Duration Of Rounds Research Articles

Impact of a Novel Virtual Rounding Queue Software on Nurse and Family Presence for Rounds in the Neonatal Intensive Care Unit: A Pilot Study

ObjectiveCoordinating getting everyone in the room at the same time for family-centered rounds (FCR) is challenging. The objective of this study was to determine if using a virtual queue that notifies nurses and families in real time when to expect the rounding team could impact their presence on rounds. MethodsWe observed rounds on two NICU teams for six weeks before and after implementation of a novel rounding software, Q-rounds™, that shares real-time updates on when the team will arrive and allows families to RSVP to join remotely when they can’t be there in person. Observers collected metrics pertinent to FCR including nurse and family presence (in-person or remotely) and duration of rounds and used chi-squared and two group t-tests for analysis. ResultsRounds were observed for 165 patient encounters pre-implementation and 179 patient encounters post-implementation, with an average rounding duration of 10.3 minutes (SD 6.5) and 10.4 minutes (SD 6.3) per patient respectively (P =0.91). The proportion of nurses who were present for the entirety of the rounding discussion increased from 18.8% to 58.2% (P < 0.001). Family presence on rounds increased from 20.0% (95% CI, 13.9-26.1) to 43.0% (95% CI, 35.8-50.3; P < 0.001). The percentage of families that participated in rounds remotely increased from 15.2% to 55.8% (P < 0.001). ConclusionsThis observational study showed that the use of a novel rounding software was associated with a significant increase in family presence for rounds and nurse presence for the entirety of rounds without increasing rounding duration.

Analysis in Table Tennis Singles at the Tokyo 2020 Olympics

&lt;p&gt;目的：主要對2020東京奧運桌球男女生單打比賽結果進行研究分析。方法：以東京奧運2020官方網站比賽日程與結果，查詢桌球單打的官方紀錄，將比賽場次的預賽 (Round 1-3) 當作初賽組(Round Group, RG)，8強賽 (Round of 16) 到決賽 (Final) 的比賽視為決賽組 (Final Group, FG)；使用記數分析 (Notational analysis) 方法分析與賽局相關的變量、比賽持續時間、最長回合 (擊球)、平均回合等變異量。以IBM SPSS 20.0統計軟體進行各數據之處理，以Mann-Whitney U考驗法來分析與比較兩組 (RG，FG) 之間的差異，以及Kruskal &amp;ndash; Wallis H test來分析兩組 (RG，FG) 各局之間的差異，若有差異，以Dunn事後比較來分析。顯著水準&amp;alpha; = .05。結果：男女單RG與FG的單局合計分數之間沒有差異，男單FG兩場獎牌戰合計球數 &gt;19分有51.8%，呈現比賽激烈；場次上，男女單打的比賽時間，FG也多於RG；局數上，儘管沒有顯著，RG持續時間有越來越久的趨勢，FG則沒有明顯增加。結論：經由對2020東京奧運資料分析，男女單打FG組的持續時間與多合計球數局是多於初賽組的；不管男單或女單，在初賽組與決賽組的發球優勢不在，自己發球失分慢慢提高。這些訊息可以幫助球員和教練準備和適應現代桌球特點的不同訓練。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purposes: The main purpose is to conduct research and analysis on the results of the singles competitions of men’s and women’s table tennis at the 2020 Tokyo Olympics. Methods: The official competition schedule and results on the Tokyo Olympic 2020 official website were utilized to check the official table tennis singles records. The preliminary rounds and rounds 1-3 of the competition were considered as the Round Group (RG), while the round of 16 to the final competition was considered as the Final Group (FG). The notational analysis method was employed to analyze the variables related to the game, the duration of the game, the longest round (batting), the average round and other variables. IBM SPSS 20.0 statistical software was used to process the collected data. The Mann-Whitney U test method was used to analyze the matches and compare the differences between THE two groups (RG, FG). The Kruskal-Wallis H test was used to analyze the difference between the two groups (RG, FG) in sets. Dunn’s post hoc comparison was used to analyze any differences. The significance level was set at &amp;alpha; = .05. Results: There was no difference in the total number of scores in a single round of men’s and women’s singles RG and FG. The total number of balls in the two medal games of men’s singles FG was &gt; 19, indicating fierce competition, with 51.8% more than RG. Regarding the number of rounds, although not significant, the duration of RG tended to be longer, while FG did not increase significantly. Conclusion: After analyzing the data from the 2020 Tokyo Olympics, it was found the duration and total number of rounds of the men’s and women’s singles in FG group were greater than that of the preliminary group. Regardless of men’s singles or women’s singles, the advantage of serving in the preliminary group and the final group is not evident as the scores gradually increased. This information helps players and coaches in preparing and adapting to the different drills that characterize modern Table tennis.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

