490 - Measured Impact of Independent Rounds on Resident Patient Care Ownership and Decision-Making Process

Poster Number: 490
Publication Number: 490.221

Nehal J.. Shah, Cohen Children's Medical Center, New Hyde Park, NY, United States; Preetha Kurian, Cohen Children's Medical Center, Astoria, NY, United States; Pratichi Goenka, Cohen Children's Medical Center - Northwell Health, Jericho, NY, United States; Alexandra Kilinsky, Children’s Hospital of Colorado, Denver, CO, United States; Joanna Fishbein, Northwell Health, Plainview, NY, United States

Background: Pediatric residents are given graduated autonomy over their three-year residency training, but the quality and amount of autonomy currently vary by attending. Autonomy is one component of patient care ownership, along with advocacy, commitment, communication, follow-through, knowledge, and teamwork. Patient care ownership and the resulting decision ownership allow physicians to develop a sense of responsibility for decisions, as well as a personal investment in the decision-making process. A lack of patient care ownership during residency can lead to diffusion of responsibility, focus on short horizons, and fewer interrelated decisions. Previous studies have shown that independent rounds increase resident autonomy. This study is novel in that it will examine its impact on patient care ownership in inpatient pediatrics and will also assess attending perceptions of independent rounds.

Objective: To determine the impact of independent rounds on resident patient care ownership and describe the attending perception of resident’s decision-making process.

Design/Methods: Independent rounds were implemented once during the resident’s two-week inpatient pediatrics rotation. Each resident completed a validated Patient Care Ownership Scale (PCOS), once after traditional rounds, and once after independent rounds. This pre- & post- data were matched for each resident. Demographic data as well as baseline burnout screening scores were collected for comparison. After independent rounds were completed, each attending was given a survey to assess the attending perception of resident decision-making as well as a validated Openness to Organizational Change Survey. A Wilcoxon signed rank test for matched pairs was performed on the difference in the PCOS scores from pre-independent rounds to post-independent rounds.

Results: Analysis of preliminary data (two months of data collection) indicates that there were statistically significant higher median PCOS scores in post-independent rounds of 0.81 points compared to pre-independent rounds (p=0.0078). Of note, most residents (70%) scored positive on the burnout screen before the intervention. Over the next few months, ongoing data collection will permit further analysis of attending perception, assessment of post-intervention burnout, and association of PCOS score change with variables such as time of year, service volume, and level of training.

Conclusion(s): Our preliminary analysis and results indicate a significant improvement in patient care ownership after implementing independent rounds. Future directions will include optimizing the implementation of independent rounds.