Abstract
ObjectiveExisting observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds.Methods and ParticipantsBetween December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census.ResultsResults presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (−2.77 adjusted bedside minutes; 95% CI −4.61 to −0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02).ConclusionsPediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities.
Highlights
Conducting rounds is the core activity for both patient care and learning the practice of medicine on inpatient teaching services in the United States
Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (22.77 adjusted bedside minutes; 95% CI 24.61 to 20.93; p,.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p =,.001)
Internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities
Summary
Two studies of internal medicine inpatient services in the early 1990s noted 22– 29% of rounds were spent on educational activities, 47–55% on patient presentation and discussion, and only 8–12% on direct patient interactions [4,5]. The transformation of medical informatics, prevalence of chronic disease, and ACGME duty-hour restrictions have changed the practice of academic medicine since these historical observations of internal medicine were performed. In response to these changes 95% of internal medicine residency programs voluntarily employed patient-census limits as a mechanism for balancing education with institutional service and patient care. The effect of patient-census, or limitations thereof, upon the education and patient care activities on rounds remains undefined
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
