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. 2015 Dec 23;10(12):e0145408.
doi: 10.1371/journal.pone.0145408. eCollection 2015.

A Survey of Rounding Practices in Canadian Adult Intensive Care Units

Jessalyn K Holodinsky  1 , Marilynne A Hebert  1 , David A Zygun  2 , Romain Rigal  3 , Simon Berthelot  4 , Deborah J Cook  5 , Henry T Stelfox  1   6
Affiliations

A Survey of Rounding Practices in Canadian Adult Intensive Care Units

Jessalyn K Holodinsky et al. PLoS One. .

Abstract

Objective: To describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement.

Design: Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7).

Measurements and main results: Medical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient's bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥ 1 interruption for ≥ 50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning.

Conclusions: There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.

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Conflict of interest statement

Competing Interests: Ms. Holodinsky was supported by a Ward of the 21st Century Health Services Research Scholarship funded by Alberta Innovates - Health Solutions’ Collaborative Research and Innovation Opportunity Team Grant. Dr. Cook is a Research Chair of the Canadian Institutes for Health Research. Dr. Stelfox is supported by a Population Health Investigator Award from Alberta Innovates – Health Solutions. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study. Funding sources had no role in the design, conduct, or reporting of this study and the authors are unaware of any conflicts of interest. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Sources of Interruption During Patient Care Rounds.
Fig 2
Fig 2. Self-Rated Rounding Quality and Room For Improvement.
Fig 3
Fig 3. Study Recommendations.
See this image and copyright information in PMC

References

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    1. Holodinsky JK, Lane D, Stelfox HT. Best Rounding Practices in the ICU. In: Bittner E, LaRosa J, editors. Current Concepts In Adult Critical Care. Mount Prospect, IL; 2016.

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