Timing of Physician Rounds for Antepartum Patients

Official title

Effect of Timing of Physician Rounds on Hospital Experience for High-Risk Antepartum Patients: A Randomized Controlled TrialTiming of Physician Rounds for Antepartum Patients

Overview

This study will include patients admitted to the Antepartum service at Duke University Hospital, many of whom are managing high-risk pregnancies that require extended hospital stays and frequent physician interactions. Currently, two rounding methods are used interchangeably for patients who do not have pregnancy or delivery complications that would preclude participation in delayed daytime rounding. This randomized controlled trial will compare two rounding models: the standard model, in which patients receive two rounds (an early morning bedside encounter and a later team discussion), and the intervention model, which consolidates both rounds into a single, later-morning bedside encounter following the team's review of clinical data. The primary objective is to assess whether consolidating physician rounds into a single, later-morning encounter-referred to as discovery rounding-improves patient satisfaction with communication.

Interventions

• Behavioral Discovery Rounding
  For certain patients with appropriate clinical risk factors, our service has adopted a policy of "discovery rounding". This method involves solely electronic health record chart review prior to the 8am attending-led Antepartum team discussion where the patient's overnight events are "discovered", clinical courses discussed, and daytime plans proposed. "Discovery rounding" consolidates bedside physician-patient encounters to one mid-morning interaction, forgoing early morning disturbances.
• Behavioral Standard Rounding
  The current standard of rounding on the Antepartum service involves a preliminarily bedside encounter with patients between 5-7am by a resident +/- medical student before an attending physician-led Antepartum team discussion from 8-9am. The patient is then rounded on for a second time in the late morning by the entire Antepartum team where patient concerns are heard and care plans for the day are relayed/reiterated/cemented.

Primary outcome measures

• Proportion of items rated as "Excellent" on the Communication Assessment Tool (CAT) [Time frame: One of the following timepoints (whichever comes first for that patient); Hospital day 6 or the immediate postpartum period: postpartum day 0 or 1, depending on the time of delivery]

Secondary outcome measures (1)

• Edinburgh Postnatal Depression Scale (EPDS) [Time frame: At the 6 week postpartum visit]

Eligibility criteria

Inclusion criteria

• Pregnant women greater than 20 weeks gestation admitted to the antepartum list at Duke University Hospital

Exclusion criteria

• Stillbirth
• ICU admission
• Admission to off-service unit
• Active magnesium sulfate administration
• Active severe hypertension or initiation of anti-hypertensive pathway within past 8 hours
• Category II fetal heart rate tracing
• Other pregnancy/delivery complication precluding delayed rounding
• Unstable/unsuitable condition per overnight team or attending physician
• Previously enrolled/on active board >1 day at morning rounds
• Postpartum readmission
• Antepartum admission within the last 4 weeks

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Other

Study locations

United States · 2 centers

• Duke University Hospital — Durham
• Duke University Hospital — Durham

Identifiers

NCT: NCT07215507 · Pro00118226

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