Article: Wang ME, Hutauruk RM, Perales S, Chang J, Kim J, Singh AT. Improving Efficiency on a Pediatric Hospital Medicine Service With Schedule-Based Family-Centered Rounds. Hosp Pediatr. 2022;12(5):491-501. doi:10.1542/hpeds.2021-006379
Fellow: Laura Lemley Hampton, MD, Second-Year Pediatric Hospital Medicine Fellow at Duke Children’s Hospital, Durham, NC
Summary: The article describes a quality improvement initiative which created an electronic health record (EHR) based scheduling tool for daily family centered rounds. On the pediatric hospital medicine service at the large children’s hospital, the rounding schedule provided a +/- 30 minute timeframe for rounds to occur to nurses, who communicated the timeframe to families. This resulted in an increase in nursing presence on rounds and overall improved team efficiency. The three aims of the initiative were met within 1 year including: starting 90% of rounds encounters within 30 minutes of the scheduled time, (2) increasing nursing presence from 79% to > 90%, and (3) increasing the percentage of rounds completed by 11:20am from 0% to 80%.
Key Strengths: The authors provided a detailed account of their interventions and presented results in run charts for their three outcome measures. They met all aims through multi-pronged interventions as illustrated in the key driver diagram. Designating one person (senior resident) as the team member responsible for creating the daily rounding order and the automation of pulling in EHR data including readily available nurse contact information were notable strengths of the implementation of the project. Additionally, the flexibility of the scheduling tool which included the ability to change the round start times (ie for Grand Rounds), add duration if interpreters were needed, and schedule buffers and teaching slots were important features for generalizability.
Limitations/Flaws: Unfortunately, there were only 8 weeks of baseline, pre-intervention data available. Notably, there was not a significant change of family member presence on rounds (75% pre-intervention and 79% during intervention) despite the specific timeframe for rounds. No data was available on family/patient, nurse, or interpreter experience related to the schedule, nor were there any data collected on quality or safety of patient care.
Takeaway Message: Creating a shared mental model through a scheduled rounding order with built in flexibility especially on days with higher census is a way to improve efficiency and nurse presence on rounds while not impacting resident perceived quality of teaching. The duration of rounds was almost 30 minutes shorter on days with a census >12 patients!
Practice Impact: A daily rounding order embedded in the medical record and visible to the broader health care team may not be feasible in all settings; however, a family centered rounds road map is a way to improve efficiency while maintaining flexibility for complex or clinically unstable patients. Empowering senior residents to create a rounding order can improve efficiency especially on days with higher census.
Fellow: Laura Lemley Hampton, MD, Second-Year Pediatric Hospital Medicine Fellow at Duke Children’s Hospital, Durham, NC
Summary: The article describes a quality improvement initiative which created an electronic health record (EHR) based scheduling tool for daily family centered rounds. On the pediatric hospital medicine service at the large children’s hospital, the rounding schedule provided a +/- 30 minute timeframe for rounds to occur to nurses, who communicated the timeframe to families. This resulted in an increase in nursing presence on rounds and overall improved team efficiency. The three aims of the initiative were met within 1 year including: starting 90% of rounds encounters within 30 minutes of the scheduled time, (2) increasing nursing presence from 79% to > 90%, and (3) increasing the percentage of rounds completed by 11:20am from 0% to 80%.
Key Strengths: The authors provided a detailed account of their interventions and presented results in run charts for their three outcome measures. They met all aims through multi-pronged interventions as illustrated in the key driver diagram. Designating one person (senior resident) as the team member responsible for creating the daily rounding order and the automation of pulling in EHR data including readily available nurse contact information were notable strengths of the implementation of the project. Additionally, the flexibility of the scheduling tool which included the ability to change the round start times (ie for Grand Rounds), add duration if interpreters were needed, and schedule buffers and teaching slots were important features for generalizability.
Limitations/Flaws: Unfortunately, there were only 8 weeks of baseline, pre-intervention data available. Notably, there was not a significant change of family member presence on rounds (75% pre-intervention and 79% during intervention) despite the specific timeframe for rounds. No data was available on family/patient, nurse, or interpreter experience related to the schedule, nor were there any data collected on quality or safety of patient care.
Takeaway Message: Creating a shared mental model through a scheduled rounding order with built in flexibility especially on days with higher census is a way to improve efficiency and nurse presence on rounds while not impacting resident perceived quality of teaching. The duration of rounds was almost 30 minutes shorter on days with a census >12 patients!
Practice Impact: A daily rounding order embedded in the medical record and visible to the broader health care team may not be feasible in all settings; however, a family centered rounds road map is a way to improve efficiency while maintaining flexibility for complex or clinically unstable patients. Empowering senior residents to create a rounding order can improve efficiency especially on days with higher census.