A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine

NCT01931553 | Completed DMC

• 1 other identifier: RoundingUCSF
• Study Type: interventional
• Target: 1,200
• Locations: 1 country
• Sites: 1

Brief Summary

Attending morning rounds take place at teaching hospitals every day. They are the primary mechanism for patient care delivery, supervision and education of trainees, and communication with patients, families, and staff. However, they are done with little standardization or widely recognized best practices. The objective of this quality improvement (QI) initiative is to evaluate the adherence to and impact of implementing standardized attending morning rounds on medicine teams at our institution. A standardized rounding intervention has been developed which includes specific guidance on completing the following activities during morning rounds: (1) Pre-rounds discretion; (2) Pre-rounds huddle; (3) Bedside registered nurse (RN) integration; (4) Patient-centered rounding; (5) Real-time order writing. This trial will randomize half of the investigators' medicine teams at University of California San Francisco to this rounding intervention whilst the other half will be randomized to continue with usual unstandardized rounding practices. The investigators will compare medicine teams randomized to undertake standardized rounding to those teams undertaking usual practice. Outcomes assessed will relate to the patient (e.g. satisfaction), providers (e.g. satisfaction), efficiency (e.g. total morning round time) as well as adherence to the intervention . The investigators' study hypotheses are that patient satisfaction scores will be higher for those patients receiving standardized bedside rounds compared to the usual care group. The investigators also hypothesize that total attending morning rounds time and interns length of workday will be shorter and that the number of consultations ordered before noon will increase for those teams undertaking standardized bedside. Further, the investigator hypothesize higher levels of nurse participation, physician and medical student satisfaction with standardized bedside rounding.

Conditions

Morning Rounds; Teaching Rounds; Hospitalization; Inpatients; Quality Improvement

Outcome Measures

Primary Outcomes (2)

• Patient satisfaction with morning rounds

  Patient satisfaction with morning ward rounds. This inpatient assessment will occur after day one of hospitalization before the patient is discharged from hospital. This time point will ensure that patients have experienced rounds at least once before completing a patient satisfaction survey.

  Once, after day one of hospitalization and before patient is discharged.

• Patient satisfaction with provider communication

  Post-discharge assessment will be sent by a commercial Vendor (Press Ganey) within a month of discharge following hospitalization

  Once, within one month of hospital discharge

Secondary Outcomes (9)

• Interns total length of workday

  Daily during the 3-month trial

• Number of consultations ordered before noon

  Daily during the 3-month trial

• Resident satisfaction

  Once during the last week of their rotation on a given team

• Attending physician satisfaction

  Once during the last week of their rotation on a given team

• Medical student satisfaction

  Once during the last week of their rotation on a given team

Other Outcomes (5)

• Number of discharges before noon

  Daily during the 3-month trial

• Cost of care per patient

  For entire 3 month study period

• Length of stay

  For entire 3 month study period

Study Arms (2)

Standardized attending morning rounds

EXPERIMENTAL

1. Pre-rounds discretion 2. Pre-rounds huddle 3. Bedside RN integration 4. Patient-centered rounding 5. Real-time order writing

Other: Standardized attending morning rounds

Usual rounding practice

NO INTERVENTION

Usual rounding practice (as defined by each clinical team)

Interventions

Standardized attending morning rounds OTHER

Standardized attending morning rounds

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All attending physicians, residents, interns and medical students of Medicine teams A through H
• All patients admitted to Medicine teams A through H
• All nurses on the Medicine floors

You may not qualify if:

• None

Sponsors & Collaborators

• University of California, San Francisco: lead

Study Sites (1)

University of California San Francisco Medical Center

San Francisco, California, 94143, United States

Location

Related Publications (1)

• Monash B, Najafi N, Mourad M, Rajkomar A, Ranji SR, Fang MC, Glass M, Milev D, Ding Y, Shen A, Sharpe BA, Harrison JD. Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial. J Hosp Med. 2017 Mar;12(3):143-149. doi: 10.12788/jhm.2694.

  PMID: 28272589 DERIVED

Study Officials

• Brad Monash, MD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

• Nader Najafi, MD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

• James D Harrison, PhD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 16, 2013
• First Posted: August 29, 2013
• Study Start: September 1, 2013
• Primary Completion: February 1, 2014
• Study Completion: December 1, 2014
• Last Updated: May 18, 2015

Record last verified: 2015-05

Locations

US (1)