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Journal of General Internal Medicine

Published in:

05-05-2022 | Original Research

Association of Mobile Workstations and Rounding-in-Flow with Resident Efficiency: A Controlled Study at an Academic Internal Medicine Department

Authors: Heather Balch, MD, Casey Gradick, MD, MPH, Polina V. Kukhareva, MS, MPH, PhD, Nathan Wanner, MD

Published in: Journal of General Internal Medicine | Issue 14/2022

Abstract

Background

Residents commonly use a batched workflow to round on hospitalized patients, creating redundancy and decreasing efficiency.

Objective

To improve resident efficiency through a novel workflow using mobile laptops and modified rounding-in-flow.

Design, Setting, Participants

A controlled experimental study conducted at an academic medical center for 3 months. One internal medicine team served as the intervention group, and two other teams served as a control group; 34 interns and 20 senior residents participated.

Intervention

Residents in the intervention group were provided a novel workflow and a mobile laptop to allow them to round “in-flow.” Control group residents rounded as usual (batched workflow without laptops).

Main Measures

Fourteen interns were monitored for a time-motion study. Time-stamped electronic medical record (EMR) data were used to assess percentage of progress notes and orders placed during rounds (9 a.m.–12:30 p.m.) and percentage of discharge summaries signed within 24 h of discharge. A post-intervention survey measured perceived efficiency.

Results

A time-motion study showed non-significant differences between time in the intervention group and that in the control group: communication time with patients (128 min vs 105 min, p = 0.37) and computer time (289 min vs 306 min, p = 0.71). EMR data for 664 visits in the control group and 374 in the intervention group showed that rounding-in-flow was associated with an odds ratio (OR) of 1.5 for placing progress notes during rounds (95% CI: 1.2–1.7, p < 0.001), an OR of 1.1 for placing non-discharge orders during rounds (95% CI: 1.0–1.2, p = 0.01), and an OR of 3.9 for signing discharge summaries within 24 h of discharge (95% CI: 2.3–7.2, p < 0.001). Post-intervention survey, completed by 23 of 34 interns, showed that interns in the intervention group perceived that orders were completed during rounds more often than the control group (OR 7.8; 95% CI: 1.3–60.1, p = 0.03).

Conclusions

Using mobile laptops with modified rounding-in-flow was associated with earlier completion of residents’ work, suggesting improved efficiency.

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Title: Association of Mobile Workstations and Rounding-in-Flow with Resident Efficiency: A Controlled Study at an Academic Internal Medicine Department
Authors: Heather Balch, MD
Casey Gradick, MD, MPH
Polina V. Kukhareva, MS, MPH, PhD
Nathan Wanner, MD
Publication date: 05-05-2022
Publisher: Springer International Publishing
Published in: Journal of General Internal Medicine / Issue 14/2022
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-022-07636-9

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Abstract

Background

Objective

Design, Setting, Participants

Intervention

Main Measures

Results

Conclusions

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