title: The impact of a lean rounding process in a pediatric intensive care unit.
abstract: OBJECTIVE
  Poor workflow associated with physician rounding can produce inefficiencies that decrease time for essential activities, delay clinical decisions, and reduce staff and patient satisfaction. Workflow and provider resources were not optimized when a pediatric intensive care unit increased by 22,000 square feet (to 33,000) and by nine beds (to 30). Lean methods (focusing on essential processes) and scenario analysis were used to develop and implement a patient-centric standardized rounding process, which we hypothesize would lead to improved rounding efficiency, decrease required physician resources, improve satisfaction, and enhance throughput.
  
  
  METHODS
  Human factors techniques and statistical tools were used to collect and analyze observational data for 11 rounding events before and 12 rounding events after process redesign. Actions included: 1) recording rounding events, times, and patient interactions and classifying them as essential, nonessential, or nonvalue added; 2) comparing rounding duration and time per patient to determine the impact on efficiency; 3) analyzing discharge orders for timeliness; 4) conducting staff surveys to assess improvements in communication and care coordination; and 5) analyzing customer satisfaction data to evaluate impact on patient experience.
  
  
  METHODS
  Thirty-bed pediatric intensive care unit in a children's hospital with academic affiliation.
  
  
  METHODS
  Eight attending pediatric intensivists and their physician rounding teams.
  
  
  METHODS
  Eight attending physician-led teams were observed for 11 rounding events before and 12 rounding events after implementation of a standardized lean rounding process focusing on essential processes.
  
  
  RESULTS
  Total rounding time decreased significantly (157 ± 35 mins before vs. 121 ± 20 mins after), through a reduction in time spent on nonessential (53 ± 30 vs. 9 ± 6 mins) activities. The previous process required three attending physicians for an average of 157 mins (7.55 attending physician man-hours), while the new process required two attending physicians for an average of 121 mins (4.03 attending physician man-hours). Cumulative distribution of completed patient rounds by hour of day showed an improvement from 40% to 80% of patients rounded by 9:30 AM. Discharge data showed pediatric intensive care unit patients were discharged an average of 58.05 mins sooner (p < .05). Staff surveys showed a significant increase in satisfaction with the new process (including increased efficiency, improved physician identification, and clearer understanding of process). Customer satisfaction scores showed improvement after implementing the new process.
  
  
  CONCLUSIONS
  Implementation of a lean-focused, patient-centric rounding structure stressing essential processes was associated with increased timeliness and efficiency of rounds, improved staff and customer satisfaction, improved throughput, and reduced attending physician man-hours.
authors: Children's Healthcare of Atlanta, Atlanta, GA, USA. atul.vats@choa.org
authors: Atul
authors: A
authors: Vats
authors: Kristin H
authors: KH
authors: Goin
authors: Monica C
authors: MC
authors: Villarreal
authors: Tuba
authors: T
authors: Yilmaz
authors: James D
authors: JD
authors: Fortenberry
authors: Pinar
authors: P
authors: Keskinocak
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration*; D003657:Decision Making; D005260:Female; D017048:Health Care Costs; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D011786:Quality Control; D018570:Risk Assessment; D056164:Teaching Rounds / Q000458:organization & administration*; D013997:Time Factors; D014481:United States; D057188:Workflow