Outcomes

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

    Shortening Rounds

    Control rounding times (random variation) versus Experimental (specific cause variation) progressive reduction in round duration, consistently below 2 hr by day 9.

  • Length of Stay   20% reduction: Control 0.93 ± 0.07, n = 242   vs Experimental 0.76 ± 0.05, n = 213  P = 0.01

    Gatorounds reduced LOS

    Length of stay based on DRGs. 1 = expected LOS, below 1 shorter than expected. 

  • 30-day readmission percentage:  30% reduction, Control  9.95 ± 1.02, n = 659 vs 6.95 ± 1.29, n = 576 P= 0.039

    Gatorounds reduces readmission rate

    Both the Control and Experimental Groups demonstrated decreased readmission rates. Both teams had case managers attend daily work rounds.

  • 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

  • Improved attending satisfaction

    Asterisk = p < 0.05 statistically significant. 5 Highly satisfied, 1 Very unsatisfied. Hashed bars = Experimental group.

    Gatorounds improves resident satisfaction

    Asterisk = P <0.05 5 highly satisfied, 1 very unsatisfied. Hashed bars = Experimental Group

    Gatorounds increased student satisfaciton

    Students demonstrated marked increases in satisfaction

    Gatorounds improved nursing satisfcation

    Nurses experienced greater respect and greater contact with physicians.

     

    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.

Run Chart Documenting the Efficiency of the AIR rounding system

Arrows show the beginning and ending date of implementation of AIR. (See text)