Study: Computerized rounding, sign-out system shortens duty hours

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Responding to limited resident duty hours, the University of Washington implemented a computerized rounding and sign-out system (UW Cores), which resulted in shortened duty hours by facilitating sign-out, decreasing rounding time and sharply reducing the time spent in prerounds data recopying, according to an article in the July edition of Academic Medicine.

To determine whether changing sign-out practices and decreasing the time spent in rounding and recopying patient data affect patient safety, Erik Van Eaton, MD, from the University of Washington School of Medicine in Seattle, and colleagues conducted a 14-week, randomized, crossover study involving 14 inpatient resident teams (six general surgery and eight internal medicine) at two hospitals. Over the course of the entire study, a total of 161 residents participated.

The authors measured resident-reported deviations in expected care that occurred during cross-coverage, medical errors and institutionally reported adverse drug events (ADEs).

The study period was 103 days. In that time, 1,365 of a possible 1,442 team-days of data were completed, including patient volumes and a conversation about resident-reported incidents. The resident teams made a total of 1,452 reports, of which 1,276 were reports of no unexpected activity and 176 were reports of unexpected overnight incidents.

The mean number of resident-reported deviations from expected care per 1,000 patient-days did not differ significantly between the control and UW Cores groups: 14.29 and 13.81, respectively, according to the researchers. The mean number of reported incidents involving errors was 6.33 per 1,000 patient-days for the control group and 5.61 per 1,000 patient-days for the UW Cores group, they found.

According to the report, a total of 84 ADEs related to study team patients were documented in the quality assurance databases of both hospitals during the study period. Control group patients experienced 39 ADEs and intervention group patients experienced 45 ADEs.

“This multi-hospital, randomized, crossover trial shows that the previously described reduction in rounding time and information handling by residents using the UW Cores computerized rounding and sign-out system does not increase the incidence of deviations from expected care, resident-reported overnight medical errors or ADEs,” Van Eaton and colleagues wrote. “In addition to the objective gains we previously reported, residents using the UW Cores system describe spending 30 to 45 fewer minutes per day in managing patient information and generating sign-out materials for colleagues.”

The researchers concluded that the system improved continuity and enhanced resident efficiency without weakening systemic defenses against error or jeopardizing patient safety. “The success of the UW Cores system stems from its ability to effectively combine data from multiple places such as the medical record, the inpatient census list and the resident’s own ‘to-do list’ and comments,” the authors noted.