Clinical trial NCT01931553: A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
Official title: Back to Bedside: A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Morning Rounds
Teaching Rounds
Hospitalization
Inpatients
Quality Improvement
Lead sponsor: University of California, San Francisco
Sponsor class: OTHER
First posted: 2013-08-29
Enrollment: 1200
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Attending morning rounds take place at teaching hospitals every day. They are the primary mechanism for patient care delivery, supervision and education of trainees, and communication with patients, families, and staff. However, they are done with little standardization or widely recognized best practices.

The objective of this quality improvement (QI) initiative is to evaluate the adherence to and impact of implementing standardized attending morning rounds on medicine teams at our institution. A standardized rounding intervention has been developed which includes specific guidance on completing the following activities during morning rounds: (1) Pre-rounds discretion; (2) Pre-rounds huddle; (3) Bedside registered nurse (RN) integration; (4) Patient-centered rounding; (5) Real-time order writing.

This trial will randomize half of the investigators' medicine teams at University of California San Francisco to this rounding intervention whilst the other half will be randomized to continue with usual unstandardized rounding practices.

The investigators will compare medicine teams randomized to undertake standardized rounding to those teams undertaking usual practice. Outcomes assessed will relate to the patient (e.g. satisfaction), providers (e.g. satisfaction), efficiency (e.g. total morning round time) as well as adherence to the intervention .

The investigators' study hypotheses are that patient satisfaction scores will be higher for those patients receiving standardized bedside rounds compared to the usual care group. The investigators also hypothesize that total attending morning rounds time and interns length of workday will be shorter and that the number of consultations ordered before noon will increase for those teams undertaking standardized bedside. Further, the investigator hypothesize higher levels of nurse participation, physician and medical student satisfaction with standardized bedside rounding.


Eligibility criteria: Inclusion Criteria:

* All attending physicians, residents, interns and medical students of Medicine teams A through H
* All patients admitted to Medicine teams A through H
* All nurses on the Medicine floors

Exclusion Criteria:

* None

Primary outcomes:
measure: Patient satisfaction with morning rounds
timeFrame: Once, after day one of hospitalization and before patient is discharged.
measure: Patient satisfaction with provider communication
timeFrame: Once, within one month of hospital discharge
Secondary outcomes:
measure: Interns total length of workday
timeFrame: Daily during the 3-month trial
measure: Number of consultations ordered before noon
timeFrame: Daily during the 3-month trial
measure: Resident satisfaction
timeFrame: Once during the last week of their rotation on a given team
measure: Attending physician satisfaction
timeFrame: Once during the last week of their rotation on a given team
measure: Medical student satisfaction
timeFrame: Once during the last week of their rotation on a given team
measure: Nurse participation in morning rounds
timeFrame: Daily during the 3-month trial
measure: Nurse satisfaction
timeFrame: Once during the last week the trial
measure: Intern satisfaction
timeFrame: Once during the last week of their rotation on a given team
measure: Total morning rounding time
timeFrame: Daily during the 3-month trial
Other outcomes:
measure: Number of discharges before noon
timeFrame: Daily during the 3-month trial
measure: Cost of care per patient
timeFrame: For entire 3 month study period
measure: Length of stay
timeFrame: For entire 3 month study period
measure: 30-day readmission rate
timeFrame: For entire 3 month study period
measure: Adherence to the intervention
timeFrame: Daily during the 3-month trial
Locations:
city: San Francisco
country: United States
facility: University of California San Francisco Medical Center
state: California
Study officials:
affiliation: University of California, San Francisco
name: Brad Monash, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of California, San Francisco
name: Nader Najafi, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of California, San Francisco
name: James D Harrison, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Monash B, Najafi N, Mourad M, Rajkomar A, Ranji SR, Fang MC, Glass M, Milev D, Ding Y, Shen A, Sharpe BA, Harrison JD. Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial. J Hosp Med. 2017 Mar;12(3):143-149. doi: 10.12788/jhm.2694.