Communication, Physician Rounds
Conditions
Brief summary
This study will include patients admitted to the Antepartum service at Duke University Hospital, many of whom are managing high-risk pregnancies that require extended hospital stays and frequent physician interactions. Currently, two rounding methods are used interchangeably for patients who do not have pregnancy or delivery complications that would preclude participation in delayed daytime rounding. This randomized controlled trial will compare two rounding models: the standard model, in which patients receive two rounds (an early morning bedside encounter and a later team discussion), and the intervention model, which consolidates both rounds into a single, later-morning bedside encounter following the team's review of clinical data. The primary objective is to assess whether consolidating physician rounds into a single, later-morning encounter-referred to as discovery rounding-improves patient satisfaction with communication.
Interventions
BEHAVIORALDiscovery Rounding
For certain patients with appropriate clinical risk factors, our service has adopted a policy of "discovery rounding". This method involves solely electronic health record chart review prior to the 8am attending-led Antepartum team discussion where the patient's overnight events are "discovered", clinical courses discussed, and daytime plans proposed. "Discovery rounding" consolidates bedside physician-patient encounters to one mid-morning interaction, forgoing early morning disturbances.
BEHAVIORALStandard Rounding
The current standard of rounding on the Antepartum service involves a preliminarily bedside encounter with patients between 5-7am by a resident +/- medical student before an attending physician-led Antepartum team discussion from 8-9am. The patient is then rounded on for a second time in the late morning by the entire Antepartum team where patient concerns are heard and care plans for the day are relayed/reiterated/cemented.
Sponsors
Duke University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Pregnant women greater than 20 weeks gestation admitted to the antepartum list at Duke University Hospital
Exclusion criteria
* Stillbirth * ICU admission * Admission to off-service unit * Active magnesium sulfate administration * Active severe hypertension or initiation of anti-hypertensive pathway within past 8 hours * Category II fetal heart rate tracing * Other pregnancy/delivery complication precluding delayed rounding * Unstable/unsuitable condition per overnight team or attending physician * Previously enrolled/on active board \>1 day at morning rounds * Postpartum readmission * Antepartum admission within the last 4 weeks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of items rated as "Excellent" on the Communication Assessment Tool (CAT) | One of the following timepoints (whichever comes first for that patient); Hospital day 6 or the immediate postpartum period: postpartum day 0 or 1, depending on the time of delivery | The CAT measures patients' perceptions of physician communication across 15 specific behaviors, such as listening carefully, showing respect, explaining information clearly, and spending sufficient time with the patient. Each item is rated on a 5-point Likert scale ranging from "Poor" to "Excellent." By focusing on the frequency of "Excellent" ratings, the CAT provides a robust, patient-centered measure of the effectiveness and impact of physician communication during hospitalization. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Edinburgh Postnatal Depression Scale (EPDS) | At the 6 week postpartum visit | A 10-item self-report questionnaire, validated for both postpartum and antepartum use, in which each item is scored 0-3 (total 0-30), with higher scores indicating greater depressive symptoms and a common cut-off of ≥13 suggesting possible clinical depression. |
Countries
United States
Contacts
CONTACTHannah Kelly, MD
CONTACTRachel Wood, MD
STUDY_DIRECTORHannah Kelly, MD
Duke University Hospital
PRINCIPAL_INVESTIGATORRachel Wood, MD
Duke University Hospital
Outcome results
None listed