Journal of General Internal Medicine

, Volume 29, Issue 7, pp 1040–1047 | Cite as

Patient-Centered Interprofessional Collaborative Care: Factors Associated with Bedside Interprofessional Rounds

  • Jed D. Gonzalo
  • Daniel R. Wolpaw
  • Erik Lehman
  • Cynthia H. Chuang
Original Research



Medical care delivered in hospital-based medicine units requires interprofessional collaborative care (IPCC) to improve quality. However, models such as bedside interprofessional rounds, or encounters that include the team of physician and nurse providers discussing medical care at the patient’s bedside, are not well studied.


To examine the incidence of and time spent in bedside interprofessional rounds on internal medicine teaching services in one academic medical center.


Observational descriptive study of internal medicine faculty serving as inpatient medicine attending physicians. Participants completed a daily electronic survey following team rounding sessions to assess rounding characteristics (November 2012–June 2013); variables such as resident level-of-training, attending physician years’ of experience, house staff call day and clinic schedule were obtained from administrative data. Descriptive, Kruskal-Wallis, and multivariable logistic regression statistics were used to evaluate the study objectives.


Primary outcomes were: (1) incidence of bedside interprofessional rounds, (2) time spent with patients during bedside interprofessional rounding encounters, and, (3) factors associated with increased occurrence of and time spent with patients during bedside interprofessional rounds. Covariates included resident level-of-training, attending physician years’ of experience, census size, and call day.


Of 549 rounding sessions, 412 surveys were collected (75 % response) from 25 attending physicians. Bedside interprofessional rounds occurred with 64 % of patients (median 8.0 min/encounter), differing by unit (intermediate care 81 %, general medicine 63 %, non-medicine 57 %, p < 0.001). Factors independently associated with increased occurrence of bedside interprofessional rounds were senior resident (OR 2.67, CI 1.75–4.06, PGY-3/PGY-4 vs. PGY-2), weekdays (OR 1.74, CI 1.13–2.69), team census size ≤ 11 (OR 2.36, CI 1.37–4.06), and attending physicians with ≤ 4 years’ experience (OR 2.15, CI 1.31–3.55). Factors independently associated with increased time spent during encounters were attending physicians with ≤ 4 years (OR 2.38, CI 1.44–3.95), 5–15 years of experience (OR 1.82, CI 1.10–3.02), and weekdays (OR 1.71, CI 1.10–2.65).


These findings highlight factors associated with increasing or decreasing occurrence and time spent in bedside interprofessional collaborative care delivery. Systematic changes to census size caps, resident scheduling, and attending physician education and staffing may be required to increase the occurrence of interprofessional collaborative care.


interprofessional care hospital-based care graduate medical education bedside rounds 


