- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01931553
A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
Back to Bedside: A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine
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.
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
California
-
San Francisco, California, United States, 94143
- University of California San Francisco Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 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
Exclusion Criteria:
- None
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Standardized attending morning rounds
|
|
No Intervention: Usual rounding practice
Usual rounding practice (as defined by each clinical team)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient satisfaction with morning rounds
Time Frame: 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.
|
Once, after day one of hospitalization and before patient is discharged.
|
Patient satisfaction with provider communication
Time Frame: 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
|
Once, within one month of hospital discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Interns total length of workday
Time Frame: Daily during the 3-month trial
|
The interns total length of workday will be recorded daily.
Over the course of the trial the average length of workday will be determined including any duty hour violations.
|
Daily during the 3-month trial
|
Number of consultations ordered before noon
Time Frame: Daily during the 3-month trial
|
The number of consultations ordered before noon will be recorded daily.
Over the course of the trial the average number of consultations ordered before noon will be calculated.
|
Daily during the 3-month trial
|
Resident satisfaction
Time Frame: Once during the last week of their rotation on a given team
|
Resident satisfaction and perceptions of with morning rounds (e.g.
efficiency, organization, educational value)
|
Once during the last week of their rotation on a given team
|
Attending physician satisfaction
Time Frame: Once during the last week of their rotation on a given team
|
Attending physician satisfaction and perceptions of with morning rounds (e.g.
efficiency, organization, educational value)
|
Once during the last week of their rotation on a given team
|
Medical student satisfaction
Time Frame: Once during the last week of their rotation on a given team
|
Medical student satisfaction and perceptions of with morning rounds (e.g.
efficiency, organization, educational value)
|
Once during the last week of their rotation on a given team
|
Nurse participation in morning rounds
Time Frame: Daily during the 3-month trial
|
The presence of RN during morning ward rounds will be recorded daily.
|
Daily during the 3-month trial
|
Nurse satisfaction
Time Frame: Once during the last week the trial
|
Nurse satisfaction and perceptions of with morning rounds (e.g.
efficiency, organization, team work)
|
Once during the last week the trial
|
Intern satisfaction
Time Frame: Once during the last week of their rotation on a given team
|
Intern satisfaction and perceptions of with morning rounds (e.g.
efficiency, organization, educational value)
|
Once during the last week of their rotation on a given team
|
Total morning rounding time
Time Frame: Daily during the 3-month trial
|
Total morning rounding time will be recorded daily for each team.
Over the course of the trial the average length of morning rounds will be determined.
|
Daily during the 3-month trial
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of discharges before noon
Time Frame: Daily during the 3-month trial
|
Daily during the 3-month trial
|
|
Cost of care per patient
Time Frame: For entire 3 month study period
|
Average cost of care per patients for each group for entire 3-month study period
|
For entire 3 month study period
|
Length of stay
Time Frame: For entire 3 month study period
|
Average length of stay for each group for entire 3-month study period
|
For entire 3 month study period
|
30-day readmission rate
Time Frame: For entire 3 month study period
|
Average readmission rate for each group for entire 3-month study period
|
For entire 3 month study period
|
Adherence to the intervention
Time Frame: Daily during the 3-month trial
|
Adherence to the standardized intervention will be recorded throughout the trial to determine the uptake of this intervention in everyday practice.
|
Daily during the 3-month trial
|
Collaborators and Investigators
Investigators
- Principal Investigator: Brad Monash, MD, University of California, San Francisco
- Principal Investigator: James D Harrison, PhD, University of California, San Francisco
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- RoundingUCSF
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Hospitalization
-
Fadoi Foundation, ItalyUniversity of GenovaUnknown
-
Kaiser PermanenteCompletedHospitalizationUnited States
-
Fadoi Foundation, ItalyCompleted
-
VA Office of Research and DevelopmentCompleted
-
Centre Hospitalier Universitaire de NīmesCompleted
-
Oregon Health and Science UniversityCompleted
-
Fadoi Foundation, ItalyANìMO (Associazione Nazionale Infermieri Medicina)Terminated
-
Children's Hospital of PhiladelphiaAcademic Pediatric AssociationCompletedHospitalizationUnited States
-
Mayo ClinicAgency for Healthcare Research and Quality (AHRQ)Completed
-
Western Galilee Hospital-NahariyaCompleted