Clinical trial NCT03210987: Effects of Bedside Compared to Outside the Room Case Presentation
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Bedside Patient Case Presentation
Outside-the-room Patient Case Presentation
Keywords: ward round
patient case presentation
communication
patient-centered care
Lead sponsor: University Hospital, Basel, Switzerland
Sponsor class: OTHER
Collaborators: name: Kantonsspital Aarau
name: Kantonsspital Liestal
First posted: 2017-07-07
Enrollment: 1092
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention 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.
Primary purpose: OTHER

Brief summary: 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: 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.

Eligibility criteria: 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:

1. Patients with cognitive impairment, such as dementia/delirium
2. Patients with paracusia.
3. Patients who do not understand local language(s).
4. Patients already included in this study

Primary outcomes:
measure: Subjective understanding of disease and management
timeFrame: post ward round up to 36 h
Secondary outcomes:
measure: Improvement understanding
timeFrame: post ward round up to 36 h
measure: Objective understanding of disease and management
timeFrame: post ward round up to 36 h
measure: Overall quality of care
timeFrame: post ward round up to 36 h
measure: Follow up health status
timeFrame: 30 days follow up after study inclusion
measure: Follow up understanding
timeFrame: 30 days follow up after study inclusion
measure: Follow up quality of hospital care
timeFrame: 30 days follow up after study inclusion
measure: Follow up readmission
timeFrame: 30 days follow up after study inclusion
measure: Follow up duration of hospitalization
timeFrame: 30 days follow up after study inclusion
measure: Treating team satisfaction
timeFrame: post ward round up to 96 h
measure: Treating team performance
timeFrame: post ward round up to 96 h
measure: Treating team affect
timeFrame: post ward round up to 96 h
measure: Treating team preference
timeFrame: post ward round up to 96 h
measure: Timeliness
timeFrame: during ward round which may last from 5 up to 30 minutes
measure: Communication-specific items during ward rounds
timeFrame: during ward round which may last from 5 up to 30 minutes
Other outcomes:
Locations:
city: Basel
country: Switzerland
facility: University Hospital Basel
Study officials:
affiliation: Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Switzerland
name: Sabina Hunziker, Prof.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lehmann LS, Brancati FL, Chen MC, Roter D, Dobs AS. The effect of bedside case presentations on patients' perceptions of their medical care. N Engl J Med. 1997 Apr 17;336(16):1150-5. doi: 10.1056/NEJM199704173361606.
citation: Chauke HL, Pattinson RC. Ward rounds -- bedside or conference room? S Afr Med J. 2006 May;96(5):398-400. No abstract available.
citation: O'Leary KJ, Killarney A, Hansen LO, Jones S, Malladi M, Marks K, M Shah H. Effect of patient-centred bedside rounds on hospitalised patients' decision control, activation and satisfaction with care. BMJ Qual Saf. 2016 Dec;25(12):921-928. doi: 10.1136/bmjqs-2015-004561. Epub 2015 Dec 1.
citation: Ramirez J, Singh J, Williams AA. Patient Satisfaction with Bedside Teaching Rounds Compared with Nonbedside Rounds. South Med J. 2016 Feb;109(2):112-5. doi: 10.14423/SMJ.0000000000000419.
citation: Seo M, Tamura K, Morioka E, Shijo H. Impact of medical round on patients' and residents' perceptions at a university hospital in Japan. Med Educ. 2000 May;34(5):409-11. doi: 10.1046/j.1365-2923.2000.00516.x. No abstract available.
citation: Becker C, Gross S, Gamp M, Beck K, Amacher SA, Mueller J, Bohren C, Blatter R, Schaefert R, Schuetz P, Leuppi J, Bassetti S, Hunziker S. Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial. J Gen Intern Med. 2023 Apr;38(5):1180-1189. doi: 10.1007/s11606-022-07775-z. Epub 2022 Sep 9.
citation: Gross S, Beck K, Becker C, Gamp M, Mueller J, Loretz N, Amacher SA, Bohren C, Gaab J, Schuetz P, Mueller B, Fux CA, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Perception of physicians and nursing staff members regarding outside versus bedside ward rounds: ancillary analysis of the randomised BEDSIDE-OUTSIDE trial. Swiss Med Wkly. 2022 Jan 19;152:w30112. doi: 10.4414/smw.2022.w30112. eCollection 2022 Jan 17.
citation: 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; BEDSIDE-OUTSIDE Study Group. 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 Sep;174(9):1282-1292. doi: 10.7326/M21-0909. Epub 2021 Jun 29.