 28 July 2017. We included experimental studies comparing BR to another form of rounds in a hospital-based setting (ie, medical/surgical unit, intensive care unit (ICU)) and reporting a quantitative patient-reported or objectively measured clinical outcome. We used random effects models to calculate pooled Cohen's d effect size estimates for the patient knowledge and patient experience outcome domains. RESULTS Twenty-nine studies met inclusion criteria, including 20 from adult care (17 non-ICU, 3 ICU), and nine from paediatrics (5 non-ICU, 4 ICU), the majority of which (n=23) were conducted in the USA. Thirteen studies implemented BR with cointerventions as part of a 'bundle'. Studies most commonly reported outcomes in the domains of patient experience (n=24) and patient knowledge (n=10). We found a small, statistically significant improvement in patient experience with BR (summary Cohen's d=0.09, 95% CI 0.04 to 0.14, p<0.001, I2=56%), but no significant association between BR and patient knowledge (Cohen's d=0.21, 95% CI -0.004 to -0.43, p=0.054, I2=92%). Risk of bias was moderate to high, with methodological limitations most often relating to selective reporting, low adherence rates and missing data. CONCLUSIONS BR have been implemented in a variety of hospital settings, often 'bundled' with cointerventions. However, BR have demonstrated limited effect on patient-centred outcomes.
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Affiliation(s)
- John T Ratelle
- Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam P Sawatsky
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Will M Schouten
- Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jed D Gonzalo
- General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Thomas J Beckman
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin P West
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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45
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Gray A, Enright H. Opening the black box: An observational study of teaching and learning interactions for paediatrics trainees on consultant ward rounds. J Paediatr Child Health 2018; 54:1011-1015. [PMID: 29790211 DOI: 10.1111/jpc.14056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/02/2018] [Accepted: 03/18/2018] [Indexed: 11/27/2022]
Abstract
AIM Ward rounds are complex activities in which education must be balanced against service. Limited evidence exists regarding how to optimise ward round education. In order to improve the educational experience, we aimed to understand the teaching and learning interactions on ward rounds with a particular focus on the experience of paediatric trainees. METHODS We conducted an initial quantitative survey as a needs assessment regarding learning and teaching in clinical settings using a structured survey of 21 trainees. This was followed by an observational study using focused ethnography of 20 consultant ward rounds in a general medical department of tertiary paediatric hospital. We used a structured observation form to document ward round characteristics and educational interactions. Data were analysed using inductive content analysis to understand key influences on teaching and learning interactions. RESULTS Trainees reported a discrepancy between the actual educational value of ward rounds (mean rating 2.7/5) and what they desired (mean 4.3/5). Ward round ethnography revealed examples of excellent education and practice alongside missed opportunities. Explicit education on rounds was dominated by technical content with little focus on other aspects of professionalism. Major influences on educational interactions were the ward round model - consultant-as-expert versus learner-centred - and the hidden curriculum. CONCLUSION There are many examples of excellence in ward round education, yet there remains substantial scope to better harness the education potential of rounds. This requires us to challenge assumptions, enable feedback and reflection and make learning explicit - while putting the learner at the centre of educational opportunities.
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Affiliation(s)
- Amy Gray
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Helen Enright
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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46
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Perversi P, Yearwood J, Bellucci E, Stranieri A, Warren J, Burstein F, Mays H, Wolff A. Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study. BMC Health Serv Res 2018; 18:643. [PMID: 30119624 PMCID: PMC6098637 DOI: 10.1186/s12913-018-3446-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ward rounds are an important and ubiquitous element of hospital care with a history extending well over a century. Although originally intended as a means of educating medical trainees and junior doctors, over time they have become focused on supporting clinical practice. Surprisingly, given their ubiquity and importance, they are under-researched and inadequately understood. This study aims to contribute knowledge in human reasoning within medical teams, meeting a pressing need for research concerning the reasoning occurring in rounds. METHODS The research reported here aimed to improve the understanding of ward round reasoning by conducting a critical realist case study exploring the collaborative group reasoning mechanisms in the ward rounds of two hospitals in Victoria, Australia. The data collection involved observing rounds, interviewing medical practitioners and holding focus group meetings. RESULTS Nine group reasoning mechanisms concerning sharing, agreeing and recording information in the categories of information accumulation, sense-making and decision-making were identified, together forming a program theory of ward round reasoning. In addition, themes spanning across mechanisms were identified, further explaining ward round reasoning and suggesting avenues for future exploration. Themes included the use of various criteria, tensions involving mechanisms, time factors, medical roles and hierarchies. CONCLUSIONS This paper contributes to the literature by representing rounds in a manner that strengthens understanding of the form of the group reasoning occurring within, thus supporting theory-based evaluation strategies, redesigned practices and training enhancements.
