Effects of Bedside Compared to Outside the Room Case Presentation - Full Text View

Purpose

Patient case presentations during ward rounds can take place at the bedside or outside the room. The best approach to patient case presentation is yet unclear. Thus, the overall aim of this multicenter, randomized-controlled study is to test the hypothesis that outside the room patient case presentation compared to bedside patient case presentation results in better outcomes across different dimensions including patient understanding and perception of quality of care as well as patient outcomes, physicians' preferences, perception of quality and effectiveness, and timing of the ward rounds, respectively.

Condition	Intervention
Bedside Patient Case Presentation Outside-the-room Patient Case Presentation	Procedure: patient case presentation bedside Procedure: patient case presentation Outside-the-room


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Intervention Model Description: On the day before the ward round, patients will be randomized 1:1 into one of both study arms. In one study arm, patient case presentation will be performed at bedside. In the other study arm, patient case presentation will be performed outside the room. Masking: Outcomes Assessor Primary Purpose: Other
Official Title:	Effect of Bedside Patient Case Presentation Compared to Outside the Room Case Presentation on Patient Perception of Quality of Care and Patient Outcomes: a Randomized-controlled, Multicenter Trial

Further study details as provided by University Hospital, Basel, Switzerland:

Primary Outcome Measures:

Subjective understanding of disease and management [ Time Frame: post ward round up to 36 h ]
average of the visual analog scale (VAS) score across the following three dimensions rated by the patient (0 "I have no knowledge at all about the situation" to 100 "I have best possible knowledge about the situation": I. Patients' subjective understanding of the disease II. Patients' subjective understanding of the therapeutic concept III. Patients' subjective understanding of the next steps

Secondary Outcome Measures:

Improvement understanding [ Time Frame: post ward round up to 36 h ]
Patients' perception about how well the current ward round improved the understanding of each of these three components, i.e., current disease, therapeutic concept, and next steps (VAS, 0-100)
Objective understanding of disease and management [ Time Frame: post ward round up to 36 h ]
Comparison of patients' recall information regarding current main diagnosis, main therapeutic measures and next steps (qualitative information) with medical chart information.

Answers regarding current main diagnosis will be categorized as: (1) patient correctly states both pathophysiology and localization, (2) patient correctly states either pathophysiology or localization, (3) patient states neither pathophysiology nor localization (correctly) but correctly states symptoms, (4) patient correctly states that the current diagnosis is still unclear, (5) patient states incorrect information, (6) patient correctly states a secondary diagnosis relevant for the current hospitalization Answers regarding main therapeutic measures and next steps will be categorized as: (1) correct (regarding main diagnosis), (2) incorrect (regarding main diagnosis), (3) correct (regarding secondary diagnosis), (4) incorrect (regarding secondary diagnosis)
Overall quality of care [ Time Frame: post ward round up to 36 h ]
Patients' perception (each rated on a VAS 0-100) regarding: comprehensibility of information during ward round, satisfaction with care, confidence in the medical team, perceived competence of the medical team, perceived interpersonal behavior during ward round, affective response of the patients, adequacy of ward round duration (includes two additional questions asking for patients' estimations on how much time the medical team spent on their case within the ward round as well as on average per day (estimates in minutes))
Follow up health status [ Time Frame: 30 days follow up after study inclusion ]
Patients' perceived health status (EuroQol five dimensions questionnaire)
Follow up understanding [ Time Frame: 30 days follow up after study inclusion ]
Patients' subjective (VAS 0-100) and objective (recall as compared to objective medical chart information) understanding
Follow up quality of hospital care [ Time Frame: 30 days follow up after study inclusion ]
Patients' overall perspective of hospital care (Hospital Consumer Assessment of Healthcare Providers and Systems, HCAHPS)
Follow up readmission [ Time Frame: 30 days follow up after study inclusion ]
Patients' readmission rate since study inclusion
Follow up duration of hospitalization [ Time Frame: 30 days follow up after study inclusion ]
total duration of hospitalization
Treating team satisfaction [ Time Frame: post ward round up to 96 h ]
The treating team's satisfaction with ward round (rated on a VAS 0-100)
Treating team performance [ Time Frame: post ward round up to 96 h ]
The treating team's perceived performance in the ward round (each rated on a VAS 0-100): time management of the ward round, interaction within the medical team and with the patient during ward round, perceived time management and feasibility
Treating team affect [ Time Frame: post ward round up to 96 h ]
The treating team's affective response (rated on a VAS 0-100)
Treating team preference [ Time Frame: post ward round up to 96 h ]
The treating team's preference of bedside compared to outside the room patient case presentation (rated on a semantic differential ranging from 1 "I prefer bedside ward rounds" to 6 "I prefer ward rounds outside the room")
Timeliness [ Time Frame: during ward round which may last from 5 up to 30 minutes ]
duration of the ward round (minutes)
Communication-specific items during ward rounds [ Time Frame: during ward round which may last from 5 up to 30 minutes ]
Rated by investigator (nominal 3-point scale (1 = yes; 2 = no; 3 = not applicable): structuring of conversation, use of patient-centered techniques, use of physician-centered techniques, dealing with emotions, conveying of complex information, negotiation of shared concepts of disease and treatment, realization of shared decision making, breaking bad news


