Our results have been published in Academic Medicine: Southwick F., M. Lewis, D. Treloar, K. Cherabuddi, N. Radakrishnan, R. Leverence, X. Hand, and L. Cottler, Applying athletic principles to medical rounds to improve teaching and patient care. Acad. Med. 89:1018-1023, 2014
As compared to a control group that had no new training, when physicians, students, nurses, pharmacists and case managers followed their playbooks and fundamentals there was:
Significant reduction in:
- Duration of rounds Shortened by 16 minutes – Control 126.1 ± 3.8 min, n = 64 vs Experimental 110.8 ± 2.8 min, n = 75 P = .0049
- Length of Stay 20% reduction: Control 0.93 ± 0.07, n = 242 vs Experimental 0.76 ± 0.05, n = 213 P = 0.01
- 30-day readmission percentage: 30% reduction, Control 9.95 ± 1.02, n = 659 vs 6.95 ± 1.29, n = 576 P= 0.039
- Significant improvement in satisfaction by Attendings, Residents, Medical Students, and Nurses.
- Improvement in patient satisfaction did not achieve statistical significance:
control group: 4.0 ± 0.1, n = 46 patients; vs experimental 4.3 ± 0.1, n = 44 patients, P = .076
Applying AIR as our rounding system increased productivity by 4 X
In October 2019 we were able to fully implement AIR and utilized the Rothman Index to assist in deciding on disposition. For patients with scores above 60 with no warnings in 2 days we planned discharge and for those with scores below 40 whose slope was downtrending despite adjustments in therapy we requested MICU placement. This allowed more rapid disposition. This run chart documents our daily census over time. The daily census is a reflection of length of stay because each teaching team receives the same number of admissions each day (short admit 6, mid-day 5, late 5, and golden 0 admissions). The arrows mark the period during which AIR and the RI were utilized to improve the efficiency of care. There was no rise in 30-day readmission rate during this period. Before initiating this system the median daily census was 18 and when the rounding system was discontinued the census again returned to 18. This run chart represents a shift indicating specific cause effect, and is highly statistically significant. During this same period the other teaching services each had a median census of 18. This run chart documents that adoption of AIR can result in a > 4 X. rise in productivity.
In February 2023 post-COVID-19 pandemic, we were able to fully implement AIR for a full month. On February 15th the attending and one of two interns changed and on February 17th the Senior Resident changed. As you can see our census was consistently below the usual 18 present on nearly all other teaching services. The census dropped to a low of 6 or a 3 fold increase in productivity.