Back to Bedside: A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,200
- 试验地点
- 2
- 主要终点
- Patient satisfaction with provider communication
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- 未提供
结局指标
主要结局
Patient satisfaction with provider communication
时间窗: Once, within one month of hospital discharge
Post-discharge assessment will be sent by a commercial Vendor (Press Ganey) within a month of discharge following hospitalization
Patient satisfaction with morning rounds
时间窗: Once, after day one of hospitalization and before patient is discharged.
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.
次要结局
- 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)
- Total morning rounding time(Daily during the 3-month trial)
- Nurse participation in morning rounds(Daily during the 3-month trial)
- Nurse satisfaction(Once during the last week the trial)
- Intern satisfaction(Once during the last week of their rotation on a given team)