1. BRING IT TO THE BEDSIDE: TABLET COMPUTERS INCREASE TEAM-PATIENT INTERACTIONS
Blake R. Barker, MD, Shannon A. Scielzo, PhD, Brett Moran, MD, James Wagner, MD
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
BACKGROUND
RESULTS
The intervention (provision of tablets) appeared to have a positive impact on numerous rounding behaviors (see Figure 1). Furthermore, actual tablet usage (whether or not a tablet was used and actual frequency of use) was also directly linked to these positive behaviors (see Figures 2 and 3).
CONCLUSIONS
In regards to the study intervention, the provision of tablet computers and a recommendation to round outside of the conference room was associated numerous positive behavioral outcomes. Specifically, patients visited by intervention teams experienced more of these positive behaviors than did patients visited by control teams.
Similarly, examining treatment level effects, tablet use and frequency of tablet use were also related to many of these outcomes. As expected, frequency of use on average had higher effects than use alone (so the more a tablet was used, the stronger the relationships with the coded behaviors).
Despite some of the prevalent concerns with using technology, this study has demonstrated many positive behavioral changes supporting its use. This study is one of the first to specifically demonstrate the linkage of rounding behaviors with tablet use.
Once a central form of care delivery and medical education at academic medical centers, rounding at the patient’s bedside has become less frequent1,2. However, bedside rounding has been found to have significant benefits for patients and learners3-6 . Some medical educators have expressed concern that technology may detract from patient interactions7. The current study sought to understand the impact of tablet computer on rounding behaviors.
One prior study8 found two distinct rounding patterns:
Twenty-seven percent of teams were “room rounders”
Significantly greater use of the EHR and fewer distractions.
Remainder were “ward rounders”
Intervention
Tablet Used
Ward Rounding
Total Time Rounding
Patients Visited During Rounds
Time Spent with Each Patient
Examination By Attending
Exchange of Information
Discussion of Plan
Access of EHR During Rounds
Patient-Related Teaching Time
Non-Patient Related Teaching Time
Distractions
Frequency of Tablet Use
Ward Rounding
Total Time Rounding
Patients Visited During Rounds
Time Spent with Each Patient
Examination By Attending
Exchange of Information
Discussion of Plan
Access of EHR During Rounds
Patient-Related Teaching Time
(Yes or No)
Tablet Use
Ward Rounding
Total Time Rounding
Patients Visited During Rounds
Time Spent with Each Patient
Examination By Attending
Exchange of Information
Discussion of Plan
Access of EHR During Rounds
Patient-Related Teaching Time
LIMITATIONS
Single institution with convenience sampling
Effect of recommendation to round outside conference room vs. provision of tablet computers is unknown. However, effect of increased frequency of tablet use suggests relationship specific to this.
METHODS
REFERENCES
Payson HE, Barchas JD. A time study of medical teaching rounds. N Engl J Med. 1965;273(27):
Crumlish CM, Yialamas MA, McMahon GT. Quantification of bedside teaching by an academic hospitalist group. J Hosp Med. 2009;4(5):
Stickrath C, Noble M, Prochazka A, Anderson M, Griffiths M, Manheim J, Sillau S, Aagaard E. Attending rounds in the current era: what is and is not happening. JAMA Intern Med. 2013;173(12):1084–1089.
Shoeb M, Khanna R, Fang M, Sharpe B, Finn K, Ranji S, Monash B. Internal medicine rounding practices and the Accreditation Council for Graduate Medical Education competencies. J Hosp Med. 2014;9(4):
Lehmann LS, Brancati FL, Chen MC, Roter D, Dobs AS. The effect of bedside case presentations on patients’ perceptions of their medical care.
Verghese A, Brady E, Kapur CC, Horwitz RI. The bedside evaluation: ritual and reason. Ann Intern Med. 2011;155(8):550-3.
Verghese A. Culture shock: patient as icon, icon as patient. N Engl J Med. 2008;359(26):
Over two consecutive months in 2013, an intervention study was conducted on ten general medicine teaching teams at a large Southwestern university teaching hospital. Five of the ten teams were randomly selected to receive four tablet computers each. These teams were provided a brief introduction on tablet functionality and were asked to conduct rounds outside of the conference room. Behaviors of intervention and control teams were recorded by observers utilizing a standardized checklist codifying team rounding patterns, including patient interaction, EHR use, teaching time. In addition to examining the ‘intent-to-treat’ categorization (control vs intervention), we were also interested in examining the treatment level effects. Specifically we examined the impact of whether or not a tablet was used, and also how frequently the tablet was used for each patient. Pearson’s correlation coefficients were used with two-tailed tests and p < 0.05 as an indicator of statistical significance.
Figure 1: Comparison of Control and Intervention Groups Rounding Behaviors
Figure 2: Impact of Tablet Use on Rounding Behaviors
Figure 3: Impact of Frequency of Tablet Use on Rounding Behaviors