Effects of Bedside Compared to Outside the Room Case Presentation

Study Overview
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Brief Summary
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Patient case presentations during ward rounds can take place at the bedside or outside the room. The best approach to patient case presentation is yet unclear. Thus, the overall aim of this multicenter, randomized-controlled study is to test the hypothesis that outside the room patient case presentation compared to bedside patient case presentation results in better outcomes across different dimensions including patient understanding and perception of quality of care as well as patient outcomes, physicians' preferences, perception of quality and effectiveness, and timing of the ward rounds, respectively.

Detailed Description
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Patient-centered care may be defined as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Involving patients in all steps of the healthcare process is thus important. Yet, best presentation of patients' cases during ward rounds remains unknown. During outside the room patient case presentation, the medical team discusses difficult patient or medical issues in the team, and later presents a patient-friendly synthesis to the patient. Bedside patient case presentation, on the other hand, allows a patient to be part of the whole team discussion. Yet, there is concern that patients may be unable to cope with the magnitude of medical information and misunderstandings may occur. Currently, there is equipoise regarding both possibilities of patient case presentation with an important lack of trial data. We thus aim to compare the effect of bedside patient case presentation with outside the room patient case presentation during ward rounds (Chefarztvisite) on different patient- and physician-related endpoints. Therefore, this randomized controlled trial aims to test the hypothesis that outside the room patient case presentation compared to bedside patient case presentation results in better outcomes across different dimensions including patient understanding and perception of quality of care as well as patient outcomes, physicians' preferences, perception of quality and effectiveness, and timing of the ward rounds, respectively.

Official Title
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Effect of Bedside Patient Case Presentation Compared to Outside the Room Case Presentation on Patient Perception of Quality of Care and Patient Outcomes: a Randomized-controlled, Multicenter Trial

Conditions
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Bedside Patient Case Presentation, Outside-the-room Patient Case Presentation

Intervention / Treatment
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* Procedure: patient case presentation bedside
* Procedure: patient case presentation Outside-the-room


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Consecutive adult (>18 years) medical inpatients during their first ward round independently of their underlying disease and reason for hospital stay. Exclusion Criteria: Patients with cognitive impairment, such as dementia/delirium Patients with paracusia. Patients who do not understand local language(s). Patients already included in this study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: On the day before the ward round, patients will be randomized 1:1 into one of both study arms. In one study arm, patient case presentation will be performed at bedside. In the other study arm, patient case presentation will be performed outside the room.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: patient case presentation Bedside<br>In the bedside presentation group, patient case presentation and discussions will be at bedside with direct involvement of the patient as needed. | Procedure: patient case presentation bedside<br>* Patient case presentation in absence or presence of Patient at bedside.<br>* Other names: ward round;|
| Active Comparator: patient case presentation Outside-the-room<br>In the outside the room condition, case presentation and discussions will take place outside without the patient being present. After the case presentation and discussions the team will enter the room and give the patient a short summary of the medical situation, complete the medical information and examine the patient, as needed, and discuss the next steps. | Procedure: patient case presentation Outside-the-room<br>* Patient case presentation Outside-the-room.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subjective understanding of disease and management | average of the visual analog scale (VAS) score across the following three dimensions rated by the patient (0 I have no knowledge at all about the situation to 100 I have best possible knowledge about the situation: I. Patients' subjective understanding of the disease II. Patients' subjective understanding of the therapeutic concept III. Patients' subjective understanding of the next steps | post ward round up to 36 h | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement understanding | Patients' perception about how well the current ward round improved the understanding of each of these three components, i.e., current disease, therapeutic concept, and next steps (VAS, 0-100) | post ward round up to 36 h | 
| Objective understanding of disease and management | Comparison of patients' recall information regarding current main diagnosis, main therapeutic measures and next steps (qualitative information) with medical chart information. Answers regarding current main diagnosis will be categorized as: (1) patient correctly states both pathophysiology and localization, (2) patient correctly states either pathophysiology or localization, (3) patient states neither pathophysiology nor localization (correctly) but correctly states symptoms, (4) patient correctly states that the current diagnosis is still unclear, (5) patient states incorrect information, (6) patient correctly states a secondary diagnosis relevant for the current hospitalization Answers regarding main therapeutic measures and next steps will be categorized as: (1) correct (regarding main diagnosis), (2) incorrect (regarding main diagnosis), (3) correct (regarding secondary diagnosis), (4) incorrect (regarding secondary diagnosis) | post ward round up to 36 h | 
| Overall quality of care | Patients' perception (each rated on a VAS 0-100) regarding: comprehensibility of information during ward round, satisfaction with care, confidence in the medical team, perceived competence of the medical team, perceived interpersonal behavior during ward round, affective response of the patients, adequacy of ward round duration (includes two additional questions asking for patients' estimations on how much time the medical team spent on their case within the ward round as well as on average per day (estimates in minutes)) | post ward round up to 36 h | 
| Follow up health status | Patients' perceived health status (EuroQol five dimensions questionnaire) | 30 days follow up after study inclusion | 
| Follow up understanding | Patients' subjective (VAS 0-100) and objective (recall as compared to objective medical chart information) understanding | 30 days follow up after study inclusion | 
| Follow up quality of hospital care | Patients' overall perspective of hospital care (Hospital Consumer Assessment of Healthcare Providers and Systems, HCAHPS) | 30 days follow up after study inclusion | 
| Follow up readmission | Patients' readmission rate since study inclusion | 30 days follow up after study inclusion | 
| Follow up duration of hospitalization | total duration of hospitalization | 30 days follow up after study inclusion | 
| Treating team satisfaction | The treating team's satisfaction with ward round (rated on a VAS 0-100) | post ward round up to 96 h | 
| Treating team performance | The treating team's perceived performance in the ward round (each rated on a VAS 0-100): time management of the ward round, interaction within the medical team and with the patient during ward round, perceived time management and feasibility | post ward round up to 96 h | 
| Treating team affect | The treating team's affective response (rated on a VAS 0-100) | post ward round up to 96 h | 
| Treating team preference | The treating team's preference of bedside compared to outside the room patient case presentation (rated on a semantic differential ranging from 1 I prefer bedside ward rounds to 6 I prefer ward rounds outside the room) | post ward round up to 96 h | 
| Timeliness | duration of the ward round (minutes) | during ward round which may last from 5 up to 30 minutes | 
| Communication-specific items during ward rounds | Rated by investigator (nominal 3-point scale (1 = yes; 2 = no; 3 = not applicable): structuring of conversation, use of patient-centered techniques, use of physician-centered techniques, dealing with emotions, conveying of complex information, negotiation of shared concepts of disease and treatment, realization of shared decision making, breaking bad news | during ward round which may last from 5 up to 30 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ward round, patient case presentation, communication, patient-centered care