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Affiliation(s)
- Paul Perversi
- School of Information Technology, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - John Yearwood
- School of Information Technology, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Emilia Bellucci
- School of Business, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Andrew Stranieri
- Centre for Informatics and Applied Optimisation, Federation University, University Drive, Mt Helen, VIC 3350 Australia
| | - Jim Warren
- Department of Computer Science, The University of Auckland, 38 Princes Street, Auckland, 1010 New Zealand
| | - Frada Burstein
- Caulfield School of Information Technology, Monash University, 900 Dandenong Road, Caulfield East, VIC 3145 Australia
| | - Heather Mays
- Caulfield School of Information Technology, Monash University, 900 Dandenong Road, Caulfield East, VIC 3145 Australia
| | - Alan Wolff
- Wimmera Health Care Group, 83 Baillie Street, Horsham, VIC 3400 Australia
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Bergl PA, Taylor AC, Klumb J, Quirk K, Muntz MD, Fletcher KE. Teaching Physical Examination to Medical Students on Inpatient Medicine Teams: A Prospective, Mixed-Methods Descriptive Study. J Hosp Med 2018; 13:399-402. [PMID: 29858550 DOI: 10.12788/jhm.2972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during the internal medicine clerkship. We conducted a prospective mixed-methods study at a single academic center. Data were gathered by a student researcher who directly observed inpatient teams over 3 months. We quantified the frequency of PE teaching activities and analyzed daily written observations using qualitative content analysis. PE was most frequently discussed during bedside rounds and least often during workroom rounds. Direct observation of students' examinations rarely occurred. Multiple factors in the learning environment were posited to affect PE instruction. In brief, we found that residents and attending physicians who are part of internal medicine teaching services do not routinely emphasize PE instruction.
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Affiliation(s)
- Paul A Bergl
- Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin, USA.
| | | | | | - Kerrie Quirk
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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48
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Abstract
Bedside hospital rounds promote patient-centered care in teaching and nonteaching settings. Patients and families prefer bedside rounds and provider acceptance is increasing. Efficient bedside rounds with an interprofessional team or with learners requires preparation of the patient and the rounding team. Bedside "choreography" provides structure and sets expectations for time spent in the room. By using relationship-centered communication, rounds can be both patient proximate and patient centered. The clinical examination can be integrated into the flow of the presentation and case discussion. Patient and provider experience can be enhanced through investing time at the bedside.
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Affiliation(s)
- Peter R Lichstein
- Department of Internal Medicine, Section on General Internal Medicine and Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Hal H Atkinson
- Department of Internal Medicine, Section on General Internal Medicine and Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
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49
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Ratcliffe TA, Crabtree MA, Palmer RF, Pugh JA, Lanham HJ, Leykum LK. Service and Education: The Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services. J Gen Intern Med 2018; 33:449-454. [PMID: 29392597 PMCID: PMC5880780 DOI: 10.1007/s11606-017-4302-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Attending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds. OBJECTIVE To explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables. DESIGN Observational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4 weeks. PARTICIPANTS Twelve medicine teaching teams consisting of one attending, one second- or third-year resident, two to three interns, and two to three medical students. MAIN MEASURES The study examined relationships between patient complexity (comorbidities, complications) and clinical workload variables (census, turnover) with educational measures. Teams were clustered based on clinical workload and patient complexity. Educational measures of interest were time spent teaching and number of teaching topics. Data were analyzed both at the daily observation level and across a given patient's admission. KEY RESULTS We observed 12 teams, 1994 discussions (approximately 373 h of rounds) of 563 patients over 244 observation days. Teams clustered into three groups: low patient complexity/high clinical workload, average patient complexity/low clinical workload, and high patient complexity/high clinical workload. Modest associations for team, patient complexity, and clinical workload variables were noted with total time spent teaching (9.1% of the variance in time spent teaching during a patient's admission; F[8,549] = 6.90, p < 0.001) and number of teaching topics (16% of the variance in the total number of teaching topics during a patient's admission; F[8,548] = 14.18, p < 0.001). CONCLUSIONS Clinical workload and patient complexity characteristics among teams were only modestly associated with total teaching time and teaching topics.
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Affiliation(s)
- Temple A Ratcliffe
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA. .,South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Raymond F Palmer
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Jacqueline A Pugh
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Holly J Lanham
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas at Austin, Austin, TX, USA
| | - Luci K Leykum
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas at Austin, Austin, TX, USA
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Beck JB, McDaniel CE, Bradford MC, Brock D, Sy CD, Chen T, Foti J, White AA. Prospective Observational Study on High-Value Care Topics Discussed on Multidisciplinary Rounds. Hosp Pediatr 2018; 8:119-126. [PMID: 29437836 DOI: 10.1542/hpeds.2017-0183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Establishing a high-value care (HVC) culture within an institution requires a multidisciplinary commitment and participation. Bedside rounds provide an ideal environment for role modeling and learning behaviors that promote an HVC culture. However, little is understood regarding the types of HVC discussions that take place at the bedside and who participates in those discussions. METHODS A prospective observational study at a tertiary-care, university-affiliated, free-standing children's hospital. The prevalence of HVC discussions was captured by using the HVC Rounding Tool, a previously developed instrument with established validity evidence. For each observed HVC discussion, raters recorded who initiated the discussion and a description of the topic. RESULTS Raters observed 660 patient encounters over 59 separate dates. Of all patient encounters, 29% (191 of 660; 95% confidence interval: 26%-33%) included at least 1 observed HVC discussion. The attending physician or fellow initiated 41% of all HVC discussions, followed by residents or medical students (31%), families (12%), and nurses (7%). CONCLUSIONS Despite a recent focus on improving health care value and educating trainees in the practice of HVC, our study demonstrated that bedside discussions of HVC are occurring with a limited frequency at our institution and that attending physicians initiate the majority of discussions. The capacity of the nonphysician team members to contribute to establishing and sustaining an HVC culture may be underused. Multi-institutional studies are necessary to determine if this is a national trend and whether discussions have an impact on patient outcomes and hospital costs.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew A White
- Medicine, and
- Center for Scholarship in Patient Care Quality and Safety, University of Washington, Seattle, Washington; and
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