Background Bedside rounds (BR) have been proposed as an ideal method to promote patient-centred hospital care, but there is substantial variation in their implementation and effects Our objectives were to describe the implementation of BR in hospital settings and determine their effect on patient-centred outcomes Methods Data sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through 28 July 2017 We included experimental studies comparing BR to another form of rounds in a hospital-based setting (ie, medical/surgical unit, intensive care unit (ICU)) and reporting a quantitative patient-reported or objectively measured clinical outcome We used random effects models to calculate pooled Cohen9s d effect size estimates for the patient knowledge and patient experience outcome domains Results Twenty-nine studies met inclusion criteria, including 20 from adult care (17 non-ICU, 3 ICU), and nine from paediatrics (5 non-ICU, 4 ICU), the majority of which (n=23) were conducted in the USA Thirteen studies implemented BR with cointerventions as part of a ‘bundle’ Studies most commonly reported outcomes in the domains of patient experience (n=24) and patient knowledge (n=10) We found a small, statistically significant improvement in patient experience with BR (summary Cohen’s d=009, 95% CI 004 to 014, p Conclusions BR have been implemented in a variety of hospital settings, often ‘bundled’ with cointerventions However, BR have demonstrated limited effect on patient-centred outcomes

https://qualitysafety.bmj.com/content/qhc/early/2018/09/16/bmjqs-2017-007778.full.pdf

Implementing bedside rounds to improve patient-centred outcomes: a systematic review.

Ward rounds are important for communicating with patients, but it is unclear whether bedside or non-bedside case presentation is the better approach. We conducted a comprehensive search up to July 2018 to identify randomized controlled trials (RCTs) comparing bedside and non-bedside case presentations. Data was abstracted independently by two researchers and study quality was assessed using the Cochrane Risk of Bias Tool. Our primary outcome was patient’s satisfaction with ward rounds. Our main secondary outcome was patient’s understanding of disease and the management plan. Among 1647 identified articles, we included five RCTs involving 655 participants with overall moderate trial quality. We found no difference in having low patient’s satisfaction between bedside and non-bedside case presentations (risk ratio [RR], 0.85; 95% CI, 0.66 to 1.09). We also found no impact on patient’s understanding of their disease and management plan (RR, 0.92; 95% CI, 0.67 to 1.28). Trial sequential analysis (TSA) indicated low power of our main analysis. We found no differences in patient-relevant outcomes between bedside and non-bedside case presentations with a lack of statistical power among current trials. There is a need for larger studies to find the optimal approach to patient case presentation during ward rounds.

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Effect of Bedside vs. Non-bedside Patient Case Presentation During Ward Rounds: a Systematic Review and Meta-analysis

Strategies to Improve Bedside Clinical Skills Teaching

Introduction Research assessing the size of learning groups in medical education and how that affects the learner's experience is limited. The main goals of the study were to (1) assess the effect of varying group size on medical students' subjective experiences during clinical years. We hypothesized that students in smaller groups were more likely to have better experiences during clinical rotation than those in larger groups, and (2) determine if medical students have desirable experiences working with other medical learners (fellows, residents, osteopathic students, physician assistants, and nurse practitioners) during clinical rotations. Methods The study utilized a mixed method approach where 153 medical students in their clinical years were asked to complete a 10-item survey. A linear-by-linear association test of trend and Mann-Whitney U test were used to evaluate the students' quantitative data. A multidisciplinary team used an immersion-crystallization approach to analyze the content of the students' qualitative data. Results There was a 90% (137/153) response rate. Most students (80%) reported desirable experiences during clinical rotations because of supportive learning environments, engaging preceptors, willingness of residents to teach, as well as the opportunity to participate in patient care. There were significant differences in students' perceived clinical experiences as a function of group size, where groups of two students were preferable over groups of four or more. Conclusions Varying group size appears to affect students' clinical experiences.

Exploring the Impact of Group Size on Medical Students' Perception of Learning and Professional Development During Clinical Rotations.

This study was approved by Partners Institutional Review Board. Patients, residents, nurses, and attendings provided verbal consent for surveys and written consent to be videotaped. Study and control patients were asked to participate (AAP and HMS). Interested study patients were “coached” for 15– 30 min by the resident (AAP) the day before to ask a question. The resident (AAP) created a brightly colored folder (Staples File Folders, Assorted Colors # 875429) which showed the question on the front and answer inside (see Fig. 1). The answer required approximately 30 min to produce. Rounds began with the patient holding up the question. The team’s answers acted as the jumping off point for teaching by the resident (AAP) filmed by IAK. Control patients were filmed (HMS) during usual bedside rounds. The bedside rounds were videotaped using an iPhone 6 and stored on a password protected Drop Box. The videos were evaluated by physicians using a verbal and non-verbal previously validated checklist with permission. The first two video evaluators were trained by AAP in a short session lasting 5–10 min. When significant interobserver variability was noted, seven new evaluators were given more extensive training for at least 15–30 min. The first set of evaluators’ data was not included. A statistician calculated descriptive statistics and analyzed data using Z test for proportions. RESULTS

/pdf/patient-as-co-teacher-on-rounds-a-pilot-study-1o70shuzsf.pdf

Patient as Co-Teacher on Rounds: a Pilot Study.

Objectives Many barriers have been cited in reference to why bedside teaching rounds have decreased in frequency during graduate medical education. One perceived barrier to the use of bedside teaching rounds is a fear of it causing patient discomfort or dissatisfaction. The objective of this study was to compare patient perception of bedside versus nonbedside teaching rounds. Methods Study participants were adults admitted to a family medicine inpatient team at a large university teaching hospital. Upon admission, participants were randomized to receive bedside or nonbedside teaching rounds conducted by a team consisting of medical students, family medicine residents, and one attending physician. Each participant completed a questionnaire administered on the day of discharge assessing patients' perception of their involvement in medical decision making, trust in the medical team, satisfaction with care, and provider compassion. Statistical analysis was performed to examine any differences between the two groups. Results The vast majority of the sample indicated that they knew what they were being treated for in the hospital (n = 105, 98%), reported the medical team spent an adequate amount of time with them (n = 100, 94%), and reported the medical team explained the diagnosis and care in easy-to-understand terms (n = 101, 94%). On 1- to 5-point scales, participants reported that the medical team involved them in making decisions (4.62, standard deviation [SD] 0.72), they trusted the medical team (4.91, SD 0.32), they were satisfied with their care (4.85, SD 0.38), and their medical team was compassionate toward them (4.84, SD 0.44). Overall levels of satisfaction were positive on all of the measures, with no statistical significance between the two groups regarding measures of involvement in medical decision making, trust in the medical team, and satisfaction with care. Interestingly, subjects perceived level of compassion of their medical team to be significantly higher with a bedside teaching approach compared with a nonbedside approach. Conclusions Despite concerns that bedside teaching rounds may lead to patient discomfort, this study found no evidence supporting this perception. In fact, patients may perceive a medical team that engages in bedside teaching rounds as being more compassionate providers, supporting a patient-centered argument that teaching rounds should return to the bedside.

Jason Singh

Papers

Patient Satisfaction with Bedside Teaching Rounds Compared with Nonbedside Rounds.