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Meta-Analysis
. 2019 Mar;34(3):447-457.
doi: 10.1007/s11606-018-4714-1. Epub 2019 Jan 2.

Effect of Bedside vs. Non-bedside Patient Case Presentation During Ward Rounds: a Systematic Review and Meta-analysis

Martina Gamp  1 , Christoph Becker  1 , Theresa Tondorf  1 , Seraina Hochstrasser  1 , Kerstin Metzger  1 , Gunther Meinlschmidt  2 , Wolf Langewitz  1 , Rainer Schäfert  2 , Stefano Bassetti  3 , Sabina Hunziker  4
Affiliations
Meta-Analysis

Effect of Bedside vs. Non-bedside Patient Case Presentation During Ward Rounds: a Systematic Review and Meta-analysis

Martina Gamp et al. J Gen Intern Med. 2019 Mar.

Abstract

Background: Ward rounds are important for communicating with patients, but it is unclear whether bedside or non-bedside case presentation is the better approach.

Methods: We conducted a comprehensive search up to July 2018 to identify randomized controlled trials (RCTs) comparing bedside and non-bedside case presentations. Data was abstracted independently by two researchers and study quality was assessed using the Cochrane Risk of Bias Tool. Our primary outcome was patient's satisfaction with ward rounds. Our main secondary outcome was patient's understanding of disease and the management plan.

Results: Among 1647 identified articles, we included five RCTs involving 655 participants with overall moderate trial quality. We found no difference in having low patient's satisfaction between bedside and non-bedside case presentations (risk ratio [RR], 0.85; 95% CI, 0.66 to 1.09). We also found no impact on patient's understanding of their disease and management plan (RR, 0.92; 95% CI, 0.67 to 1.28). Trial sequential analysis (TSA) indicated low power of our main analysis.

Discussion: We found no differences in patient-relevant outcomes between bedside and non-bedside case presentations with a lack of statistical power among current trials. There is a need for larger studies to find the optimal approach to patient case presentation during ward rounds.

Keywords: communication; health communication; hospital medicine; meta-analysis; patient-centered care.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Flow of the information through the phases of the review.
Figure 2
Figure 2
Forest plots showing risk ratios for a low satisfaction with ward round and b low patient’s understanding of disease and the management plan as a function of bedside compared to non-bedside patient case presentation.
Figure 3
Figure 3
TSA analysis regarding the primary endpoint (risk for low satisfaction). The figure shows results of TSA analysis with use of the O’Brien-Fleming boundaries. Using a random effects model and the model variance-based diversity adjustment of the required information size for detecting a 25% relative risk reduction and an alpha error of 5% and a beta error of 20% (80% power) the required information size is 5286.
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