An Observational Time Study of Neonatal Intensive Care Unit Multidisciplinary Rounds

Abstract

Objective In this observational study, we aimed to describe the rounding structure in a high acuity neonatal intensive care unit (NICU) to identify potential barriers to efficient multidisciplinary rounds.

Study Design We observed daily medical rounds (January–December 2018) on the resident teaching service in a 46-bed academic level IV NICU. Daily census, duration of rounds, and causes for rounding delays were recorded. During a subset of the study period, additional data were collected describing the time spent on specific activities and the room-to-room pathway followed by the rounding team. Descriptive statistics were used to summarize the census, total rounding time, time spent on each activity, and rounding time by day of the week and by attending.

Results A total of 208 rounding days were observed. During the study period, the teaching service mean daily census was 17 patients and total rounding time (mean ± standard deviation) was 136 ± 31 minutes. Mean rounding time and time/patient varied between the nine attendings (total time range 109 minutes to 169 minutes, time/patient range 6.4 minutes/patient to 10.0 minutes/patient). In total, 91% of rounding time focused on patient care, teaching, and discussions with parents, while 9% of the time was spent deciding which patient to see next, moving between rooms, and waiting for members of the team to be ready to start rounds.

Conclusion On average, the medical team spent over 2 hours per day making multisciplinary rounds in the NICU with substantial variation between attending providers. While most time was spent on patient care, teaching, and talking with parents, we identified opportunities to improve rounding efficiency.

Key Points

• The structure of rounds in a NICU was observed to identify the potential barriers to efficiency.

• There are limited data on MDR processes in the NICU.

• In total, 9% of time was spent on patient care activities during daily rounds.

Keywords

rounds - neonatal intensive care - multidisciplinary - rounding efficiency

Authors' Contributions

C.G. conceptualized and designed the study, adapted the data collection instrument, coordinated and supervised data collection, performed the initial analyses, drafted the initial manuscript, and approved the final manuscript as submitted.

C.L. conceptualized and designed the study, participated in the analysis and interpretation of data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

P.C. conceptualized and designed the study, pilot tested the data collection instrument, participated in the analysis and interpretation of data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

G.W. conceptualized and designed the study, designed the data collection instrument, participated in the analysis and interpretation of data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

R.J.V. conceptualized and designed the study, adapted the data collection instrument, participated in the analysis and interpretation of data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

L.E. conceptualized and designed the study, adapted the data collection instrument, participated in the analysis and interpretation of data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

^* These authors contributed equally to this work.

Publication History

Received: 07 December 2021

Accepted: 23 August 2022

Accepted Manuscript online:
30 August 2022

Article published online:
28 October 2022

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