A Trainee-Led Quality Improvement Project Using Change Management Theory to Improve Bedside Rounding

Area of Science:

• Healthcare Quality Improvement
• Pediatric Patient Care
• Change Management in Medicine

Background:

• The COVID-19 pandemic significantly disrupted family-centered rounds in healthcare settings.
• A notable decrease in bedside rounds was observed on general pediatrics resident teams post-pandemic.
• Low bedside rounding rates impact patient communication and family engagement in pediatric care.

Purpose of the Study:

• To implement a trainee-led initiative to increase bedside rounds on general pediatrics teams.
• To improve the percentage of bedside rounds from 18% to 50% within 6 months for an initial team.
• To expand the improvement to 50% for all general pediatrics teams within 6 months of implementation.

Main Methods:

• Utilized the Model for Improvement framework to identify key drivers: knowledge, culture, and logistics.
• Implemented 12 plan-do-study-act (PDSA) cycles to test and refine interventions.
• Measured the percentage of bedside rounds (primary), caregiver attendance (secondary), and nurse attendance/rounding time (balancing).

Main Results:

• For the initial team, weekly bedside rounds increased from 18% to 89%, sustained for 12 months.
• Across all general pediatrics teams, bedside rounding increased from 7% to 54% after project spread.
• Significant improvements were linked to a communication bundle (PDSA cycle 2) and project expansion (PDSA cycle 5).

Conclusions:

• A trainee-led initiative effectively integrated change management theory with quality improvement.
• The approach led to rapid and sustainable increases in bedside rounds in pediatric care.
• This model demonstrates a successful strategy for enhancing family-centered care practices.