1808 QIP to improve the board round process on a general geriatric medicine ward

Abstract Introduction Effective board rounds improve the patient’s experience and reduce the risks associated with a prolonged hospital stay. Ward C54 at Queen’s Medical Centre is a 30-bedded ward dedicated to the provision of care for older, frail (CFS ≥ 6) patients. Board round on C54 was unstructured and could take over an hour. The project team set out to reduce the duration of board round, improve the quality of information handed over and improve staff satisfaction with board round. Method Pre- and post-intervention data on the daily duration of board round were collected by the junior doctors on the ward. PDSA methodology was then used to test the following interventions: 1. Nerve centre updated daily by the junior doctor responsible for that bay 2. Junior doctors to present information using 4Q approach 3. Staff nurse in each bay highlighting any issues for that bay. Pre- and post-intervention surveys were also distributed to staff working on C54. Results The duration of board round was reduced from an average of 52 minutes to an average of 38 minutes post-intervention. Over 90% of survey respondents believed the board round to be more efficient and over 80% were either satisfied or very satisfied with board round duration. Conclusions The findings have shown it is possible to improve the duration of and staff satisfaction with board round by giving MDT members a framework to help structure handover of written and verbal information. Future considerations include providing teaching sessions to staff on the board round process.

Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

ObjectiveDiscussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre...

Exercise Intensity and Activity Energy Expenditure of Professional Golf Players in Official Competitive Setting.

Research regarding the physical needs of professional golf players is lacking. With advances in wearable technology, it has become easier to analyze physiological responses such as heart rate (HR) to determine activity energy expenditure (AEE). The purpose of the study was to evaluate exercise intensity (EI) and AEE during 4 consecutive tournament's golf rounds using a popular wrist-based HR monitoring. Wearable systems for HR monitoring can be used to provide an accurate estimate of energy expenditure. Cross-sectional study. Level 3. A total of 20 male professional golfers participated in the study. Each player was monitored during an official tournament consisting of 4 rounds of 18 holes. EI and AEE were determined using HR wrist monitoring (Whoop Strap 2.0). We calculated the percentage of HRmax (%HRmax) and the percentage of HRres (%HRres) and the AEE in kcal/min using Keytel's formula. The calculated mean %HRmax and %HRres for the study population were 56.4% ± 1.8% and 40.5% ± 2.6%, respectively. Considering American College of Sports Medicine guidelines, these average percentages correspond to a moderate EI. The average caloric expenditure was 5.4 ± 0.4 kcal/min and 1555.8 ± 157.8 kcal per round considering an average golf round duration of 288.3 ± 19.5 minutes. A professional player's golf round is moderate physical activity. The AEE of this activity was equal to 5.4 cal/min, which is moderate energy consumption. These data could help golf coaches and conditioning coaches to have a better understanding of the load placed on golfers during tournaments.

Round duration and equity injection in venture capital. An empirical analysis in the medtech sector

ABSTRACT The pandemic has brought extraordinary attention (and therefore funds) to the medical technology (medtech) sector. The urgent need for innovation in this industry is widely acknowledged; thus, venture capitalists (VCs) are playing a major role in supporting its renovation. The present research aims to identify how venture capitalists approach medtech companies, which are typically perceived as considerably risky. Specifically, the objective is to highlight the features of the control mechanisms employed by VCs when financing firms operating in the health care industry, with explicit focus on the staged structure of the investment. Previous studies have supported the hypothesis of shorter financing rounds with higher required equity stakes when a VC firm approaches a hazardous investment. To test the consistency of such evidence with the case of medtech firms, two sets of regressions on a unique dataset have been performed. The results reported show partial suitability of the expectations to the specific case.

