"Mini-Rounds" May Help Improve Physician-Patient Communication and Satisfaction

Laurie Barclay, MD

May 25, 2007

May 25, 2007 (Dallas) — "Mini-rounds" appear to be an effective and time-efficient method for improving physician–patient communication and satisfaction, and deserve future study on a larger scale, according to a presentation at Hospital Medicine 2007, the Society for Hospital Medicine annual meeting.

"Effective physician–patient communication is extremely important in providing high-quality patient care," lead author and presenter Vesselin Dimov, MD, a clinical assistant professor of medicine at Cleveland Clinic Lerner College of Medicine, in Ohio, told Medscape. "Face-to-face contact is essential but is also time-consuming. Our goal was to explore a time-efficient method, called mini-rounds, for improving physician–patient communication and satisfaction at an academic hospitalist group located at a large tertiary-care center."

The authors noted that many lawsuits stem from poor communication between healthcare providers and patients. Communication can be especially difficult for hospitalists, who often face the challenges of communicating with patients they have never met before, and who must gain their patients’ trust and achieve empathy and rapport in a timely manner to provide high-level care and to facilitate the transition to outpatient providers.

In this pilot project, researchers at The Cleveland Clinic studied the feasibility of mini-rounds as an aid to improving communication between hospitalists and their patients.

"Mini-rounds were defined as a series of short patient encounters [each lasting about a minute] during which the physician asked patient[s about] any changes in their condition and provided a concise daily update," said Dr. Dimov, who is also an associate staff member of The Cleveland Clinic, Section of Hospital Medicine, Department of General Internal Medicine. "Mini-rounds were done in addition to the regularly scheduled work rounds."

In an acute inpatient setting, mini-rounds were conducted at the end of the workday, whereas at a subacute step-down facility, they took place at the start of the day. Two hospitalists from a group of 26 were assigned to mini-rounds, and their performances were compared with those of their peers. Regularly scheduled work rounds were conducted independently at both facilities.

Average duration of mini-rounds was 20 minutes to see 15 patients in the hospital and 30 minutes to see 30 patients at the subacute facility.

A callback program, conducted by telephone surveyors not connected to or funded by the hospitalist group, ws used. Surveyors called patients after discharge from the hospital and the subacute facility and asked about their impression of their stay and their perceived satisfaction with care received.

At the end of the 2-month pilot period, the satisfaction score of patients seen by hospitalists using the mini-rounds method was significantly higher than that of patients seen by other hospitalists. Both patients and physicians believed that mini-rounds improved communication and patient care.

"Hospitalists have the potential to improve patient satisfaction by being more available than primary care physicians who must maintain their outpatient practice," Franklin Michota, Jr., MD, head of the section of hospital medicine at The Cleveland Clinic, told Medscape. Dr. Michota was not involved with this study but was asked to provide independent commentary. "Yet, hospitalists are being stretched thin by multiple tasks and may not be able to spend a lot of time at the bedside daily. The concept [of mini-rounds] appears to satisfy patients in a time-efficient manner."

Study limitations noted by Dr. Michota are that it was a single-site study with a small number of patients. Whether mini-rounds will truly satisfy the majority of patients is unknown.

"I think this is a unique approach to a growing problem — overworked hospitalists being stretched too thin," Dr. Michota says. "A quick mini-rounds can let your patients know you are there and that you want to check up on them, and you can hear any questions or concerns that need to be addressed before the next day. Arguably, this is what hospitalists should be doing anyway — rounding on patients at least twice daily. "

In terms of future research, Dr. Michota suggested that it would be interesting to know the national standard for hospitalists for the number and frequency of daily contacts per patient.

"In our study, mini-rounds appeared to be an effective and time-efficient method for improving physician–patient communication and satisfaction, which deserves further exploration on a larger scale," Dr. Dimov concluded. "We are considering expanding the pilot by including more hospitalists and patients in order to validate our results."

This project had no funding sources. None of the authors nor Dr. Michota report any relevant financial relationships.

Hospital Medicine 2007: Abstract. Presented May 23-25, 2007.



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