Clinical staff spends significantly less time with intensive care unit (ICU) patients at the end of rounds as compared with the beginning, according to a new clinical study.

Researchers at Emory University (Atlanta, GA, USA) accompanied clinical staff on 20 nonconsecutive weekdays during rounds in a 12-bed cardiothoracic ICU to study time distribution during clinical rounds; all patients had undergone coronary bypass surgery. On any given day, participants in rounds included one or more physicians, nurses, medical students, a pharmacist, a dietitian, and other healthcare providers. At the very least, an intensivist and one other physician participated in each session. While following the clinical staff, the researchers used a tablet computer to document the time spent on various activities with each patient, such as treatment plans, teaching, looking for information, speaking with family members, and responding to interruptions.

The results showed that the number of patient visits during the study period averaged 6.4, and rounds duration averaged 117.9 minutes. Interruptions accounted for about 10 minutes per rounds session, and social interruptions for another 11.5 minutes. Overall, the time spent with each patient during rounds decreased by 54 seconds per patient. Using a nine-patient session as an example, clinical staff spent about eight minutes less with the last patient seen compared with the first. Comparison of the first four and last four patients seen on rounds produced a statistically significant difference in the time spent with physicians and other participants in rounds. The study was presented at the Society of Critical Care Medicine (SCCM) annual meeting, held during February 2012 in Houston (TX, USA).

“We've just begun to look at this issue,” said lead author and study presenter Laura Jones, PhD. “Our findings were unexpected, because we hypothesized that the time spent with each patient wouldn't change significantly during rounds. At this point, we really don't know whether spending less time with patients has clinical significance.”

Clinical rounds play a major role in establishing a patient's short- and long-term goals and communicating the goals to both patients and clinical staff. Discussions during rounds can range from formal and highly structured to free form, which can have a substantial impact on the efficiency and effectiveness of rounds and, potentially quality of care.

 

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