PURPOSE: Morning rounds in the intensive care unit (ICU) enables multidisciplinary providers to interact and exchange information regarding patient care. ICU rounds are characterized by unique challenges including high acuity illness, frequent interruptions and processing of large quantities of highly dynamic data. These intersecting features complicate attempts to reliably characterize the structure and function of ICU rounds. Most existing studies have surveyed rounds participants, typically outside of the ICU setting. The aim of this study is to develop and validate a rounding observational tool that could be deployed in a working ICU environment by medically trained observers.
METHODS: Investigators designed a survey inquiring about ICU rounding practice and distributed it to all members of the multidisciplinary rounding team in a tertiary teaching hospital. Seventy five surveys were collected for a response rate of 71.4%. Answers were grouped thematically and used as a reference to define 13 discrete rounding tasks in three defined locations (bedside, outside room, remote). Specific definitions and standard of operation for each task were vetted by an expert group and integrated into a web-based tool with multiple timer/event interfaces. After initial training sessions the final version of the tool was calibrated and interobserver variability was calculated.
RESULTS: Over a two month period two independent, trained observers performed 16 paired observations of individual providers during 27 hours of ICU rounds. Interobserver variability was assessed showing good to excellent task categorizations (Kappa 0.87). Associated Bland-Altman plots showed consistent agreement of major provider’s specific task duration, such as presentation (p=0.48, mean difference -0.02), discussion (p=0.21, mean difference -0.99), data gathering (p= 0.15, mean difference -0.39)
CONCLUSIONS: This novel observation tool for ICU rounds provides a reliable method to record real time performance of common ICU rounding tasks by multidisciplinary providers.
CLINICAL IMPLICATIONS: The observation tool will be used to observe rounding practice in various ICUs in order to characterize the process and to develop strategies and interventions to improve the efficiency of ICU rounds.
DISCLOSURE: The following authors have nothing to disclose: Ramez Smairat, John Litell, Jyoti Assudani, Naman Trivedi, Jyothsna Giri, Vitaly Herasevich, Senthilkumar Palaniappan, Felicity Enders, Ognjen Gajic, Brian Pickering, Yue Dong
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