Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  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.

    PubMed  Google Scholar 

  2. Davies C. Getting health professionals to work together. BMJ. 2000;320(7241):1021–1022.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Butcher L. Teamswork! Hospitals & health networks/AHA. Mar 2012;86(3):24–27, 21.

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    CAS  PubMed  Google Scholar 

  7. Foundation. JMJ. Transforming Patient Care: Aligning Interprofessional Education and Clinical Practice Redesign.; January 17–20, 2013., 2013; Atlanta, GA.

  8. Reeves S, Lewin S. Interprofessional collaboration in the hospital: strategies and meanings. J Health Serv Res Pol. 2004;9(4):218–225.

    Article  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Gonzalo J. The return of bedside rounds. Journal of General Internal Medicine. Nov 9 2010.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  14. Nair BR, Coughlan JL, Hensley MJ. Impediments to bed-side teaching. Med Educ. 1998;32(2):159–162.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Kroenke K. Attending rounds: guidelines for teaching on the wards. J Gen Intern Med. 1992;7(1):68–75.

    Article  CAS  PubMed  Google Scholar 

  23. LaCombe MA. On bedside teaching. Ann Intern Med. 1997;126(3):217–220.

    Article  CAS  PubMed  Google Scholar 

  24. Janicik RW, Fletcher KE. Teaching at the bedside: a new model. Med Teach. 2003;25(2):127–130.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  27. Crumlish CM, Yialamas MA, McMahon GT. Quantification of bedside teaching by an academic hospitalist group. J Hosp Med. 2009;4(5):304–307.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  29. ACGME. ACGME Outcomes Project. 1999. http://www.acgme.org. Accessed February 7, 2014

  30. Gonzalo J. Bedside rounding strategies used by bedside teachers. The authors’ reply. J Gen Intern Med. 2013;28(9):1131.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  37. Lefrancois D, Leung S. Bedside rounding strategies used by bedside teachers. J Gen Intern Med. 2013;28(9):1130.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the medicine nursing staff and physicians for their dedication to patient centered care. We would also like to thank the Internal Medicine attending physicians for their willingness to participate in this study.

Conflicts of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA

    Jed D. Gonzalo MD, MSc, Daniel R. Wolpaw MD & Cynthia H. Chuang MD, MS

  2. Department of Public Health Services, Pennsylvania State University College of Medicine, Hershey, PA, USA

    Jed D. Gonzalo MD, MSc, Erik Lehman MS & Cynthia H. Chuang MD, MS

  3. Kienle Center for Humanistic Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA

    Daniel R. Wolpaw MD

Authors
  1. Jed D. Gonzalo MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel R. Wolpaw MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erik Lehman MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cynthia H. Chuang MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jed D. Gonzalo MD, MSc.

Appendix 1: Survey of Inpatient Attending Physicians

Appendix 1: Survey of Inpatient Attending Physicians

figure a

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gonzalo, J.D., Wolpaw, D.R., Lehman, E. et al. Patient-Centered Interprofessional Collaborative Care: Factors Associated with Bedside Interprofessional Rounds. J GEN INTERN MED 29, 1040–1047 (2014). https://doi.org/10.1007/s11606-014-2817-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-014-2817-x

KEY WORDS

Search

Navigation