How Much Time are Physicians and Nurses Spending Together at the Patient Bedside?
BACKGROUND: Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician–nurse (MD–RN) overlap at the patient bedside are lacking.
OBJECTIVE: This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency.
DESIGN: This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology.
SETTING: Single-institution academic hospital.
MEASUREMENTS: The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD–RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station.
RESULTS: A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD–RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD–RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD–RN overlap (Pearson’s r = –0.67, P < .05).
CONCLUSION: RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.
© 2019 Society of Hospital Medicine
Effective communication between physicians and nurses is an essential element of any healthcare system. Numerous studies have highlighted the benefits of high quality physician–nurse (MD–RN) communication, including improved patient outcomes,1 higher patient satisfaction,2 and better nurse job satisfaction and retention rates.3-5 Having physicians and nurses round together (bedside interdisciplinary rounding) has been shown to improve the perception of teamwork,6,7 reduce the number of pages for the physician team,6,8 better involve the patients in developing the plan of care,8 and even decrease the length and cost of stay.9
Being physically in the same space at the same time is the first and nonnegotiable requirement of bedside interdisciplinary rounding. However, precise and objective data regarding the extent to which physicians and nurses overlap at the patient bedside are lacking. Studies that examine the face-to-face component of MD–RN communication have generally relied on either qualitative methods, such as focus groups and surveys,10,11 or quantitative methods that are subjective, such as validated scales.12 In addition, the few studies that report quantitative data usually rely on manual observation methods that can be affected by various forms of observer bias.10,13,14 There is also a paucity of data on how bedside overlap changes over the work week or as a function of room location.
Recently, real-time locator systems using radio frequency identification (RFID) have allowed measurement of staff and equipment movement in a precise and quantitative manner.9,15 Although there have been previous studies using RFID locators to create time-motion maps of various hospital staff, no study has used RFID to measure and analyze the workflow of both physicians and nurses simultaneously.16-18 The purpose of our investigation was to utilize our hospital-wide RFID staff locator technology to accurately and quantitatively assess physician and nurse rounding habits. Understanding the current rate of overlap is an important first step to establishing bedside interdisciplinary rounding.
METHODS
Setting and Participants
The investigation was conducted at a single quaternary-care academic center. The study is exempt per our Institutional Review Board. Data were gathered from three adjacent medical-surgical acute care wards. The layout for each ward was the same: 19 single- or double-occupancy patient rooms arranged in a linear hallway, with a nursing station located at the center of the ward.
The study utilized wearable RFID tags (manufactured by Hill-Rom Holdings, Inc) that located specific staff within the hospital in real time. The RFID tags were checked at Hill-Rom graphical stations to ensure that their locations were tracked accurately. The investigators also wore them and walked around the wards in a prescripted manner to ensure validity. In addition, the locator accuracy was audited by participating attendings once per week and cross-checked with the generated data. Attending physicians on the University Hospitalist inpatient medicine teams were then given their uniquely-tagged RFIDs at the beginning of this study. Nurses already wear individual RFID tags as part of their normal standard-of-care workflow.
The attending hospitalists wore their RFID tags when they were on service for the entirety of the shift. They were encouraged to include nurses at the bedside, but this was not mandatory. The rounding team also included residents and medical students. Rounding usually begins at a prespecified time, but the route taken varies daily depending on patient location. Afternoon rounds were done as needed, depending on patient acuity. The attending physicians’ participation in this study was not disclosed to the patient. The patient care activities and daily routines of both nurses and physicians were otherwise unaltered.
