title: The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients' Outcomes.
abstract: BACKGROUND
  Sensemaking is the social act of assigning meaning to ambiguous events. It is recognized as a means to achieve high reliability. We sought to assess sensemaking in daily patient care through examining how inpatient teams round and discuss patients.
  
  
  OBJECTIVE
  Our purpose was to assess the association between inpatient physician team sensemaking and hospitalized patients' outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates.
  
  
  METHODS
  Eleven inpatient medicine teams' daily rounds were observed for 2 to 4 weeks. Rounds were audiotaped, and field notes taken. Four patient discussions per team were assessed using a standardized Situation, Task, Intent, Concern, Calibrate (STICC) framework.
  
  
  METHODS
  Inpatient physician teams at the teaching hospitals affiliated with the University of Texas Health Science Center at San Antonio participated in the study. Outcomes of patients admitted to the teams were included.
  
  
  METHODS
  Sensemaking was assessed based on the order in which patients were seen, purposeful rounding, patient-driven rounding, and individual patient discussions. We assigned teams a score based on the number of STICC elements used in the four patient discussions sampled. The association between sensemaking and outcomes was assessed using Kruskal-Wallis sum rank and Dunn's tests.
  
  
  RESULTS
  Teams rounded in several different ways. Five teams rounded purposefully, and four based rounds on patient-driven needs. Purposeful and patient-driven rounds were significantly associated with lower complication rates. Varying the order in which patients were seen and purposefully rounding were significantly associated with lower LOS, and purposeful and patient-driven rounds associated with lower ULOS. Use of a greater number of STICC elements was associated with significantly lower LOS (4.6 vs. 5.7, p = 0.01), ULOS (0.3 vs. 0.6, p = 0.02), and complications (0.2 vs. 0.5, p = 0.0001).
  
  
  CONCLUSIONS
  Improving sensemaking may be a strategy for improving patient outcomes, fostering a shared understanding of a patient's clinical trajectory, and enabling high reliability.
authors.affiliation: South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA. Leykum@uthscsa.edu.|Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USA. Leykum@uthscsa.edu.|McCombs School of Business, University of Texas at Austin, 7400 Merton Minter, San Antonio, TX, 78229, USA. Leykum@uthscsa.edu.
authors.forename: Luci K
authors.initials: LK
authors.lastname: Leykum
authors.affiliation: School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Chesser
authors.affiliation: South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA.|Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USA.|McCombs School of Business, University of Texas at Austin, 7400 Merton Minter, San Antonio, TX, 78229, USA.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Lanham
authors.affiliation: Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USA.|University of Dallas, Dallas, TX, USA.
authors.forename: Pezzia
authors.initials: P
authors.lastname: Carla
authors.affiliation: Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Ray
authors.initials: R
authors.lastname: Palmer
authors.affiliation: South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA.|Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USA.
authors.forename: Temple
authors.initials: T
authors.lastname: Ratcliffe
authors.affiliation: Iowa City VA Health Care System, Iowa City, IA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Reisinger
authors.affiliation: Ethknoworks LLC, Santa Fe, NM, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Agar
authors.affiliation: South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA.|Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pugh
mesh_terms: D032882:Comprehension; D004503:Education, Medical, Graduate / Q000379:methods / Q000458:organization & administration / Q000592:standards; D006760:Hospitalization; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D063868:Patient Outcome Assessment; D010817:Physician-Patient Relations; D056164:Teaching Rounds / Q000458:organization & administration* / Q000592:standards; D013781:Texas
keywords: complexity science; complication rates; inpatient teams; length of stay; sensemaking