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A Trainee-Led Quality Improvement Project Using Change Management Theory to Improve Bedside Rounding
Kim Tran Lopez1,2, Katherine Pumphrey1,2, Jessica Hart1,2
1Section of Hospital Medicine, Division of General Pediatrics, Department of Pediatrics.
Insights
A trainee-led quality improvement initiative successfully increased bedside rounds in pediatric care, enhancing patient-centered communication. This approach combined change management theory with practical interventions, leading to sustained improvements in family-centered care practices.
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.
Objective:
The coronavirus disease 2019 pandemic disrupted the practice of family-centered rounds. After the height of the pandemic, a trainee-led team identified a low percentage of bedside rounds on general pediatrics resident teams and combined a quality improvement framework and change management theory to increase bedside rounds. Initial efforts focused on a single general pediatrics team with the aim to increase bedside rounds from 18% to 50% within 6 months and sustain improvement for 12 months. A second aim was to increase bedside rounds from 7% to 50% for all general pediatrics resident teams within 6 months of spread.
Methods:
The Model for Improvement informed the identification of 3 primary drivers of bedside rounds: knowledge, culture, and logistics. Twelve plan-do-study-act (PDSA) cycles were implemented. Measures included the percentage of bedside rounds (primary outcome), caregiver attendance (secondary outcome), and nurse attendance and rounding time (balancing measures).
Results:
For the initial team, 13 522 patient days were analyzed for the primary outcome with the average percentage of weekly bedside rounds increasing from 18% to 89% with 12 months of sustained improvement. The spread of the intervention to all teams revealed an increase in bedside rounding from 7% to 54%. The most significant improvements occurred after PDSA cycle 2, a communication bundle, and PDSA cycle 5, when the project was spread to all teams.
Conclusions:
This trainee-led initiative reveals the strength of the incorporation of change management theory within a quality improvement framework, resulting in rapid and sustainable increase in bedside rounds.
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