Improvement in Multidisciplinary Provider Rounding (Surgical Rounds) in the Pediatric Cardiac ICU: An Application of Lean Methodology.

Provider-only, combined surgical, and medical multidisciplinary rounds ("surgical rounds") are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times. Single-center improvement science study with observational and interventional phases from February 2, 2021, to July 31, 2021. Tertiary pediatric cardiac ICU. Cardiothoracic surgery and cardiac intensive care team members participating in daily "surgical" rounds. Implementation of technology automation, creation of work instructions, standardization of patient presentation content and order, provider training, and novel role assignment. Sixty-one multidisciplinary rounds were observed (30 pre, 31 postintervention). During the preintervention period, identified inefficiencies included prolonged preparation time, redundant work, presentation variability and extraneous information, and frequent provider transitions. Application of targeted interventions resulted in a 26% decrease in indexed rounds duration (2.42 vs 1.8 min; p = 0.0003), 50% decrease in indexed rounds preparation time (0.53 vs 0.27 min; p < 0.0001), and 66% decrease in transition time between patients (0.09 vs 0.03 min; p < 0.0001). The number of presenting provider changes also decreased (9 vs 4; p < 0.0001). Indexed discussion duration did not change (1 vs 0.98 min; p = 0.08) nor did balancing measures (bedside rounds and surgical start times) change (8.5 vs 9 min; p = 0.89 and 38 vs 22 min; p = 0.09). Lean methodology can be effectively applied to multidisciplinary rounds in a joint cardiothoracic surgery/cardiac intensive care setting to decrease waste and inefficiency. Interventions resulted in decreased preparation time, transition time, presenting provider changes, total rounds duration indexed to patient census, and anecdotal improvements in provider satisfaction.

An Observational Time Study of Neonatal Intensive Care Unit Multidisciplinary Rounds.

In this observational study, we aimed to describe the rounding structure in a high acuity neonatal intensive care unit (NICU) to identify potential barriers to efficient multidisciplinary rounds. We observed daily medical rounds (January-December 2018) on the resident teaching service in a 46-bed academic level IV NICU. Daily census, duration of rounds, and causes for rounding delays were recorded. During a subset of the study period, additional data were collected describing the time spent on specific activities and the room-to-room pathway followed by the rounding team. Descriptive statistics were used to summarize the census, total rounding time, time spent on each activity, and rounding time by day of the week and by attending. A total of 208 rounding days were observed. During the study period, the teaching service mean daily census was 17 patients and total rounding time (mean ± standard deviation) was 136 ± 31 minutes. Mean rounding time and time/patient varied between the nine attendings (total time range 109 minutes to 169 minutes, time/patient range 6.4 minutes/patient to 10.0 minutes/patient). In total, 91% of rounding time focused on patient care, teaching, and discussions with parents, while 9% of the time was spent deciding which patient to see next, moving between rooms, and waiting for members of the team to be ready to start rounds. On average, the medical team spent over 2 hours per day making multisciplinary rounds in the NICU with substantial variation between attending providers. While most time was spent on patient care, teaching, and talking with parents, we identified opportunities to improve rounding efficiency. · The structure of rounds in a NICU was observed to identify the potential barriers to efficiency.. · There are limited data on MDR processes in the NICU.. · In total, 9% of time was spent on patient care activities during daily rounds..