  1. 1.
    Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009;3, CD000072.PubMedGoogle Scholar
  2. 2.
    Davies C. Getting health professionals to work together. BMJ. 2000;320(7241):1021–1022.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Butcher L. Teamswork! Hospitals & health networks/AHA. Mar 2012;86(3):24–27, 21.Google Scholar
  4. 4.
    Schmitt MH, Gilbert JH, Brandt BF, Weinstein RS. The coming of age for interprofessional education and practice. Am J Med. 2013;126(4):284–288.PubMedCrossRefGoogle Scholar
  5. 5.
    Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, D.C.: National Academy Press; 2000.Google Scholar
  6. 6.
    Curley C, McEachern JE, Speroff T. A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care. 1998;36(8 Suppl):AS4–AS12.PubMedGoogle Scholar
  7. 7.
    Foundation. JMJ. Transforming Patient Care: Aligning Interprofessional Education and Clinical Practice Redesign.; January 17–20, 2013., 2013; Atlanta, GA.Google Scholar
  8. 8.
    Reeves S, Lewin S. Interprofessional collaboration in the hospital: strategies and meanings. J Health Serv Res Pol. 2004;9(4):218–225.CrossRefGoogle Scholar
  9. 9.
    Gonzalo JD, Masters PA, Simons RJ, Chuang CH. Attending rounds and bedside case presentations: medical student and medicine resident experiences and attitudes. Teach Learn Med. 2009;21(2):105–110.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Gonzalo JD, Chuang CH, Huang G, Smith C. The return of bedside rounds: an educational intervention. J Gen Intern Med. 2010;25(8):792–798.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Gonzalo J. The return of bedside rounds. Journal of General Internal Medicine. Nov 9 2010.Google Scholar
  12. 12.
    Lehmann LS, Brancati FL, Chen MC, Roter D, Dobs AS. The effect of bedside case presentations on patients’ perceptions of their medical care. N Engl J Med. 1997;336(16):1150–1155.PubMedCrossRefGoogle Scholar
  13. 13.
    Gonzalo JD, Heist BS, Duffy BL, et al. The value of bedside rounds: a multicenter qualitative study. Teach Learn Med. 2013;25(4):326–333.PubMedCrossRefGoogle Scholar
  14. 14.
    Nair BR, Coughlan JL, Hensley MJ. Impediments to bed-side teaching. Med Educ. 1998;32(2):159–162.PubMedCrossRefGoogle Scholar
  15. 15.
    Ramani S, Orlander JD, Strunin L, Barber TW. Whither bedside teaching? A focus-group study of clinical teachers. Acad Med. 2003;78(4):384–390.PubMedCrossRefGoogle Scholar
  16. 16.
    Gonzalo JD, Heist BS, Duffy BL, et al. Identifying and overcoming the barriers to bedside rounds: a multicenter qualitative study. Acad Med. 2014;89(2):326–334.PubMedCrossRefGoogle Scholar
  17. 17.
    Stickrath C, Noble M, Prochazka A, et al. Attending rounds in the current era: what is and is not happening. JAMA. 2013;173(12):1084–1089.Google Scholar
  18. 18.
    Horwitz RI, Kassirer JP, Holmboe ES, et al. Internal medicine residency redesign: proposal of the Internal Medicine Working Group. Am J Med. 2011;124(9):806–812.PubMedCrossRefGoogle Scholar
  19. 19.
    Stickrath C, Aagaard E, Anderson M. MiPLAN: a learner-centered model for bedside teaching in today’s academic medical centers. Acad Med. 2013;88(3):322–327.PubMedCrossRefGoogle Scholar
  20. 20.
    Gonzalo J, Herzig S, Reynolds E, Yang J. Factors associated with non-compliance during 16-hour long call shifts. J Gen Intern Med. 2012;27(11):1424–1431.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Gonzalo JD, Heist BS, Duffy BL, et al. The art of bedside rounds: a multi-center qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med. 2013;28(3):412–420.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Kroenke K. Attending rounds: guidelines for teaching on the wards. J Gen Intern Med. 1992;7(1):68–75.PubMedCrossRefGoogle Scholar
  23. 23.
    LaCombe MA. On bedside teaching. Ann Intern Med. 1997;126(3):217–220.PubMedCrossRefGoogle Scholar
  24. 24.
    Janicik RW, Fletcher KE. Teaching at the bedside: a new model. Med Teach. 2003;25(2):127–130.PubMedCrossRefGoogle Scholar
  25. 25.
    Landry MA, Lafrenaye S, Roy MC, Cyr C. A randomized, controlled trial of bedside versus conference-room case presentation in a pediatric intensive care unit. Pediatrics. 2007;120(2):275–280.PubMedCrossRefGoogle Scholar
  26. 26.
    O’Leary KJ, Buck R, Fligiel HM, et al. Structured interdisciplinary rounds in a medical teaching unit: improving patient safety. Arch Intern Med. 2011;171(7):678–684.PubMedGoogle Scholar
  27. 27.
    Crumlish CM, Yialamas MA, McMahon GT. Quantification of bedside teaching by an academic hospitalist group. J Hosp Med. 2009;4(5):304–307.PubMedCrossRefGoogle Scholar
  28. 28.
    Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA: J Am Med Assoc. 2008;300(10):1146–1153.CrossRefGoogle Scholar
  29. 29.
    ACGME. ACGME Outcomes Project. 1999. Accessed February 7, 2014
  30. 30.
    Gonzalo J. Bedside rounding strategies used by bedside teachers. The authors’ reply. J Gen Intern Med. 2013;28(9):1131.PubMedCrossRefGoogle Scholar
  31. 31.
    McCoy CP, Stenerson MB, Halvorsen AJ, Homme JH, McDonald FS. Association of volume of patient encounters with residents’ in-training examination performance. J Gen Intern Med. 2013;28(8):1035–1041.PubMedCrossRefGoogle Scholar
  32. 32.
    McMahon GT, Katz JT, Thorndike ME, Levy BD, Loscalzo J. Evaluation of a redesign initiative in an internal-medicine residency. N Engl J Med. 2010;362(14):1304–1311.PubMedCrossRefGoogle Scholar
  33. 33.
    O’Leary KJ, Thompson JA, Landler MP, et al. Patterns of nurse-physician communication and agreement on the plan of care. Qual Saf Health Care. 2010;19(3):195–199.PubMedCrossRefGoogle Scholar
  34. 34.
    O’Leary KJ, Ritter CD, Wheeler H, Szekendi MK, Brinton TS, Williams MV. Teamwork on inpatient medical units: assessing attitudes and barriers. Qual Saf Health Care. 2010;19(2):117–121.PubMedCrossRefGoogle Scholar
  35. 35.
    Havens DS, Vasey J, Gittell JH, Lin WT. Relational coordination among nurses and other providers: impact on the quality of patient care. J Nurs Manag. 2010;18(8):926–937.PubMedCrossRefGoogle Scholar
  36. 36.
    Reeves S, Zwarenstein M, Goldman J, et al. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008;1, CD002213.PubMedGoogle Scholar
  37. 37.
    Lefrancois D, Leung S. Bedside rounding strategies used by bedside teachers. J Gen Intern Med. 2013;28(9):1130.PubMedCrossRefGoogle Scholar
  38. 38.
    Weinstein RS, Brandt BF, Gilbert JH, Schmitt MH. Bridging the quality chasm: interprofessional teams to the rescue? Am J Med. 2013;126(4):276–277.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Jed D. Gonzalo
    • 1
    • 2
  • Daniel R. Wolpaw
    • 1
    • 3
  • Erik Lehman
    • 2
  • Cynthia H. Chuang
    • 1
    • 2
  1. 1.Department of MedicinePennsylvania State University College of MedicineHersheyUSA
  2. 2.Department of Public Health ServicesPennsylvania State University College of MedicineHersheyUSA
  3. 3.Kienle Center for Humanistic MedicinePennsylvania State University College of MedicineHersheyUSA

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