Increasing adherence to a standardized rounding procedure in two hospital in‐patient units

Abstract

Standardized bedside rounds can improve communication and the quality of care for patients in hospitals. However, it can be challenging to change previously established provider practices to adhere to new procedures. This study evaluated 2 packaged interventions, derived from a modified Performance Diagnostic Checklist interview, to increase adherence to standardized rounding practices in 2 hospital units. Researchers observed physicians at a university hospital on rounds 2-3 times per week, and 2 phases of intervention were implemented to improve adherence. The interventions included task clarification, feedback, and weekly huddles. Compared to baseline, phases 1 and 2 of the intervention improved clinician adherence to the standardized bedside rounding checklist by 24.94% and 30.94% in unit 1 and 26.76% and 44.06% in unit 2, respectively. The standardized rounds did not require additional time following the intervention. These results indicate that physician adherence can be improved through behavioral interventions.

Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay

“…Behavioural scientists were recruited to design interventions that would encourage more faithful adoption of the rounding system. 37 Prior to the intervention, we interviewed both high and low performing physicians and nurses to determine how to best address their concerns during our training sessions in order to maximise adherence. The first intervention consisted of an email reminder the day prior to each rotation from the Director of Patient Care, Quality, and Safety and senior author (FSS) describing in detail the rounding protocol.…”

Facing pandemic challenges: Helping health care professionals cope.

“…Behavioral professionals working in organizational behavior management may integrate ACT skills within a larger framework aimed at improving the health care system. Behavioral interventions, such as task clarification, performance feedback, and regular check-ins, appear helpful in improving adherence to health care procedures (Gravina et al, 2021) and may be useful in teaching new strategies for working with COVID-19. Environmental changes, such as increasing availability of hand sanitizer and behavioral skills training for complex tasks, such as putting on PPE, may help reduce COVID-19 transmission (Gravina et al, 2020).…”

“…Data on employee retention and sick leave utilization (Gaupp et al, 2020) may provide information on health care professional well-being. Broader system data can be supplemented with targeted observation of key outcomes, such as adherence to safety procedures (Gravina et al, 2021) gathered via behavioral observation.…”

Management strategies to de-implement low-value care—an applied behavior analysis

“…However, the operant learning theory explicitly distinguishes between strategies for increasing and decreasing behaviors [ 13 , 14 ]. The contemporary application of the operant learning theory is applied behavior analysis, which has been used in health care for a variety of purposes (e.g., increased staff attendance [ 15 ], improved compliance with safety routines [ 16 ], increased emergency department efficiency [ 17 ], improved compliance to routines [ 18 , 19 ]). However, to the best of our knowledge, applied behavior analysis has yet to be used to understand the management strategies for LVC de-implementation, despite its potential usefulness for understanding how and why strategies influence LVC-relevant behaviors.…”