77 Evaluating virtual family-centered rounds effectiveness, efficiency and usability during the COVID-19 pandemic

Abstract Background Virtual care has seen exponential growth since the onset of the COVID-19 pandemic, however, the evaluation of virtual care tools and services is lacking, particularly in the inpatient setting. In April 2020, we virtualized our in-person family-centered rounds (FCR) process and demonstrated the ability to perform virtual family-centered rounds (vFCR). In this study, we evaluate vFCR against the accepted standard of in-person FCR to ensure high quality care is maintained and encourage adoption by health care providers, administrators, patients and caregivers. Objectives The objective of this study is to compare vFCR to established core components and timing for in-person FCR. Perceptions of overall satisfaction, safety and technology usability were also explored. Design/Methods This is a mixed methods process evaluation of vFCR. Data collection was through virtual and in-person observation and post-vFCR survey of participants. Virtual observations focused on timing and adherence to core components of FCR, while in-person naturalistic observations focused on technology interaction and usability. Observation data underwent quantitative and content analysis. Data from post-vFCR questionnaires were subject to descriptive statistical analysis and content analysis of free-text responses. Results Sixty-two vFCR were observed virtually and 35 vFCR were observed in-person. Adherence to the core components of FCR during vFCR was variable (Table 1). Mean duration of a single patient round was 8.44 ± 4.93 minutes, with a mean transition time between patients of 3.96 ± 2.96 minutes. One hundred and four surveys were completed (76% response rate), 42 by patients and caregivers and 62 by members of the interdisciplinary medical team. The majority (93%) of respondents surveyed were satisfied or very satisfied with vFCR, and 67% felt it was important or very important to do FCR virtually during the pandemic to keep people safer. Importantly, vFCR was perceived by 96% of medical team members as supporting shared decision making with patients and caregivers, and 78% of patients/caregivers felt like a valued partner in their (child’s) care. Virtual family-centered rounds technology was perceived as easy or very easy to use by 95% of respondents. Additional positive and negative comments were submitted by 38% of respondents about their experience with vFCR (Figure 1). Conclusion Virtual family-centered rounds afford adherence to the core components of family-centered rounds. Satisfaction with vFCR and perceived usability of vFCR technology were both highly rated. Respondents also felt vFCR were important for safety during the pandemic. Rounds duration and transition times between patients were seen as opportunities for improvement. Observation and questionnaire data suggest the efficiency and quality of vFCR may be optimized through routine training on the rounding process and technology, as well as recognition of family-centered rounds as a component of inpatient pediatric care that should be prioritized.

Virtual Family-Centered Rounds During the COVID-19 Pandemic – Technology Usability Analysis

Family-centered rounds (FCR) are multidisciplinary rounds, involving patients and caregivers with the aim of shared decision making in medical care planning. In response to the COVID-19 pandemic, a tertiary care pediatric hospital re-engineered the in-person FCR process used by inpatient Pediatric Medicine teams implemented virtual family-centered rounds (vFCR). As part of a mixed methods study evaluating vFCR, naturalistic observation was used to evaluate the usability of vFCR technology. Functional and user requirements were assessed and confirmed through observation of interactions with technology intended to support vFCR. The duration of individual patient rounds and transition time between patients was also captured. Technology interactions were assessed in terms of what worked (successful interactions) and what did not work (usability issues and errors). Neilsen and Norman’s (1994) usability heuristics were used to support the evaluation and explanation of findings. While naturalistic observation yielded clear results in terms of effectiveness and efficiency, user satisfaction was not formally examined. The identified usability requirements and key characteristics for ease of use and adoption of vFCR identified in this study can be used by other hospitals looking to implement or improve inpatient virtual care technology usability.

1016 USING VIDEO TELEMEDICINE FOR INPATIENT WORKING: A NOVEL APPROACH TO REMOTE WORKING DURING THE COVID-19 PANDEMIC

BackgroundOrthogeriatrics inpatient ward.IntroductionThe COVID-19 pandemic changed working patterns for many trainees. Remote telephone or video outpatient consultations became established practice, with clinically vulnerable staff able to support this provision. We adapted the use of telemedicine to provide remote clinical working for inpatient care and continued speciality training opportunities.MethodMicrosoft Teams video conferencing facilitated interaction between the specialist registrar working remotely and the on-site multidisciplinary team (MDT). Daily activities included virtual handover attendance, inpatient ward round consultations and MDT discussions. A portable computer enabled the clinician to see and interact with inpatients remotely. Access to electronic patient records facilitated timely decision making and enactment of management plans. Anonymous MDT feedback was collected via online questionnaires. This project conformed to service evaluation guidelines and ethical approval was not required.ResultsFourteen staff members completed the feedback survey. Results were overwhelmingly positive, with 78.6% of respondents strongly agreeing that the senior doctor working remotely supported the MDT, facilitated complex clinical decision making and was beneficial to patient care. Feedback noted that some patients praised the ‘clever’ and ‘innovative’ method. Limitations included technical difficulties due to Wi-Fi connection, which contributed to communication not being as fluid as face-to-face consultations and increased ward round duration. Patient factors, namely hearing and cognitive impairment, limited the interaction that patients were able to have with the clinician via video link.ConclusionVideo inpatient ward round consultations offer an effective opportunity for physicians to continue clinical patient-facing roles whilst working remotely. Furthermore, this minimises the impact of COVID-19 on specialty trainees, by providing continued training and assessment opportunities for individuals required to shield. This novel method affords a framework transferrable to clinicians from other hospital specialties who may be required to work remotely. Future reviews of patient and relative satisfaction with this process are required.

