The Return of Bedside Rounds: An Educational Intervention

Abstract

Background

Bedside rounds have decreased in frequency on teaching services. Perceived barriers toward bedside rounds are inefficiency and patient and house staff lack of preference for this mode of rounding.

Objectives

To evaluate the impact of a bedside rounding intervention on the frequency of bedside rounding, duration of patient encounters and rounding sessions, and patient and resident attitudes toward bedside rounds.

Design

A pre- and postintervention design, with a bedside rounding workshop midway through two consecutive internal medicine rotations, with daily resident interviews, patient surveys, and an end-of-the-year survey given to all Medicine house staff.

Participants

Medicine house staff and medicine patients.

Measures

Frequency of bedside rounds, duration of new patient encounters and rounding sessions, and patient and house staff attitudes regarding bedside rounds.

Results

Forty-four residents completed the bedside rounding workshop. Comparing the preintervention and postintervention phases, bedside rounds increased from <1% to 41% (p < 0.001). The average duration of walk rounding encounters was 16 min, and average duration of bedside rounding encounters was 15 min (p = 0.42). Duration of rounds was 95 and 98 min, respectively (p = 0.52). Patients receiving bedside rounds preferred bedside rounds (99% vs. 83%, p = 0.03) and perceived more time spent at the bedside by their team (p < 0.001). One hundred twelve house staff (71%) responded, with 73% reporting that bedside rounds are better for patient care. House staff performing bedside rounds were less likely to believe that bedside rounds were more educational (53% vs. 78%, p = 0.01).

Conclusions

Bedside rounding increased after an educational intervention, and the time to complete bedside rounding encounters was similar to alternative forms of rounding. Patients preferred bedside rounds and perceived more time spent at the bedside when receiving bedside rounds. Medicine residents performing bedside rounds were less likely to believe bedside rounds were more educational, but all house staff valued the importance of bedside rounding for the delivery of patient care.

Appendices

Appendix I

”Tips for Bedside Rounding” Handout18–20

Before Rounding Session:

• Prepare for patient cases before rounds

• Decide with team which patients are appropriate for bedside rounds

• Orient learners—ensure everyone knows what is expected of them

• Prepare patients prior to rounds, when possible

• Invite patient’s nurse if feasible

During Rounding Session:

• Have patient’s doctor (resident, student, etc.) introduce all members of the team

• Orient patient and learners—encourage patient to correct/contribute to details

• Position patient appropriately; position team around bedside

• Do not avoid sensitive material

• Allow interruptions by patient and learners

• Examine pertinent or illustrative parts−invite students to participate

• Discuss events, labs, assessment, plan

• Challenge intellectually with open-ended questions

• Use “teachable moments” when available

• Teach to all levels of learners and encourage all to participate

• “I don’t know” is an appropriate answer

• Communicate and summarize plan for patient and team

After Rounding Session:

• Debrief sessions when appropriate

• Offer time to clarify questions or address remaining issues after session

• Offer feedback to reinforce positive skills demonstrated at bedside

Appendix II

Patient Survey Items.

• 1. Introductory statements:

• For patients not receiving bedside rounds: “Your Medicine team of doctors discussed your case outside of your room, then updated you about the plan.”

• For patients receiving bedside rounds: “Your Medicine team of doctors discussed your case at the bedside in your presence.”

• 2. What is your ethnic background (circle one):

• Black/African-American

• White

• Asian

• Other

• 3. Which language do you consider your primary language?

• English

• Spanish

• Russian

• Other

• 4. “In reference to the degree of respect your medicine team showed during your stay, please choose:”

• a. Significant Gain of Respect—respect almost always demonstrated

• b. Moderate Gain of Respect—most of the time, I was treated with respect

• c. Mild Gain of Respect—I often experienced a sense of respect

• d. No sense of loss or gain of respect

• e. Mild Loss of Respect—I often experienced low-grade loss of respect

• f. Moderate Loss of Respect—almost most of the time, I had concerns about disrespectful behavior

• g. Significant Loss of Respect—sense of loss of respect was almost always present

• 5. Please comment on the statement: “Your Medicine team used confusing terms.”

• strongly agree

• somewhat agree

• neutral

• disagree

• strongly disagree

• 6. Please comment on the statement: “I would prefer my medicine team of doctors to round as a team at the bedside during morning rounds”

• strongly agree

• somewhat agree

• neutral

• disagree

• strongly disagree

• 7. Please comment on the statement: “My medicine team involved me with medical decisions.”

• strongly agree

• somewhat agree

• neutral

• disagree

• strongly disagree

• 8. How many minutes per morning were at least two of your physicians together at the bedside with you?

• zero minutes

• 1 to 5 minutes

• 6 to 10 minutes

• 11 to 15 minutes

• 16 to 20 minutes

• 21-25 minutes

• 25+ minutes