The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

NET Rounding: A Standardized Rounding Intervention to Improve Rounding Efficiency and Optimize the Inpatient Experience for Internal Medicine Attendings and Residents

Authors: Emily R. Insetta, MD, Peter Barish, MD, Nathan Baskin, MD, Rebeccah M. Brusca, MD, MPH, David Chia, MD, MS, Sandra Oreper, MPH, Shirley Chan, MD, MS, Molly A. Kantor, MD, Stephanie M. Conner, MD

Abstract

Objectives: There is a scarcity of published best practices for efficient and effective hospital rounds. We introduced a standardized rounding intervention (NET Rounding, or Novel Rounding Practices, Shared Expectations, and Time Management) with the primary aims of improving rounding efficiency, reducing resident work-hour violations, and positively affecting clinician experience. Secondary aims included identifying efficient rounding practices and describing the intervention's impact on the attending and resident experience.

Methods: A standardized rounding intervention was implemented February-June 2022. Attendings and residents completed preintervention surveys October 2021-January 2022 and postintervention surveys immediately after their inpatient rotation during the intervention period. Survey data were compared using qualitative thematic analysis along with ?2 and Fisher exact tests to assess intervention uptake, helpfulness of rounding strategies, and impact on education and efficiency.

Results: A total of 171 attendings and 188 residents participated in the intervention. The survey response rates were 38% and 35%, respectively. Residents reported reduced rounding time and fewer work-hour violations with NET Rounding. There were perceived improvements in timeliness of patient care, shared expectations among team members, and overall inpatient clinician experience.

Conclusions: A novel rounding intervention improved perceived rounding efficiency, resident work hours, and overall inpatient experience for attendings and residents.

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References

1. Linfors EW, Neelon FA. The Case for Bedside Rounds. N Engl J Med 1980;303:1230-1233.
2. Tariq M, Motiwala A, Ali SU, et al. The learners’ perspective on internal medicine ward rounds: a cross-sectional study. BMC Med Educ 2010;10:53.
3. Goitein L, Shanafelt TD, Wipf JE, et al. The Effects of Work-Hour Limitations on Resident Well-being, Patient Care, and Education in an Internal Medicine Residency Program. Arch Intern Med 2005;165:2601-2606.
4. Harrison R, Allen E. Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations. J Gen Intern Med 2006;21:447-452.
5. Rabinowitz R, Farnan J, Hulland O, et al. Rounds Today: A Qualitative Study of Internal Medicine and Pediatrics Resident Perceptions. J Grad Med Educ 2016;8:523-531.
6. Stickrath C, Noble M, Prochazka A, et al. Attending Rounds in the Current Era: What Is and Is Not Happening. JAMA Intern Med 2013;173:1084-1089.
7. Lau CY, Johnson C, Apgar S, et al. How Did You Spend Your Time Today? Similarities and Differences in Clinical Work of Medicine Interns and Direct Care Hospitalist (abs). https://shmabstracts.org/abstract/how-did-you-spend-your-time-today-similarities-and-differences-in-clinical-work-of-medicine-interns-and-direct-care-hospitalists. Published 2020. Accessed March 31, 2023.
8. Haddon Mullins C, Roderick A, Deaver J, et al. Contemporary practice of standardised bedside teaching rounds. Clin Teach 2020;17:483-488.
9. Tang B, Sandarage R, Chai J. A systematic review of evidence-based practices for clinical education and health care delivery in the clinical teaching unit. CMAJ 2022;194:E186-E194.
10. Chan SJ, Archibald HL, Conner SM. NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment. BMC Med Educ 2022;22:600.
11. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 2007;42:1758-1772.
12. Reid M, , Misky G, , Harrison R, , et al. Demographics, Productivity, and Promotion among Academic Hospitalists in 2008 (abs) https://shmabstracts.org/abstract/demographics-productivity-and-promotion-among-academic-hospitalists-in-2008/. Published 2008. Accessed March 31, 2023.
13. Monash B, Najafi N, Mourad M, et al. Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial. J Hosp Med 2017;12:143-149.
14. 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;28:412-420.
15. Wang-Cheng RM, Barnas GP, Sigmann P, et al. Bedside case presentations: why patients like them but learners don’. J Gen Intern Med 1989;4:284-287.
16. Gonzalo JD, Chuang CH, Huang G, et al. The return of bedside rounds: an educational intervention. J Gen Intern Med 2010;25:792-798.
17. Crumlish CM, Yialamas MA, McMahon GT. Quantification of bedside teaching by an academic hospitalist group. J Hosp Med 2009;4:304-307.