Computerized rounding in a community hospital surgery residency program

With the institution of the 80-hour work week, residency programs have worked to institute programs that decrease the time that residents spend in the hospital while maintaining patient safety. This study was intended to assess the amount of time saved using computerized patient information in the form of a personal data assistant (PDA).

A community hospital surgical residency program with 22 residents initially collected data daily for 4 weeks without PDA use. Data included preround time, check-out time, total number of patients, number of medical/surgical patients, and number of intensive care unit patients. The definition of prerounding time was started when residents first began collecting information on their patients in the morning until 6:00 am. Check-out time started at 5:00 pm and lasted until the discussion of patient care with the night team had finished. Residents were then given PDAs allowing immediate up-to-date access to patient information, which most importantly included current vital signs, laboratory data, radiological dictations, medication lists, and fluid intake and output. After a 4-week acquaintance period with the PDA had passed, data were again collected from the residents daily for 4 weeks. Daily averages for each week and an overall total average were calculated. Daily averages were also calculated for each PGY level. Paired t-tests compared the pre-PDA and post-PDA total averages.

No significant difference was found between the total number of patients pre-PDA and post-PDA (7.6 and 7.6, respectively, p = 0.98), the average number of medical/surgical patients (4.7 and 7.1, respectively, p = 0.16), or the average number of intensive care unit patients (2.6 and 0.4, respectively, p = 0.06). Also, no significant difference was found between pre-PDA and post-PDA with average check-out time (24.5 minutes and 21.9 minutes, respectively, p = 0.06). However, a significant decrease in rounding time occurred with pre-PDA round time at 50.5 minutes and post-PDA round time at 40.7 minutes (p = 0.02).

Results of this study support the hypothesis that the prerounding time dramatically decreases with the PDA compared to without. Not only does this decrease in time help to keep residents under the 80-hour work week rule, but also it helps to eliminate much of the confusion that can cause patient safety issues.