Effects of Unit Census and Patient Acuity Levels on Discussions During Patient Rounds.

Area of Science:

• Clinical Medicine
• Pediatric Critical Care
• Healthcare Operations

Background:

• Patient rounding is a critical component of interprofessional care in pediatric intensive care units (PICUs).
• Existing research highlights risks of information omission with shortened rounding discussions.
• The impact of contextual factors like unit census and patient acuity on specific topic discussions during rounds remains understudied.

Purpose of the Study:

• To investigate how varying unit census and patient acuity influence the time spent discussing essential patient topics during PICU rounds.
• To identify specific patient topics (introduction/history, acute clinical status, care plans) affected by these contextual factors.

Main Methods:

• An observational study was conducted over 10 weeks in a PICU at a university-affiliated children's hospital.
• 165 individual patient encounters during morning interprofessional rounding were recorded and analyzed.
• Time spent on specific discussion topics was measured and correlated with unit census and patient acuity levels.

Main Results:

• Discussion duration for patient introductions/history remained consistent regardless of census or acuity.
• Discussions on acute clinical status significantly decreased under high census for both low and high acuity patients (-49.5% and -42.6% change, respectively).
• Care plan discussions were significantly shortened with higher census, particularly for low acuity patients (-54.7% change), but not for high acuity patients.

Conclusions:

• PICU rounding teams disproportionately reduce time on essential patient topics during periods of high census and acuity.
• While care planning time for acute patients was preserved, low acuity patients experienced reduced care plan discussions.
• Findings underscore the need to consider contextual factors in rounding guidelines to mitigate potential negative impacts on clinical outcomes.