title: Patient-centered interprofessional collaborative care: factors associated with bedside interprofessional rounds.
abstract: BACKGROUND
  Medical care delivered in hospital-based medicine units requires interprofessional collaborative care (IPCC) to improve quality. However, models such as bedside interprofessional rounds, or encounters that include the team of physician and nurse providers discussing medical care at the patient's bedside, are not well studied.
  
  
  OBJECTIVE
  To examine the incidence of and time spent in bedside interprofessional rounds on internal medicine teaching services in one academic medical center.
  
  
  METHODS
  Observational descriptive study of internal medicine faculty serving as inpatient medicine attending physicians. Participants completed a daily electronic survey following team rounding sessions to assess rounding characteristics (November 2012-June 2013); variables such as resident level-of-training, attending physician years' of experience, house staff call day and clinic schedule were obtained from administrative data. Descriptive, Kruskal-Wallis, and multivariable logistic regression statistics were used to evaluate the study objectives.
  
  
  METHODS
  Primary outcomes were: (1) incidence of bedside interprofessional rounds, (2) time spent with patients during bedside interprofessional rounding encounters, and, (3) factors associated with increased occurrence of and time spent with patients during bedside interprofessional rounds. Covariates included resident level-of-training, attending physician years' of experience, census size, and call day.
  
  
  RESULTS
  Of 549 rounding sessions, 412 surveys were collected (75 % response) from 25 attending physicians. Bedside interprofessional rounds occurred with 64 % of patients (median 8.0 min/encounter), differing by unit (intermediate care 81 %, general medicine 63 %, non-medicine 57 %, p < 0.001). Factors independently associated with increased occurrence of bedside interprofessional rounds were senior resident (OR 2.67, CI 1.75-4.06, PGY-3/PGY-4 vs. PGY-2), weekdays (OR 1.74, CI 1.13-2.69), team census size ≤ 11 (OR 2.36, CI 1.37-4.06), and attending physicians with ≤ 4 years' experience (OR 2.15, CI 1.31-3.55). Factors independently associated with increased time spent during encounters were attending physicians with ≤ 4 years (OR 2.38, CI 1.44-3.95), 5-15 years of experience (OR 1.82, CI 1.10-3.02), and weekdays (OR 1.71, CI 1.10-2.65).
  
  
  CONCLUSIONS
  These findings highlight factors associated with increasing or decreasing occurrence and time spent in bedside interprofessional collaborative care delivery. Systematic changes to census size caps, resident scheduling, and attending physician education and staffing may be required to increase the occurrence of interprofessional collaborative care.
authors.affiliation: Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA, jgonzalo@hmc.psu.edu.
authors.forename: Jed D
authors.initials: JD
authors.lastname: Gonzalo
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wolpaw
authors.forename: Erik
authors.initials: E
authors.lastname: Lehman
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D018802:Patient-Centered Care; D012189:Retrospective Studies; D014481:United States