title: Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study.
abstract: BACKGROUND
  Recent research has shown evidence of disproportionate time allocation for patient communication during multidisciplinary rounds (MDRs). Studies have shown that patients discussed later during rounds receive lesser time.
  
  
  OBJECTIVE
  The aim of our study was to investigate whether disproportionate time allocation effects persist with the use of structured rounding tools.
  
  
  METHODS
  Using audio recordings of rounds (N=82 patients), we compared time allocation and communication breakdowns between a problem-based Subjective, Objective, Assessment, and Plan (SOAP) and a system-based Handoff Intervention Tool (HAND-IT) rounding tools.
  
  
  RESULTS
  We found no significant linear dependence of the order of patient presentation on the time spent or on communication breakdowns for both structured tools. However, for the problem-based tool, there was a significant linear relationship between the time spent on discussing a patient and the number of communication breakdowns (P<.05)--with an average of 1.04 additional breakdowns with every 120 seconds in discussion.
  
  
  CONCLUSIONS
  The use of structured rounding tools potentially mitigates disproportionate time allocation and communication breakdowns during rounds, with the more structured HAND-IT, almost completely eliminating such effects. These results have potential implications for planning, prioritization, and training for time management during MDRs.
authors.affiliation: Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Joanna
authors.identifier: http://orcid.org/0000-0003-0235-1632
authors.initials: J
authors.lastname: Abraham
authors.affiliation: Department of Family Medicine, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Thomas G
authors.identifier: http://orcid.org/0000-0003-4119-4836
authors.initials: TG
authors.lastname: Kannampallil
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health, New York Academy of Medicine, New York, NY, United States.
authors.forename: Vimla L
authors.identifier: http://orcid.org/0000-0003-1656-6642
authors.initials: VL
authors.lastname: Patel
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, University of Texas Health Science Center, Houston, TX, United States.
authors.forename: Bela
authors.identifier: http://orcid.org/0000-0001-5804-5226
authors.initials: B
authors.lastname: Patel
authors.affiliation: Memorial Hermann Katy Hospital, Katy, TX, United States.
authors.forename: Khalid F
authors.identifier: http://orcid.org/0000-0003-4656-4306
authors.initials: KF
authors.lastname: Almoosa
keywords: communication; intensive care units; teaching rounds