Date Published: February 7, 2017
Publisher: Public Library of Science
Author(s): Christophe Luthy, Patricia Francis Gerstel, Angela Pugliesi, Valérie Piguet, Anne-Françoise Allaz, Christine Cedraschi, Iratxe Puebla.
Concerns that bedside presentation (BsP) rounds could make patients uncomfortable led many residency programs to move daily rounds outside the patients’ room (OsPR). We performed a prospective quasi-experimental controlled study measuring the effect of these two approaches on patient satisfaction.
Patient satisfaction was measured using the Picker questionnaire (PiQ). Results are expressed in problematic percentage scores scaled from 0 = best-100 = worst. During three months, 3 wards of a 6 ward medical rehabilitation division implemented BsP and 3 control wards kept their usual organization of rounds. In total, 90 patients of each group were included in the study and completed the PiQ.
Socio-clinical characteristics were similar in both groups: mean age = 67 years (SD = 13), mean Charlson comorbidity index = 8.6 (2.4); mean length of stay = 22 days (12). During their stay, patients in the BsP units had a mean of 14.3 (8) BsP rounds and 0.5 (0.8) OsPR; control patients had a mean of 0.9 (0.7) BsP and 14.8 (7.3) OsPR (p<0.0001). Patients in BsP units reported lower problematic scores regarding coordination of care (39% vs 45%, p = 0.029), involvement of family/friends (29 vs 41%, p = 0.006) and continuity/transition (44% vs 54%, p = 0.020); two questions of the PiQ had worse scores in the BsP: trust in nurses (46.7% vs 30 %, p = 0.021) and recommendation of the institution (61.1% vs 44.4%. p = 0.025). No worsening in dimensions such as respect for patient preferences was seen. BsP rounds influenced the patient-healthcare professionals’ encounter. These rounds were associated with improved patient satisfaction with care, particularly regarding interprofessional collaboration and discharge planning.
Time dedicated to ward rounds (between 3 and 12 minutes per patient) varies according to the clinical setting . In any case, these rounds constitute an important part of the healthcare team workday . Bedside rounds is a manifold task as it aims to gather and synthesize information about patients, to transmit interdisciplinary information, to build a shared project of care and decision making with the patient. These tasks require medical knowledge, communication skills, both with patients and with multidisciplinary healthcare teams, as well as a capacity to deal with time and organizational constraints .
This pragmatic study showed that when assigned to conduct rounds as usual, healthcare teams perform a vast majority of visits in the hallway and only few visits at the patient’s bedside. Yet, when requested to conduct bedside rounds, they change their usual clinical practice and the number of visits at the patient’s bedside significantly increases. This change was associated with a significant improvement of patient satisfaction with care, in particular with identification of the treating physician and nurse, the possibility of getting sufficient information about one’s health and treatment, the ability to express one’s worries and fears with the physician or nurse in charge, the opportunity to discuss treatments tailored to the patient’s needs and to use a shared-decision making approach; these elements may contribute to significant improvements in terms of satisfaction with the dimensions of treatment coordination, information and discharge planning. In addition, despite potential breaches in confidentiality or possible use of medical jargon, the bedside rounds group experienced no decrease in the dimension of satisfaction related to feeling respected as an individual. Considering this general picture, it somehow comes as a surprise that recommendation of the hospital was lower in the bedside rounds group than in the control group; however, it is also noteworthy that the additional satisfaction item related to restriction of care due to financial constraints showed that this was less of a preoccupation in this group. This latter result is in line with the absence changes in the hospital setting, i.e. the two groups had similar staffing and number of procedures during the study period.
Bedside visits are an essential part of inpatient care that contributes to increased patient satisfaction with better family involvement, care coordination and transition of care. However, bedside visits can also be associated with worse scores on certain items such as trust in nurses and hospital recommendation. Even though our study did not explore the reasons for this, it could be that insufficient preparation of the healthcare team and lack of allotment of roles prior to visits contributed to this result. Further studies need to be conducted to explore these aspects and to determine if better preparation and role assignment will lead to increased confidence. Nevertheless, the challenge remains in improving interdisciplinary education and training and in developing quality metrics specific to bedside visits that emphasize and enhance teamwork.