Improving Efficiency of Multidisciplinary Bedside Rounds in the NICU: A Single Centre QI Project.

Inconsistent workflow, communication, and role clarity generate inefficiencies during bedside rounds in a neonatal intensive care unit. These inefficiencies compromise the time needed for essential activities and result in reduced staff and family satisfaction. This study's primary aim was to reduce the mean duration of bedside rounds by 25% within 3 months by redesigning the rounding processes and applying QI principles. The secondary aims were to improve staff and family experience. We conducted this work in an academic 50-bed neonatal intensive care unit involving 350 staff members. The change interventions included: (i) reinforcing essential value-added activities like standardizing rounding time, the sequencing of patients rounded, sequencing each team member rounding presentations, team preparation, bedside presentation content, and time management; (ii) reducing non-value-added activities; and (iii) moving value-added nonessential activities outside of the rounds. The mean duration of rounds decreased from 229 minutes in the pre-implementation to 132 minutes in the postimplementation phase. The proportion of staff showing satisfaction regarding various components of the rounds increased from 5% to 60%, and perceived staff involvement during the rounds increased from 70% to 77%. Ninety-three percent of family experience survey respondents expressed satisfaction at being invited for bedside reporting and being involved in decision-making or care planning. The staff did not report any adverse events related to the new rounds process. Redesigning bedside rounds improved staff engagement and workflow, resulting in efficient rounds and better staff experience.

Investigating consultant-led virtual review as a model for implementing 7-day cardiology services in UK clinical practice

Disparities between weekend and weekday care, termed 'the weekend effect', have led to a UK government pledge to provide 7-day services. Despite this, poor outcomes have led to criticism of the programme. This study consequently sought to evaluate consultant-led virtual review as a model for 7-day cardiology services. Over 4 weekends, cardiology patients underwent virtual review alongside in-person teams. Outcomes included length of stay, same-day discharge and 30-day mortality rates, as well as duration of ward rounds and change in patient management. Patients were surveyed on attitudes towards virtual review. Statistical analysis revealed no significant difference in clinical outcomes, while virtual review was noted to significantly decrease time taken (p<0.0001). Attitudes towards virtual review were broadly favourable. By demonstrating comparable outcomes compared with conventional review, as well as high acceptability, this study identified virtual review as an effective substitute for in-person care.

P.093 Implementation of virtual interdisciplinary bedside rounds on an acute stroke unit

Background: The novel corona virus pandemic presented the Saskatoon Stroke Program with challenges related to patient- and caregiver-centered communication. Keeping all parties informed of a patient’s health status and plan of care in the setting of extreme visitation restrictions was difficult. Virtual interdisciplinary bedside rounds (VIDR) were introduced to enhance communication for stroke patients. Methods: A video conferencing application was adopted by the Saskatchewan Health Authority. Consent to participate was obtained by a social worker. Bedside nurses facilitated patient participation in VIDR on either a tablet or workstation on wheels, while caregivers were able to attend virtually. Each team member accessed the VIDR from an individual device to maintain social distancing. A structured questionnaire has been initiated to capture participant reported experiences and satisfaction with VIDR (data collection ongoing). Results: Most patients and caregivers were amiable to participate in VIDR. Challenges included: accessing appropriate technology for both family and staff members; rural and remote internet reliability; and maintaining a reasonable duration of rounds. There was overwhelming anecdotal positive feedback from participants. Conclusions: We implemented VIDR to enhance communication during the pandemic. Caregivers felt connected to the care team and up-to-date in the plan of care.

Standardization of rounds on a general paediatric ward: Implementation of a checklist to improve efficiency, quality of rounds, and family satisfaction.

