Abstract
BACKGROUND: Residents commonly use a batched workflow to round on hospitalized patients, creating redundancy and decreasing efficiency. OBJECTIVE: To improve resident efficiency through a novel workflow using mobile laptops and modified rounding-in-flow. DESIGN, SETTING, PARTICIPANTS: A controlled experimental study conducted at an academic medical center for 3 months. One internal medicine team served as the intervention group, and two other teams served as a control group; 34 interns and 20 senior residents participated. INTERVENTION: Residents in the intervention group were provided a novel workflow and a mobile laptop to allow them to round "in-flow." Control group residents rounded as usual (batched workflow without laptops). MAIN MEASURES: Fourteen interns were monitored for a time-motion study. Time-stamped electronic medical record (EMR) data were used to assess percentage of progress notes and orders placed during rounds (9 a.m.-12:30 p.m.) and percentage of discharge summaries signed within 24 h of discharge. A post-intervention survey measured perceived efficiency. RESULTS: A time-motion study showed non-significant differences between time in the intervention group and that in the control group: communication time with patients (128 min vs 105 min, p = 0.37) and computer time (289 min vs 306 min, p = 0.71). EMR data for 664 visits in the control group and 374 in the intervention group showed that rounding-in-flow was associated with an odds ratio (OR) of 1.5 for placing progress notes during rounds (95% CI: 1.2-1.7, p < 0.001), an OR of 1.1 for placing non-discharge orders during rounds (95% CI: 1.0-1.2, p = 0.01), and an OR of 3.9 for signing discharge summaries within 24 h of discharge (95% CI: 2.3-7.2, p < 0.001). Post-intervention survey, completed by 23 of 34 interns, showed that interns in the intervention group perceived that orders were completed during rounds more often than the control group (OR 7.8; 95% CI: 1.3-60.1, p = 0.03). CONCLUSIONS: Using mobile laptops with modified rounding-in-flow was associated with earlier completion of residents' work, suggesting improved efficiency.