TY - JOUR
T1 - An Analysis of the Daily Work-Rounding Process in a Pediatric Intensive Care Unit
AU - Gangadharan, Sandeep
AU - Belpanno, Brian
AU - Silver, Peter
N1 - Publisher Copyright:
© National Association for Healthcare Quality.
PY - 2017
Y1 - 2017
N2 - Objective:To complete an objective analysis of the activities that occur during the course of daily rounds in a high acuity academic tertiary care pediatric intensive care unit (PICU).Design:Prospective observational work sampling design.Setting:Tertiary care academic Children's Hospital Pediatric Intensive Care Unit.Subjects:Multidisciplinary PICU teams.Interventions:None.Methods:Intensive care unit rounds were observed as part of an initiative to improve efficiency over a 2-month period. The number of observations required was determined by Neibel's work sampling method. Rounds were broken into various constituent events and then later classified as "value-added/essential," "value-added/nonessential," and "nonessential" based on whether the observed event was essential to the core mission of PICU rounds.Results:The mean time spent per patient for all observed teams was 17.9 min (SD 1.3 min). Teams spent 64% of their time doing value-added/essential tasks (11.2 min, SD 2.2 min) and 13% of their time doing value-added/nonessential tasks (2.4 min, SD 0.9 min). Teams spent 23% of their time on non-value-added activities (4.1 min, SD 2.3 min). The top three non-value-added activities conducted during rounds were travel, waiting, and interruptions regarding care of other patients. Given the consistency of time spent on value-added activities among attendings, these non-value-added activities might explain the significant variability observed among attendings in total time spent rounding.Conclusions:This was an observational study to characterize the activities that occur during the course of a routine PICU work rounds. Although there was significant consistency in the time spent per patient in value-added activities, there was significant disparity in time spent on nonessential activities, such as travel and waiting. A dedicated attempt to reduce time spent on nonessential activities can substantially reduce rounding times and improve the efficiency and value of rounds.
AB - Objective:To complete an objective analysis of the activities that occur during the course of daily rounds in a high acuity academic tertiary care pediatric intensive care unit (PICU).Design:Prospective observational work sampling design.Setting:Tertiary care academic Children's Hospital Pediatric Intensive Care Unit.Subjects:Multidisciplinary PICU teams.Interventions:None.Methods:Intensive care unit rounds were observed as part of an initiative to improve efficiency over a 2-month period. The number of observations required was determined by Neibel's work sampling method. Rounds were broken into various constituent events and then later classified as "value-added/essential," "value-added/nonessential," and "nonessential" based on whether the observed event was essential to the core mission of PICU rounds.Results:The mean time spent per patient for all observed teams was 17.9 min (SD 1.3 min). Teams spent 64% of their time doing value-added/essential tasks (11.2 min, SD 2.2 min) and 13% of their time doing value-added/nonessential tasks (2.4 min, SD 0.9 min). Teams spent 23% of their time on non-value-added activities (4.1 min, SD 2.3 min). The top three non-value-added activities conducted during rounds were travel, waiting, and interruptions regarding care of other patients. Given the consistency of time spent on value-added activities among attendings, these non-value-added activities might explain the significant variability observed among attendings in total time spent rounding.Conclusions:This was an observational study to characterize the activities that occur during the course of a routine PICU work rounds. Although there was significant consistency in the time spent per patient in value-added activities, there was significant disparity in time spent on nonessential activities, such as travel and waiting. A dedicated attempt to reduce time spent on nonessential activities can substantially reduce rounding times and improve the efficiency and value of rounds.
KW - critical care rounds
KW - efficiency
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85018705429&partnerID=8YFLogxK
U2 - 10.1097/JHQ.0000000000000024
DO - 10.1097/JHQ.0000000000000024
M3 - Article
C2 - 27049625
AN - SCOPUS:85018705429
SN - 1062-2551
VL - 39
SP - 122
EP - 127
JO - Journal for Healthcare Quality
JF - Journal for Healthcare Quality
IS - 2
ER -