The purpose of this study was to develop a standardized rounding tool for use on the general paediatric ward and to determine if its use can improve quality of rounds as well as patient and parent satisfaction. The study used a pre- and post-intervention prospective observational methodology. The intervention consisted of the implementation of a Checklist Rounding Tool (CRT) entitled the 'Paediatric Inpatient Rounding Checklist (PIRC)' which outlined items deemed essential to discuss during rounds for all patients admitted to the paediatric ward. The PIRC was created by the research team after reviewing the literature and it was peer reviewed by a panel of expert paediatricians. Performance on rounds based on discussion of checklist items as well as patient and parent satisfaction were evaluated by an external observer both pre- and post-PIRC implementation. Four of the five less frequently addressed checklist items were discussed significantly more post-intervention. The Rounds Quality Score was significantly improved after checklist implementation, the pre- and post-intervention scores being 8.24 and 9.61/10, respectively (P-value <0.001). Patient and parent satisfaction were rated higher with the use of the checklist. There was no difference in the duration of rounds between the pre- and post-implementation phases. In summary, utilization of a standardized rounding tool on an inpatient paediatric ward led to improvement in quality of rounds as well as patient and parent satisfaction.

Do ward rounds offer effective teaching and training? Obstacles to learning and what makes good teaching in a large tertiary care hospital from trainee doctor's perspective.

Background: Ward rounds (WR) have been integral to the process of teaching and learning medicine and also provides a vital opportunity to communicate with the patient, their relatives, and other healthcare professionals. Yet in recent years trainees’ perception of the educational value of WRs seems to have declined. Objectives: The aim of this study to assess trainees’ perception of the educational value of WRs at King Abdulaziz Medical City(KAMC), Riyadh, a 1500 bed academic hospital in Saudi Arabia.Methods: A self-administered, paper-based survey was distributed to physicians in training at KAMC between October and December 2019. All residents who attended WRs were invited to participate. The questionnaire was adapted from a survey used in a previous study. The demographic section requested details of the respondent's age, gender, specialty, and seniority. The second and third sections asked about the logistics of current ward round practices. It included several questions on the structure as well as the duration and frequency of ward rounds. The fourth and fifth sections asked for participant’s perception of the opportunities for, and the obstacles to, learning on ward rounds. The subsequent sections asked several questions onward round structure and the clinical teacher. Responses were requested on a 5-point Likert-type scale (strongly disagree, disagree, neutral, agree, strongly agree). The last section asked the participant for general comments and feedbackResult: The study targeted 250 residents in specialties that routinely performed WRs. Only 166 residents returned the questionnaire (response rate of 66.4%). Male 89 (53.6%), medical 108 (65.1%), surgical 58 (34.9%), resident in first year 81 (48.8%). The overall average time spent on WR was 13 (± 11 SD) hours per week. The WR was perceived as a good opportunity to learn about diagnostic investigation 138 (83%) and patient management 133(80.1%), history taking114 (68.7%) physical examination 103 (62.0%), and time management skills 86 (51.8%). The majority of our trainees felt that the WR was educationally very useful to 86 (52%) and attribute to at least a third of the education they receive during their training. They also reported that about the quarter of the time spent on WRs is devoted to teaching. The good teacher described as enthusiastic to teach 137 (82.5%), provide feedback to trainees 135 (81%), do not rush 139(83.7), communicate to trainee 144 (86.7), and consultant level,101 (60.8). Trainees also identify a few factors that hinder their training such as lack of time 130 (79%), and the number of patients 129 (78.3). Conclusion: This study identifies the strengths and weaknesses of WR in our institution. Finding will help training supervisors in addressing and rectifying these shortcoming and factors hinder training.

Standardized Work Rounds Enhance Teaming, Comprehensiveness, Shared Mental Model Development, and Achievement Rate of End-of-Shift Goals.

