An Observational Time Study of Neonatal Intensive Care Unit Multidisciplinary Rounds

Area of Science:

• Neonatal Medicine
• Healthcare Management
• Clinical Operations

Background:

• Multidisciplinary rounds are crucial for coordinating care in high-acuity neonatal intensive care units (NICUs).
• Limited data exist on the structure and efficiency of these rounds in NICU settings.
• Optimizing rounding processes can enhance patient care and team collaboration.

Purpose of the Study:

• To describe the structure of daily medical rounds in a level IV NICU.
• To identify potential barriers to efficient multidisciplinary rounds.
• To analyze time allocation during NICU rounds.

Main Methods:

• Observational study of daily medical rounds over 12 months in a 46-bed academic level IV NICU.
• Data collection included daily census, rounding duration, and causes of delays.
• Time spent on specific activities and team movement patterns were analyzed using descriptive statistics.

Main Results:

• A total of 208 rounding days were observed, with a mean daily census of 17 patients.
• Total rounding time averaged 136 minutes, with significant variation (109-169 minutes) among nine attending physicians.
• 91% of time was dedicated to patient care, teaching, and parent discussions; 9% was spent on logistical issues like determining the next patient, inter-room movement, and team readiness.

Conclusions:

• NICU multidisciplinary rounds consume significant time, averaging over two hours daily.
• Substantial variation exists in rounding time and efficiency among attending providers.
• Opportunities for improving rounding efficiency were identified, primarily related to non-patient-care activities.