A Study of Bedside Versus Hallway Rounding

Study Overview
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Brief Summary
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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
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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.

Official Title
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A Study of Bedside Versus Hallway Rounding for Neurology Inpatient Teams

Conditions
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Education, Medical

Intervention / Treatment
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* Other: Assigned to a rounding style


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: new admission to neurology team Exclusion Criteria: comfort measures as sole treatment goal

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Bedside<br>The bedside rounding team will perform patient presentations at the bedside, with a focus on the patient, and will ensure nursing involvement when rounding on each patient, | Other: Assigned to a rounding style<br>* Team rounded on new admissions either in hallway or at the bedside<br>|
| Active Comparator: Hallway<br>The hallway rounding team will present patients outside of the patient's room, without an emphasis on nurse participation. | Other: Assigned to a rounding style<br>* Team rounded on new admissions either in hallway or at the bedside<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean patient rounding time as assessed by time-motion analysis | The first primary outcome measure will be mean rounding time in minutes per patient in the bedside and hallway groups. | 90 days | 
| Mean rounding proportion spent at the patient's bedside as assessed by time-motion analysis | The second primary outcome measure will be mean rounding proportion in percent spent at the patient's bedside in the bedside and hallway groups | 90 days | 
| Mean rounding proportion spent on various rounding activities as assessed by time-motion analysis | The third primary outcome measure will be mean rounding proportion in percent spent on history taking, review of data such as imaging, physical exam, answering patient questions, teaching, and discussion of plan in the bedside and hallway groups | 90 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient, nurse, resident, and attending physician satisfaction with rounds as assessed by surveys | The secondary outcome will be patient, nurse, resident, and attending physician satisfaction with and perception of rounds as assessed by surveys using a 5-point Likert scale with 5 being the highest satisfaction. | 90 days |