Estimated Enrollment:	760
Anticipated Study Start Date:	July 2017
Estimated Study Completion Date:	July 2019
Estimated Primary Completion Date:	June 2019 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: patient case presentation Bedside In the bedside presentation group, patient case presentation and discussions will be at bedside with direct involvement of the patient as needed.	Procedure: patient case presentation bedside Patient case presentation in absence or presence of Patient at bedside. Other Names: teaching round bedside round ward round
Active Comparator: patient case presentation Outside-the-room In the outside the room condition, case presentation and discussions will take place outside without the patient being present. After the case presentation and discussions the team will enter the room and give the patient a short summary of the medical situation, complete the medical information and examine the patient, as needed, and discuss the next steps.	Procedure: patient case presentation Outside-the-room Patient case presentation Outside-the-room.

Arms

Assigned Interventions

Active Comparator: patient case presentation Bedside

In the bedside presentation group, patient case presentation and discussions will be at bedside with direct involvement of the patient as needed.

Procedure: patient case presentation bedside

Patient case presentation in absence or presence of Patient at bedside.

Other Names:

teaching round
bedside round
ward round

Active Comparator: patient case presentation Outside-the-room

In the outside the room condition, case presentation and discussions will take place outside without the patient being present. After the case presentation and discussions the team will enter the room and give the patient a short summary of the medical situation, complete the medical information and examine the patient, as needed, and discuss the next steps.

Procedure: patient case presentation Outside-the-room

Patient case presentation Outside-the-room.

Detailed Description:

Patient-centered care may be defined as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions". Involving patients in all steps of the healthcare process is thus important. Yet, best presentation of patients' cases during ward rounds remains unknown. During outside the room patient case presentation, the medical team discusses difficult patient or medical issues in the team, and later presents a "patient-friendly" synthesis to the patient. Bedside patient case presentation, on the other hand, allows a patient to be part of the whole team discussion. Yet, there is concern that patients may be unable to cope with the magnitude of medical information and misunderstandings may occur. Currently, there is equipoise regarding both possibilities of patient case presentation with an important lack of trial data. We thus aim to compare the effect of bedside patient case presentation with outside the room patient case presentation during ward rounds ("Chefarztvisite") on different patient- and physician-related endpoints.

Therefore, this randomized controlled trial aims to test the hypothesis that outside the room patient case presentation compared to bedside patient case presentation results in better outcomes across different dimensions including patient understanding and perception of quality of care as well as patient outcomes, physicians' preferences, perception of quality and effectiveness, and timing of the ward rounds, respectively.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Consecutive adult (>18 years) medical inpatients during their first ward round independently of their underlying disease and reason for hospital stay.

Exclusion Criteria:

Patients with cognitive impairment, such as dementia/delirium
Patients with paracusia.
Patients who do not understand local language(s).
Patients already included in this study

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT03210987

Contacts


Contact: Martina Gamp, Dr.	+41 61 328 56 63	martina.gamp@usb.ch
Contact: Sabina Hunziker, Prof.	+41 61 32 85262	sabina.hunziker@usb.ch

Sponsors and Collaborators

University Hospital, Basel, Switzerland

Kantonsspital Aarau

Kantonsspital Liestal

Investigators


Principal Investigator:	Sabina Hunziker, Prof.	Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Switzerland

More Information

Publications:

Lehmann LS, Brancati FL, Chen MC, Roter D, Dobs AS. The effect of bedside case presentations on patients' perceptions of their medical care. N Engl J Med. 1997 Apr 17;336(16):1150-5.

Chauke HL, Pattinson RC. Ward rounds -- bedside or conference room? S Afr Med J. 2006 May;96(5):398-400.

O'Leary KJ, Killarney A, Hansen LO, Jones S, Malladi M, Marks K, M Shah H. Effect of patient-centred bedside rounds on hospitalised patients' decision control, activation and satisfaction with care. BMJ Qual Saf. 2016 Dec;25(12):921-928. doi: 10.1136/bmjqs-2015-004561. Epub 2015 Dec 1.

Ramirez J, Singh J, Williams AA. Patient Satisfaction with Bedside Teaching Rounds Compared with Nonbedside Rounds. South Med J. 2016 Feb;109(2):112-5. doi: 10.14423/SMJ.0000000000000419.

Seo M, Tamura K, Morioka E, Shijo H. Impact of medical round on patients' and residents' perceptions at a university hospital in Japan. Med Educ. 2000 May;34(5):409-11.


Responsible Party:	University Hospital, Basel, Switzerland
ClinicalTrials.gov Identifier:	NCT03210987 History of Changes
Other Study ID Numbers:	Visitenstudie (2017-00991)
Study First Received:	June 27, 2017
Last Updated:	July 4, 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	No


Studies a U.S. FDA-regulated Drug Product:		No
Studies a U.S. FDA-regulated Device Product:		No

Keywords provided by University Hospital, Basel, Switzerland:


ward round patient case presentation communication patient-centered care

ClinicalTrials.gov processed this record on July 11, 2017