The association between residents' work-rounds styles and the process and outcome of medical care.

OBJECTIVE: To determine whether the manner in which residents conduct work rounds is associated with the adequacy of their care processes and the outcomes of their patients. METHODS: Two types of data were collected: time and motion data for residents (n = 12) during work rounds, and clinical and outcome data for the patients they cared for during the observation period (n = 211). Five residents were classified as data gatherers because they spent twice as much time gathering clinical data about their patients as they spent engaging in other activities. Three physicians blinded to the resident's identity rated the quality of the care process and assessed the frequency of undesirable events occurring during the stay and after discharge. RESULTS: A data-gathering style was associated with higher quality of care as judged by both process and outcomes. The data gatherers were more likely to comply with the "stability of medications before discharge" criterion (86% of the data gatherers' cases vs 73% of others', p = 0.07), and their patients were less likely to have unanticipated problems, in that fewer required calls from nurses (20% vs 37%, p < 0.01) and visits by on-call housestaff (33% vs 50%, p = 0.01). The data gatherers' patients were less likely to be readmitted within 30 days (14% vs 38%, p < 0.01). CONCLUSIONS: A data-gathering work-rounds style is associated with better process and outcome. Residency programs should provide formal instruction to trainees in the conduct of work rounds.

Characteristics of house staff work rounds on two academic general medicine services.

In this study, the authors determined how residents in internal medicine allotted their time during patient management rounds (work rounds). Fourteen house staff teams were observed for four days each, and the time spent on all activities was recorded. Of the 56 days studied, work rounds were not conducted on nine days. On the 47 days during which work rounds occurred, only 502 (76.4 percent) of a possible 657 visits to patients were made. Daily time spent on work rounds by each team averaged 49.4 minutes (range: 23.9 to 73.1), or 4.6 minutes (range: 2.3 to 6.6) per patient evaluated. Some part of a physical examination was performed on only 44 percent of the patients. For those patients examined, the average time of an examination was approximately one minute per patient. Vital signs sheets and medication sheets were reviewed infrequently. This study suggests that medical educators should be concerned about the thoroughness of house staff work rounds.