Journal article
The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients' Outcomes
Journal of general internal medicine : JGIM, Vol.30(12), pp.1821-1827
12/2015
DOI: 10.1007/s11606-015-3377-4
PMCID: PMC4636564
PMID: 26014891
Abstract
Sensemaking is the social act of assigning meaning to ambiguous events. It is recognized as a means to achieve high reliability. We sought to assess sensemaking in daily patient care through examining how inpatient teams round and discuss patients.
Our purpose was to assess the association between inpatient physician team sensemaking and hospitalized patients' outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates.
Eleven inpatient medicine teams' daily rounds were observed for 2 to 4 weeks. Rounds were audiotaped, and field notes taken. Four patient discussions per team were assessed using a standardized Situation, Task, Intent, Concern, Calibrate (STICC) framework.
Inpatient physician teams at the teaching hospitals affiliated with the University of Texas Health Science Center at San Antonio participated in the study. Outcomes of patients admitted to the teams were included.
Sensemaking was assessed based on the order in which patients were seen, purposeful rounding, patient-driven rounding, and individual patient discussions. We assigned teams a score based on the number of STICC elements used in the four patient discussions sampled. The association between sensemaking and outcomes was assessed using Kruskal-Wallis sum rank and Dunn's tests.
Teams rounded in several different ways. Five teams rounded purposefully, and four based rounds on patient-driven needs. Purposeful and patient-driven rounds were significantly associated with lower complication rates. Varying the order in which patients were seen and purposefully rounding were significantly associated with lower LOS, and purposeful and patient-driven rounds associated with lower ULOS. Use of a greater number of STICC elements was associated with significantly lower LOS (4.6 vs. 5.7, p = 0.01), ULOS (0.3 vs. 0.6, p = 0.02), and complications (0.2 vs. 0.5, p = 0.0001).
Improving sensemaking may be a strategy for improving patient outcomes, fostering a shared understanding of a patient's clinical trajectory, and enabling high reliability.
Details
- Title: Subtitle
- The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients' Outcomes
- Creators
- Luci K Leykum - McCombs School of Business, University of Texas at Austin, 7400 Merton Minter, San Antonio, TX, 78229, USA. Leykum@uthscsa.eduHannah Chesser - School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USAHolly J Lanham - McCombs School of Business, University of Texas at Austin, 7400 Merton Minter, San Antonio, TX, 78229, USAPezzia Carla - University of Dallas, Dallas, TX, USARay Palmer - Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USATemple Ratcliffe - Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USAHeather Reisinger - Iowa City VA Health Care System, Iowa City, IA, USAMichael Agar - Ethknoworks LLC, Santa Fe, NM, USAJacqueline Pugh - Department of Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter, San Antonio, TX, 78229, USA
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.30(12), pp.1821-1827
- DOI
- 10.1007/s11606-015-3377-4
- PMID
- 26014891
- PMCID
- PMC4636564
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Language
- English
- Date published
- 12/2015
- Academic Unit
- Center for Social Science Innovation; Internal Medicine
- Record Identifier
- 9984094548402771
Metrics
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