A Time-Motion Study of Inpatient Rounds Using a Family-Centered Rounds Model

Abstract

Objective: Family-centered rounds (FCR) have become increasingly prevalent in pediatric hospital settings. The objective of our study was to describe time use and discrete events during pediatric inpatient rounds by using a FCR model. Methods: We conducted a prospective observational study at Children’s National Medical Center between September 2010 and February 2011. Investigators directly observed rounds on hospitalist and neurology services. Events were timed, and key features were recorded by using a Microsoft Access-based program. Associations with increased time spent during rounds were determined by using regression analyses. Results: One hundred fifty-nine rounding encounters were observed. Rounds lasted 7.9 minutes on average per patient. An average of 1.3 minutes was spent between patients during rounds. Eighty-six (54%) encounters occurred outside the patient’s room, 3% of the time because of the family’s request. Infectious isolation was associated with rounds occurring outside the room (P < .0001). Participation of the parent, location of rounds inside or outside the patient’s room, most teaching behaviors, and interruptions were not significantly associated with increased time spent during rounds. Teaching physical examination techniques by allowing multiple trainees to examine the patient was associated with increased rounding time (P = .02). Conclusions: The majority of rounds occurred outside the patient’s room, yet rarely at the parent’s request. Patients on infectious isolation were more likely to have rounds occur outside the patient’s room. Neither parental participation nor most teaching behaviors were associated with increased time spent on rounds. These findings will enrich the evidence base needed to establish FCR best practices.