To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals. A single-center, pre-post, prospective cohort study. A 259-bed, quaternary, pediatric referral center. Children 0-18 years old from November 2018 to January 2020. Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist. Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters were observed (50 preintervention, 52 after Plan-Do-Study-Act cycle 1, and 52 after Plan-Do-Study-Act cycle 2). We observed improvements in overall shared mental model index (24-87%), rounds comprehensiveness (72-98%), and ideal teaming behaviors (including closed-loop communication: 82-100%; responsibility delegation: 74-100%; interdependence behaviors: 26-98%, all p < 0.01) by the end of study. Nursing presentations accounted for 3.6 ± 1.5 minutes of rounds and rounds duration was unchanged postintervention (11 ± 5 min preintervention and 11 ± 4 min after Plan-Do-Study-Act cycle 2, p > 0.99). Face validity, assessed using questionnaire data from 953 participants, revealed positive attitudes regarding efficiency, clarity, and participant self-value. Greatest enhancements in self-value were noted among advanced practice providers and respiratory therapists. On exploratory modeling, we noted associations between ideal teaming behaviors, rounds comprehensiveness, and shared mental model index. Similarly, we noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7-46; p < 0.01). Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.

Bedside Rounds in Intensive Care Units during the COVID-19 Pandemic and Beyond.

A survey-based pilot study was performed to examine the feasibility of videoconferencing to facilitate multidisciplinary rounds following the initiation of strict isolation and social distancing policies in a pediatric intensive care unit (PICU). The use of a mobile workstation was implemented as the central hub for rounding at the bedside by the attending physicians, while other members of the multidisciplinary and multispecialty team joined rounds from other locations with maintaining appropriate social distance. Fifty-eight staff members who participated in videoconferencing rounds completed the postimplementation survey. Eighty-eight per cent of staff agreed that the use of videoconferencing to facilitate rounds was an effective strategy to maintain social distancing between team members during the pandemic. Sixty-four percent of staff agreed that the use of videoconferencing improved participation of the PICU team and consultants by increasing access to rounds. Over 50% of staff agreed that the use of videoconferencing improved the efficiency of rounds and team productivity. Only 4% of staff responded that videoconferencing increased the duration of rounds and 37% responded that it decreased resident and team education. Fifty-five percent of staff agreed that videoconferencing was used to promote parental participation during this pandemic month. Videoconferencing was found to be a feasible solution to safely conduct multidisciplinary rounds while maintaining social distancing, and participants found it effective without interfering with normal workflow. Incorporating videoconferencing into traditional rounding practices may be advantageous following the pandemic to improve team and family access to rounds and workflow efficiency and rounding structure.

An Evaluation of the Impact of Barcode Patient and Medication Scanning on Nursing Workflow at a UK Teaching Hospital.

Barcode medication administration (BCMA) is advocated as a technology that reduces medication errors relating to incorrect patient identity, drug or dose. Little is known, however, about the impact it has on nursing workflow. Our aim was to investigate the impact of BCMA on nursing activity and workflow. A comparative study was conducted on two similar surgical wards within an acute UK hospital. We observed nurses during drug rounds on a non-BCMA ward and a BCMA ward. Data were collected on drug round duration, timeliness of medication administration, patient identification, medication verification and general workflow patterns. BCMA appears not to alter drug round duration, although it may reduce the administration time per dose. Workflow was more streamlined, with less use of the medicines room. The rate of patient identification increased from 74% (of 47) patients to 100% (of 43), with 95% of 255 scannable medication doses verified using the system. This study suggests that BCMA does not affect drug round duration; further research is required to determine the impact it has on timeliness of medication administration. There was reduced variability in the medication administration workflow of nurses, along with an increased patient identification rate and high medication scan rate, representing potential benefits to patient safety.

SAFA: A Semi-Asynchronous Protocol for Fast Federated Learning With Low Overhead

Federated learning (FL) has attracted increasing attention as a promising approach to driving a vast number of end devices with artificial intelligence. However, it is very challenging to guarantee the efficiency of FL considering the unreliable nature of end devices while the cost of device-server communication cannot be neglected. In this paper, we propose SAFA, a semi-asynchronous FL protocol, to address the problems in federated learning such as low round efficiency and poor convergence rate in extreme conditions (e.g., clients dropping offline frequently). We introduce novel designs in the steps of model distribution, client selection and global aggregation to mitigate the impacts of stragglers, crashes and model staleness in order to boost efficiency and improve the quality of the global model. We have conducted extensive experiments with typical machine learning tasks. The results demonstrate that the proposed protocol is effective in terms of shortening federated round duration, reducing local resource wastage, and improving the accuracy of the global model at an acceptable communication cost.