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

ABSTRACT

BACKGROUND

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.

OBJECTIVE

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

DESIGN AND PARTICIPANTS

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.

MAIN MEASURES

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.

KEY RESULTS

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).

CONCLUSIONS

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.

KEY WORDS

interprofessional care hospital-based care graduate medical education bedside rounds 

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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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