249 - Let's Round Efficiently!: Improving Rounding Times on the Inpatient Wards

To date, we have completed three plan-do-study-act (PDSA) cycles. During the first cycle, we developed discharge readiness checklists. Inpatient attendings were coached to help their resident teams identify and prepare next-day discharges using a checklist tool, to aid with expediting the discharge process and order times. Biweekly email reminders were sent.  Recognizing that discharges were still often delayed due to system-based issues and poor discharge readiness, a multidisciplinary huddle was started as the second intervention. This huddle engaged physicians, case managers, nurses, and social workers in identifying discharge barriers and completing tasks for discharge readiness.  During the third cycle, we implemented weekly case-based mini-workshops for residents, aimed at cultivating best practices for efficiency on the inpatient wards.
The main outcome measure is inpatient round completion time. A secondary outcome measure is the time the discharge order is placed. Entry of discharge instructions in the electronic health record on the day prior to anticipated discharge is a process measure. Change in resident duty hours was studied as a balancing measure to ensure time spent on discharge readiness did not adversely impact their workload.

Results: With each intervention thus far, round completion times are earlier, with 80% ending by 1230 which is improved from the baseline median (Figure 1). Preintervention discharge order times averaged at 1400 and now average at 1230 (Figure 2). Resident duty hours have remained unchanged.

Conclusion(s): Educating residents on organizational skills to optimize daily workflow on inpatient wards and providing support for discharge readiness allows for more efficient rounds. Our next steps include having nursing presence at the bedside during rounds to further streamline rounding processes.