Published in:
01-12-2015 | Original Research
The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients’ Outcomes
Published in: Journal of General Internal Medicine | Issue 12/2015
Login to get accessABSTRACT
BACKGROUND
Sensemaking is the social act of assigning meaning to ambiguous events. It is recognized as a means to achieve high reliability. We sought to assess sensemaking in daily patient care through examining how inpatient teams round and discuss patients.
OBJECTIVE
Our purpose was to assess the association between inpatient physician team sensemaking and hospitalized patients’ outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates.
DESIGN
Eleven inpatient medicine teams’ daily rounds were observed for 2 to 4 weeks. Rounds were audiotaped, and field notes taken. Four patient discussions per team were assessed using a standardized Situation, Task, Intent, Concern, Calibrate (STICC) framework.
PARTICIPANTS
Inpatient physician teams at the teaching hospitals affiliated with the University of Texas Health Science Center at San Antonio participated in the study. Outcomes of patients admitted to the teams were included.
MAIN MEASURES
Sensemaking was assessed based on the order in which patients were seen, purposeful rounding, patient-driven rounding, and individual patient discussions. We assigned teams a score based on the number of STICC elements used in the four patient discussions sampled. The association between sensemaking and outcomes was assessed using Kruskal-Wallis sum rank and Dunn’s tests.
KEY RESULTS
Teams rounded in several different ways. Five teams rounded purposefully, and four based rounds on patient-driven needs. Purposeful and patient-driven rounds were significantly associated with lower complication rates. Varying the order in which patients were seen and purposefully rounding were significantly associated with lower LOS, and purposeful and patient-driven rounds associated with lower ULOS. Use of a greater number of STICC elements was associated with significantly lower LOS (4.6 vs. 5.7, p = 0.01), ULOS (0.3 vs. 0.6, p = 0.02), and complications (0.2 vs. 0.5, p = 0.0001).
CONCLUSIONS
Improving sensemaking may be a strategy for improving patient outcomes, fostering a shared understanding of a patient’s clinical trajectory, and enabling high reliability.