Improving Efficiency on a Pediatric Hospital Medicine Service With Schedule-Based Family-Centered Rounds.

BACKGROUND AND OBJECTIVES: Inconsistencies in the timing and process of family-centered rounds can contribute to inefficiencies in patient care, inconsistent nursing participation, and variable end times. Through the implementation of schedule-based rounds, our aims were to (1) start 90% of rounds encounters within 30 minutes of the scheduled time, (2) increase nursing presence from 79% to >90%, and (3) increase the percentage of rounds completed by 11:20 am from 0% to 80% within 1 year. METHODS: We used quality improvement methods to implement and evaluate a scheduled rounds process on a pediatric hospital medicine service at a university-affiliated children's hospital. Interventions included customization of an electronic health record-linked scheduling tool, daily schedule management by the senior resident, real-time rounds notification to nurses, improved education on rounding expectations, streamlined rounding workflow, and family notification of rounding time. Data were collected daily and run charts were used to track metrics. RESULTS: One year after implementation, a median of 96% of rounds encounters occurred within 30 minutes of scheduled rounding time, nursing presence increased from a median of 79% to 94%, and the percentage of rounds completed by 11:20 am increased from a median of 0% to 86%. Rounds end times were later with a higher patient census. CONCLUSIONS: We improved the efficiency of our rounding workflow and bedside nursing presence through a scheduled rounds process facilitated by an electronic health record-linked scheduling tool.

Role of Texting as a Source of Cognitive Burden in a Pediatric Cardiovascular ICU.

OBJECTIVES: To characterize frontline provider perception of clinical text messaging and quantify clinical texting data in a pediatric cardiovascular ICU (CICU). METHODS: This is a mixed-methods, retrospective single center study. A survey of frontline CICU providers (pediatric fellows, nurse practitioners, and physician assistants) was conducted to assess attitudes characterizing text messaging on cognitive burden. Text messaging data were abstracted and quantified between January 29, 2020, and April 18, 2020, and the patterns of text messages were analyzed per shift and by provider. RESULTS: The survey was completed by 33 of 39 providers (85%). Out of responders, 78% indicated that clinical text messaging frequently or very frequently disrupts critical thinking and workflow. They also felt that the burden of messages was worse during the night shift. Through abstraction, 31 926 text messages were identified. A median of 15 (interquartile range: 12-19) messages per hour were received. A median of 5 messages were received per hour per provider during the day shift and 6 during the night shift. From the entire study period, there were total 2 hours of high-frequency texting (≥15 texts per hour) during the day shift and 68 hours during the night shift. CONCLUSION: In our study, providers in the CICU received a large number of texts with a disproportionate burden during the night shift. Text messages are a potential source of cognitive overload for providers. Optimization of text messaging may be needed to mitigate cognitive burden for frontline providers.

Current Practices and Perspectives on Peer Observation and Feedback: A National Survey.

OBJECTIVE: Peer observation and feedback (POF) is the direct observation of an activity performed by a colleague followed by feedback with the goal of improved performance and professional development. Although well described in the education literature, the use of POF as a tool for development beyond teaching skills has not been explored. We aimed to characterize the practice of POF among pediatric hospitalists to explore the perceived benefits and barriers and to identify preferences regarding POF. METHODS: We developed a 14-item cross-sectional survey regarding divisional expectations, personal practice, perceived benefits and barriers, and preferences related to POF. We refined the survey based on expert feedback, cognitive interviews, and pilot testing, distributing the final survey to pediatric hospitalists at 12 institutions across the United States. RESULTS: Of 357 eligible participants, 198 (56%) responded, with 115 (58%) practicing in a freestanding children's hospital. Although 61% had participated in POF, less than one half (42%) reported divisional POF expectation. The most common perceived benefits of POF were identifying areas for improvement (94%) and learning about colleagues' teaching and clinical styles (94%). The greatest perceived barriers were time (51%) and discomfort with receiving feedback from peers (38%), although participation within a POF program reduced perceived barriers. Most (76%) desired formal POF programs focused on improving teaching skills (85%), clinical management (83%), and family-centered rounds (82%). CONCLUSIONS: Although the majority of faculty desired POF, developing a supportive environment and feasible program is challenging. This study provides considerations for improving and designing POF programs.