Wall‐mounted folding chairs to promote resident physician sitting at the hospital bedside

Abstract

AbstractBackgroundSitting at the bedside may improve patient‐clinician communication; however, many clinicians do not regularly sit during inpatient encounters.ObjectiveTo determine the impact of adding wall‐mounted folding chairs inside patient rooms, beyond any impact from a resident education campaign, on the patient‐reported frequency of sitting at the bedside by internal medicine resident physicians.Design, Setting, and ParticipantsProspective, controlled pre‐post trial between 2019 and 2022 (data collection paused 2020–2021 due to COVID‐19) at an academic hospital in Baltimore, Maryland. Folding chairs were installed in two of four internal medicine units and educational activities were delivered equally across all units.Main Outcome and MeasuresPatient‐reported frequency of sitting at bedside, assessed as means on Likert‐type items with 1 being “never” and 5 being “every single time.” We also examined the frequency of other patient‐reported communication behaviors.ResultsTwo hundred fifty six and 206 patients enrolled in the pre and post‐intervention periods, respectively. The mean frequency of patient‐reported sitting by resident physicians increased from 1.8 (SD 1.2) to 2.3 (1.2) on education‐only units (absolute difference 0.48 [95% CI: 0.21–0.75]) and from 2.0 (1.3) to 3.2 (1.4) on units receiving chairs (1.16, [0.87–1.45]). Comparing differences between groups using ordered logistic regression adjusting for clustering within residents, units with added chairs had greater increases in sitting (odds ratio 2.05 [1.10–3.82]), spending enough time at the bedside (2.43 [1.32–4.49]), and checking for understanding (3.04 [1.44–6.39]). Improvements in sitting and other behaviors were sustained on both types of units.ConclusionsAdding wall‐mounted folding chairs may help promote effective patient‐clinician communication.