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Changing focus of traditional hospital 'rounds' improves patient care

Researchers at Johns Hopkins are challenging a practice that's almost as old as American medicine: the venerable doctors' "rounds," visiting hospitalized patients daily to check their health status with eager, white-coated medical students and residents scurrying along from bed to bed as each case is reviewed and discussed.

"It's a great way to teach medicine, but it doesn't seem to be in the best interest of the patient," says Peter Pronovost, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at Johns Hopkins and co-author of a study on rounds published in the recent issue of the Journal of Critical Care Medicine.

"Upon listening to discussions between doctor and patient, we discovered that rounds were more provider focused than patient centered," adds Pronovost. "The doctors focused on the physiology, pharmacology and so-called "available evidence" aspect of the patient, not on creating a set of goals for their recovery."

The team of researchers, from Johns Hopkins, the Institute for Healthcare Improvement (IHI) and the Volunteer Hospital Association (VHA), say a better way is to make rounds centered on step-by-step goals for the patient. By developing a list of short-term aims for each patient, timed directly to a daily care plan, the medical team was able to reduce hospital time while also improving patient safety and satisfaction.

The study, implemented from July 2001 to June 2002, involved 112 patients in The Johns Hopkins Hospital's surgical oncology intensive care unit and a team of medical personnel that included staff physicians, post doctoral fellows, anesthesia and surgery residents, nurse practitioners, nurses and a pharmacist. During daily rounds, the team visited each patient for approximately 25 minutes and created a plan of care for the day.

At the end of rounds, the patient's primary nurse and resident on call were evaluated on their understanding of the daily recovery
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Contact: John Lazarou
jlazaro1@jhmi.edu
410-502-8902
Johns Hopkins Medical Institutions
14-Jul-2003


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