title: Maximizing efficiency on trauma surgeon rounds.
abstract: Rounding by trauma surgeons is a complex multidisciplinary team-based process in the inpatient setting. Implementation of lean methodology aims to increase understanding of the value stream and eliminate nonvalue-added (NVA) components. We hypothesized that analysis of trauma rounds with education and intervention would improve surgeon efficacy.
  
  
  
  Level 1 trauma center with 4300 admissions per year. Average non-intensive care unit census was 55. Five full-time attending trauma surgeons were evaluated. Value-added (VA) and NVA components of rounding were identified. The components of each patient interaction during daily rounds were documented. Summary data were presented to the surgeons. An action plan of improvement was provided at group and individual interventions. Change plans were presented to the multidisciplinary team. Data were recollected 6 mo after intervention.
  
  
  
  The percent of interactions with NVA components decreased (16.0% to 10.7%, P = 0.0001). There was no change between the two periods in time of evaluation of individual patients (4.0 and 3.5 min, P = 0.43). Overall time to complete rounds did not change. There was a reduction in the number of interactions containing NVA components (odds ratio = 2.5).
  
  
  
  The trauma surgeons were able to reduce the NVA components of rounds. We did not see a decrease in rounding time or individual patient time. This implies that surgeons were able to reinvest freed time into patient care, or that the NVA components were somehow not increasing process time. Direct intervention for isolated improvements can be effective in the rounding process, and efforts should be focused upon improving the value of time spent rather than reducing time invested.
authors.affiliation: Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Aliaksandr
authors.initials: A
authors.lastname: Ramaniuk
authors.affiliation: Department of Trauma and Acute Care Surgery, Grant Medical Center, Ohio Health, Columbus, Ohio.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Dickson
authors.affiliation: Department of Trauma and Acute Care Surgery, Grant Medical Center, Ohio Health, Columbus, Ohio.
authors.forename: Sean
authors.initials: S
authors.lastname: Mahoney
authors.affiliation: Department of Trauma and Acute Care Surgery, Grant Medical Center, Ohio Health, Columbus, Ohio. Electronic address: shay.omara@ohiohealth.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: O'Mara
mesh_terms: D004526:Efficiency; D006801:Humans; D016015:Logistic Models; D009820:Ohio; D010348:Patient Care Team / Q000458:organization & administration*; D066231:Surgeons / Q000458:organization & administration*; D056164:Teaching Rounds / Q000458:organization & administration*; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*
keywords: Lean; Lean methodology; Rounding; Surgeons; Trauma