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The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients' Outcomes.
- Source :
-
Journal of general internal medicine [J Gen Intern Med] 2015 Dec; Vol. 30 (12), pp. 1821-7. Date of Electronic Publication: 2015 May 27. - Publication Year :
- 2015
-
Abstract
- Background: Sensemaking is the social act of assigning meaning to ambiguous events. It is recognized as a means to achieve high reliability. We sought to assess sensemaking in daily patient care through examining how inpatient teams round and discuss patients.<br />Objective: Our purpose was to assess the association between inpatient physician team sensemaking and hospitalized patients' outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates.<br />Design: Eleven inpatient medicine teams' daily rounds were observed for 2 to 4 weeks. Rounds were audiotaped, and field notes taken. Four patient discussions per team were assessed using a standardized Situation, Task, Intent, Concern, Calibrate (STICC) framework.<br />Participants: Inpatient physician teams at the teaching hospitals affiliated with the University of Texas Health Science Center at San Antonio participated in the study. Outcomes of patients admitted to the teams were included.<br />Main Measures: Sensemaking was assessed based on the order in which patients were seen, purposeful rounding, patient-driven rounding, and individual patient discussions. We assigned teams a score based on the number of STICC elements used in the four patient discussions sampled. The association between sensemaking and outcomes was assessed using Kruskal-Wallis sum rank and Dunn's tests.<br />Key Results: Teams rounded in several different ways. Five teams rounded purposefully, and four based rounds on patient-driven needs. Purposeful and patient-driven rounds were significantly associated with lower complication rates. Varying the order in which patients were seen and purposefully rounding were significantly associated with lower LOS, and purposeful and patient-driven rounds associated with lower ULOS. Use of a greater number of STICC elements was associated with significantly lower LOS (4.6 vs. 5.7, p = 0.01), ULOS (0.3 vs. 0.6, p = 0.02), and complications (0.2 vs. 0.5, p = 0.0001).<br />Conclusions: Improving sensemaking may be a strategy for improving patient outcomes, fostering a shared understanding of a patient's clinical trajectory, and enabling high reliability.
- Subjects :
- Comprehension
Education, Medical, Graduate methods
Education, Medical, Graduate organization & administration
Education, Medical, Graduate standards
Hospitalization
Humans
Interprofessional Relations
Length of Stay statistics & numerical data
Medical Staff, Hospital education
Medical Staff, Hospital psychology
Patient Care Team standards
Patient Outcome Assessment
Physician-Patient Relations
Teaching Rounds standards
Texas
Medical Staff, Hospital standards
Patient Care Team organization & administration
Teaching Rounds organization & administration
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1497
- Volume :
- 30
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of general internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 26014891
- Full Text :
- https://doi.org/10.1007/s11606-015-3377-4