46. THE ROUNDS EFFICIENCY INDEX: A NOVEL PHYSICS-BASED CONSTRUCT FOR PATIENT- AND FAMILY-CENTERED ROUNDS

Abstract

Background Patient- and family-centered rounds (PFCR) are used to accomplish work in key areas (patient care, education, family experience) and require considerable work from those involved (time). Limited research has evaluated rounds length, but not efficiency. We sought to evaluate rounds efficiency using the physics-based concept of work output divided by work input. Objectives 1) Establish baseline for clinical work (CW), educational effectiveness (EE), family experience (FE) and rounds length (RL); and 2) Develop a rounds efficiency index (REI) construct. Methods This project aimed to establish baseline data for 4 components of rounds efficiency on 5 inpatient acute care teams at Children's Wisconsin. Process measures included 3 types of work output (CW, EE, FE) and work input (RL). CW was evaluated as the percent (%) of daily orders placed on rounds abstracted from the electronic health record on a 10-point rating system corresponding to decile (higher ratings with higher % of daily orders on rounds). EE was assessed as a 1 to 10 rating by learners. FE was assessed as a 1 to 10 rating by families during post-rounds interviews by a rounds coach. RL was recorded in minutes/patient. The outcome measure (REI) was calculated as a ratio of work output/work input (%). A 3-month period of baseline data assessments were collected. The REI was calculated using aggregate ratings for CW, EE, FE, and RL. Results CW analysis of 809 weekday orders (described as % of daily orders placed on rounds/percentile/CW rating) were: 55%/80th/8; 38%/50th/5; 26%/20th/2. 59 EE ratings had a median of 7 (interquartile range [IQR] 1.3). 21 FE ratings had a median of 9 (IQR 2). 60 RL measurements demonstrated mean of 11.4 minutes/patient (SD 3.2). The average REI was 62%. Discussion This project yielded a novel efficiency construct incorporating patient care, educational effectiveness, family experience, and rounds length. Our teams are currently 62% efficient. The REI is a promising tool that provides the basis for providing feedback and targeting interventions for programs seeking to improve rounds efficiency.