Education, Teaching, and Quality Improvement |

The Structure of Rounds on a Medical Intensive Care Unit in a Teaching Hospital FREE TO VIEW

Ronaldo Sevilla Berrios; Lisbeth Garcia Arguello; Aysen Erdogan; Kaur Sumanjit; John O'Horo; Adil Ahmed; Vitaly Harasevich; Brain Pickering; Ognjen Gajic; Yue Dong
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Mayo Clinic, Rochester, MN

Chest. 2014;146(4_MeetingAbstracts):485A. doi:10.1378/chest.1994473
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SESSION TITLE: Education and Teaching in Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Multidisciplinary rounds (MDR) are a key component of intensive care, where medical decisions are discussed and disseminated to the entire care team. Understanding the components and their time distribution of the MDR remained a vital knowledge gap. Furthermore, roles of the family and patient during rounds have not been fully described before. In order to improve the process, we aim to analyze the structure of the MDR. We iniciate by describing the time spent on different components of MDR in a Medical Intensive Care Unit (MICU) of a Teaching Tertiary Medical Center.

METHODS: A prospective direct field observation study in the MICU of a tertiary teaching hospital was conducted. Morning rounds were observed by three trained observers with good interobserver agreement (Bland-Altman with a RSquare of 0.98). Each observer was assigned to one member of the MDR team (attending, fellow, and presenting resident). The times of pre-defined rounding components were recorded, particularly: presentation, data gathering, listening, direct patient contact, and family contact. YAST® software was used for time recording and data were analyzed by JMP® 9 software.

RESULTS: There were 20 MDR rounds observed on the period of September to December 2013, totaling 39 hours of rounds which represent 131 hours of task time. There were 152 unique patients evaluated by the MDR team representing 180 encounters, 13 consultants and 12 fellows. A total of 180 encounters that include 152 unique patients were evaluated by the team. The median (IQR) encounter time per provider-per patient in minutes were 10.89 (0-42.76), 10.88 (0.48-42.68), 10.85 (0-39.83) minutes for consultant, fellow, and resident respectively. The overall time distribution in minutes of the selected round components was: data gathering a median of 1.18 (0.03-13.22); discussion or presentation 3.44 (0.08-33.1); listening 5.27 (0.05-9.98); interruptions 0.80 (0.05-9.98); patient contact 2.27 (0.03-33.94); and family contact 7.82 (0.01-42.55).

CONCLUSIONS: In this preliminary resutls, the structure of MDR on this teaching medical center was highly variable across all components. There was extensive overlap of simultaneous activities by several team members. It is likely that standarization and stream line of the process could minimize oportunities for medical error.

CLINICAL IMPLICATIONS: This data provides potential targets to streamline the rounding structure in future quality improvement initiatives.

DISCLOSURE: The following authors have nothing to disclose: Ronaldo Sevilla Berrios, Lisbeth Garcia Arguello, Aysen Erdogan, Kaur Sumanjit, John OHoro, Adil Ahmed, Vitaly Harasevich, Brain Pickering, Ognjen Gajic, Yue Dong

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