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• Patient-centered bedside rounds-Exploring patient preferences before patient-centered care
  Naseema B Merchant
  Published on: 27 January 2016

• Published on: 27 January 2016

  Patient-centered bedside rounds-Exploring patient preferences before patient-centered care

  • Naseema B Merchant
  • Other Contributors:
    • Dr. Daniel G Federman

  Dear Editor,

  It was with great interest that we read the study of O'Leary et al published in the December issue of the journal and were quite surprised by their findings that patient centered- rounds had no impact on patients' perceptions of shared decision making, activation, and satisfaction with care.1

  Previous studies have shown that patients prefer their rounding team conduct rounds at the bedside...

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  Dear Editor,

  It was with great interest that we read the study of O'Leary et al published in the December issue of the journal and were quite surprised by their findings that patient centered- rounds had no impact on patients' perceptions of shared decision making, activation, and satisfaction with care.1

  Previous studies have shown that patients prefer their rounding team conduct rounds at the bedside 2-5and based on these studies, one would expect that if bedside rounds were conducted, patients would feel more satisfied with their care and be more engaged in medical decision making compared to other forms of rounding.

  The findings of this study do make us pause and reconsider some of our perceived beliefs regarding patient benefits from bedside rounds. The authors propose several explanations to support their findings. However, before abandoning patient-centered bedside rounding (PCBR), one must consider several potential issues that may make this study less generalizable. One explanation not explored might be the possibility of patients being asleep at that time of the day (7.30 am) and they may not have wanted or have been in a position to participate in PCBR. Additionally, the control group was cared for by a small team: one of the units was a cardiac type unit where patients were being admitted to initiate and monitor medications. It is possible that the small care team, type of patients on that unit, and the general structure of the control team was designed so patients may have had positive perceptions about their care, which might explain their findings. It is also possible that the language used by the team during PCBR after the initial few weeks of mentoring may have contained medical jargon or the script used to invite patient participation may not have been r conducive to patient engagement. These potential factors could have affected the perception by patients.

  An important critique of the study is that patients were not given a choice of whether they in fact wanted PCBR. In our experience of querying Veterans at our institution, while the majority state they would prefer PCBR "If they have something to say, I want to hear it", a sizable minority prefer NOT to have PCBR, as they are uncomfortable with medical uncertainty and hearing worst case scenarios "You're the doctor. You tell me". Perhaps a better approach would be to ask every patient upon admission if they prefer team rounds at the bedside or outside the room. The teams should ask the patient how much they would like to participate in their care, and whether they'd be comfortable if there were other patients in the hospital room, and then proceed accordingly. It is essential to explain what these rounds entail and possible roles the patient can assume. Once patients are provided this information they may be in better position to think through their choice of actively participating or not in becoming informed customers; they may be able to make the choice that best suits their preferences. Given the challenges of executing PCBR and O'Leary's findings perhaps PCBR should only be done on those that actually want them. As simplistic as it sounds, patients should actually be asked in a patient-centered manner whether they actually want patient centered bedside rounding.

  REFERENCES:

  1. O'Leary, KJ, et al, Effect of patient-centered bedside rounds on hospitalized patients' decision control, activation and satisfaction with care, BMJ Qual Saf 2015;0:1-8. doi:10.1136/bmjqs-2015-004561

  2. Wang-Cheng, R.M., et al., Bedside case presentations: why patients like them but learners don't. J Gen Intern Med, 1989. 4(4): p. 284-7

  3 Rogers, H.D., J.D. Carline, and D.S. Paauw, Examination room presentations in general internal medicine clinic: patients' and students' perceptions. Acad Med, 2003. 78(9): p. 945-9. 4. Gonzalo, J.D., et al., The return of bedside rounds: an educational intervention. J Gen Intern Med, 2010. 25(8): p. 792-8.

  5. Lehmann, L.S., et al., The effect of bedside case presentations on patients' perceptions of their medical care. N Engl J Med, 1997. 336(16): p. 1150-5.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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