A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours - 21/08/11
, Karen D. Horvath, MD ⁎ : FACS, William B. Lober, MD †, Anthony J. Rossini, ScD †, Carlos A. Pellegrini, MD : FACS Department of Surgery, University of Washington, Seattle, WA Correspondence address: Karen Horvath, MD, FACS, Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA 98195-6410.Résumé |
Background |
Adoption of limits on resident work hours prompted us to develop a centralized, Web-based computerized rounding and sign-out system (UWCores) that securely stores sign-out information; automatically downloads patient data (vital signs, laboratories); and prints them to rounding, sign-out, and progress note templates. We tested the hypothesis that this tool would positively impact continuity of care and resident workflow by improving team communication involving patient handovers and streamlining inefficiencies, such as hand-copying patient data during work before rounds (“prerounds”).
Study design |
Fourteen inpatient resident teams (6 general surgery, 8 internal medicine) at two teaching hospitals participated in a 5-month, prospective, randomized, crossover study. Data collected included number of patients missed on resident rounds, subjective continuity of care quality and workflow efficiency with and without UWCores, and daily self-reported prerounding and rounding times and tasks.
Results |
UWCores halved the number of patients missed on resident rounds (2.5 versus 5 patients/team/month, p = 0.0001); residents spent 40% more of their prerounds time seeing patients (p = 0.36); residents reported better sign-out quality (69.6% agree or strongly agree); and improved continuity of care (66.1% agree or strongly agree). UWCores halved the portion of prerounding time spent hand-copying basic data (p < 0.0001); it shortened team rounds by 1.5 minutes/patient (p = 0.0006); and residents reported finishing their work sooner using UWCores (82.1% agree or strongly agree).
Conclusions |
This system enhances patient care by decreasing patients missed on resident rounds and improving resident-reported quality of sign-out and continuity of care. It decreases by up to 3 hours per week (range 1.5 to 3) the time used by residents to complete rounds; it diverts prerounding time from recopying data to more productive tasks; and it facilitates meeting the 80-hour work week requirement by helping residents finish their work sooner.
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| Competing interests declared: None. Drs Van Eaton and Lober have filed a Provisional Patent Application in the US Patent Office as application No. 60,582,434: “Method and System for Managing Healthcare Provider Rounding and Sign-out Information.” No financial or licensing arrangements regarding the system herein described currently exist with any organization. |
Vol 200 - N° 4
P. 538-545 - avril 2005 Retour au numéro
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