Balch H, Gradick C, Kukhareva PV, Wanner N. Association of Mobile Workstations and Rounding-in-Flow with Resident Efficiency: A Controlled Study at an Academic Internal Medicine Department.
J Gen Intern Med 2022;
37:3700-3706. [PMID:
35513750 PMCID:
PMC9585150 DOI:
10.1007/s11606-022-07636-9]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND
Residents commonly use a batched workflow to round on hospitalized patients, creating redundancy and decreasing efficiency.
OBJECTIVE
To improve resident efficiency through a novel workflow using mobile laptops and modified rounding-in-flow.
DESIGN, SETTING, PARTICIPANTS
A controlled experimental study conducted at an academic medical center for 3 months. One internal medicine team served as the intervention group, and two other teams served as a control group; 34 interns and 20 senior residents participated.
INTERVENTION
Residents in the intervention group were provided a novel workflow and a mobile laptop to allow them to round "in-flow." Control group residents rounded as usual (batched workflow without laptops).
MAIN MEASURES
Fourteen interns were monitored for a time-motion study. Time-stamped electronic medical record (EMR) data were used to assess percentage of progress notes and orders placed during rounds (9 a.m.-12:30 p.m.) and percentage of discharge summaries signed within 24 h of discharge. A post-intervention survey measured perceived efficiency.
RESULTS
A time-motion study showed non-significant differences between time in the intervention group and that in the control group: communication time with patients (128 min vs 105 min, p = 0.37) and computer time (289 min vs 306 min, p = 0.71). EMR data for 664 visits in the control group and 374 in the intervention group showed that rounding-in-flow was associated with an odds ratio (OR) of 1.5 for placing progress notes during rounds (95% CI: 1.2-1.7, p < 0.001), an OR of 1.1 for placing non-discharge orders during rounds (95% CI: 1.0-1.2, p = 0.01), and an OR of 3.9 for signing discharge summaries within 24 h of discharge (95% CI: 2.3-7.2, p < 0.001). Post-intervention survey, completed by 23 of 34 interns, showed that interns in the intervention group perceived that orders were completed during rounds more often than the control group (OR 7.8; 95% CI: 1.3-60.1, p = 0.03).
CONCLUSIONS
Using mobile laptops with modified rounding-in-flow was associated with earlier completion of residents' work, suggesting improved efficiency.
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