A Study of Bedside Versus Hallway Rounding
Condition: Education, Medical
Study type: Interventional

Summary: 
      The purpose of this study is to compare bedside rounding with hallway and conference room
      rounding on the neurology inpatient ward service at an academic hospital and identify best
      practices associated with educational and patient care outcomes. Specifically, this study
      will determine which rounding practices are associated with a positive educational experience
      for learners, greatest patient and care team communication, and time efficiency.
    

Detailed description: 
      This study will evaluate the efficacy of bedside rounding and compare it to hallway and
      conference room rounding on the neurology ward service at the Brigham and Women's Hospital
      (BWH). The neurology ward service consists of two teams, each with 10-15 vascular neurology
      and general neurology patients. The teams perform daily attending rounds.

      Each team consists of an attending physician, a senior supervisory resident, two junior
      residents, several rotating residents and interns from other departments, medical students,
      as well as a physician assistant who alternates daily between the teams. Neurology attendings
      spend two weeks at a time on a team.

      During a two-week attending rotation, we plan to designate one of the teams as the "bedside
      rounding team" and the other team as the "hallway rounding team", which will serve as the
      control group. The bedside rounding team will carry out patient presentations at the bedside,
      with a focus on the patient, while ensuring nursing involvement in each patient's room. The
      hallway rounding team ("the usual method") will present patients outside of the patient's
      room, without an added emphasis on nurse participation. Halfway through the two-week
      rotation, the team designation will switch in a crossover fashion, so that the initial
      bedside rounding team will become the hallway rounding team, and vice versa. Our planned
      study period is Monday through Friday for a consecutive 6-8 week period, and we anticipate
      including about 150-200 patients in our study.

      To evaluate staff educational experience, patient and interprofessional communication, and
      clinical care outcomes of these two rounding approaches, we plan to survey patients, resident
      trainees, attendings, and nurses on both teams. For collection of data, a student observer or
      research assistant familiar with the study purpose and methods will accompany a neurology
      team during weekday morning rounds and record data about the composition and timing of
      rounds.

      Eligible participants include adult patients and providers (nurses; physicians, including
      residents and attendings; and ancillary providers) involved in the inpatient neurology
      service at BWH. Patients whose primary language is English will be included in the study with
      notation of this feature. Observations will focus on activities of the physician providers.
      Surveys for medical education will involve physician participants who give consent. Surveys
      of patient care and communication will involve patients and nurses who give consent.
    

Intervention name(s): Assigned to a rounding style
Intervention type(s): Other
Intervention description(s): Team rounded on new admissions either in hallway or at the bedside
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Other