A Pragmatic Cluster Randomized Controlled Trial to Standardize Attending Morning Rounds in Medicine

Attending morning rounds take place at teaching hospitals every day. They are the primary
mechanism for patient care delivery, supervision and education of trainees, and
communication with patients, families, and staff. However, they are done with little
standardization or widely recognized best practices.

The objective of this quality improvement (QI) initiative is to evaluate the adherence to
and impact of implementing standardized attending morning rounds on medicine teams at our
institution. A standardized rounding intervention has been developed which includes specific
guidance on completing the following activities during morning rounds: (1) Pre-rounds
discretion; (2) Pre-rounds huddle; (3) Bedside registered nurse (RN) integration; (4)
Patient-centered rounding; (5) Real-time order writing.

This trial will randomize half of the investigators' medicine teams at University of
California San Francisco to this rounding intervention whilst the other half will be
randomized to continue with usual unstandardized rounding practices.

The investigators will compare medicine teams randomized to undertake standardized rounding
to those teams undertaking usual practice. Outcomes assessed will relate to the patient
(e.g. satisfaction), providers (e.g. satisfaction), efficiency (e.g. total morning round
time) as well as adherence to the intervention .

The investigators' study hypotheses are that patient satisfaction scores will be higher for
those patients receiving standardized bedside rounds compared to the usual care group. The
investigators also hypothesize that total attending morning rounds time and interns length
of workday will be shorter and that the number of consultations ordered before noon will
increase for those teams undertaking standardized bedside. Further, the investigator
hypothesize higher levels of nurse participation, physician and medical student satisfaction
with standardized bedside rounding.