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Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs’ Service Model for Inpatient Teaching

Bennett, Nadia L. MD; Flesch, Judd D. MD; Cronholm, Peter MD, MSCE; Reilly, James B. MD, MS; Ende, Jack MD

doi: 10.1097/ACM.0000000000001459
Research Reports

Purpose: The Chiefs’ Service (CS), a structured approach to inpatient teaching rounds, focuses on resident education and patient-centered care without disrupting patient census sizes or admitting cycles. It has five key elements: morning huddles; bedside rounds; diagnostic “time-outs”; day-of-discharge rounds; and postdischarge follow-up rounds. The authors hypothesized the CS model would be well received by residents and considered more effective than more-traditional rounds.

Method: The CS was implemented on Penn Presbyterian Medical Center’s general medicine inpatient service using a quasi-experimental design. Its first year (January 2013–January 2014) was evaluated with a mixed-methods approach. Residents completed end-of-rotation evaluation questionnaires; 20 CS and 10 traditional service (TS) residents were interviewed. Measures of resident agreement on questionnaire items were compared across groups using independent sample t testing. A modified grounded theory approach was used to assess CS residents’ perspectives on the CS elements and identify emergent themes.

Results: The questionnaires were completed by 183/188 residents (response rate 97%). Compared with TS residents, CS residents reported significantly greater satisfaction in the domains of resident education and patient care, and they rated the overall value of the rotation significantly higher. The majority of CS residents found the CS elements to be effective. CS residents described the CS as focused on resident education, patient-centered care, and collaboration with an interdisciplinary team.

Conclusions: The CS approach to inpatient rounding is seen by residents as valuable and is associated with positive outcomes in terms of residents’ perceptions of learning, interdisciplinary communication, and patient care.

N.L. Bennett is codirector, Internal Medicine Clerkship, and assistant professor of clinical medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

J.D. Flesch is associate program director, Internal Medicine Residency, and assistant professor of clinical medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

P. Cronholm is associate professor of family medicine and community health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

J.B. Reilly is internal medicine residency program director, Allegheny Health Network, Pittsburgh, Pennsylvania, and assistant professor of medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.

J. Ende is Schaeffer Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A401.

Funding/Support: This work was supported by a grant from an anonymous, private, philanthropic family foundation.

Other disclosures: None reported.

Ethical approval: The institutional review board of the University of Pennsylvania approved the study (IRB approval number: 817005; date approved: January 2, 2013).

Correspondence should be addressed to Nadia Bennett, Hospital of the University of Pennsylvania, 3400 Spruce St., Maloney Building, Room 5019, Philadelphia, PA 19104; telephone: (443) 854-3706; e-mail: nadia.bennett@uphs.upenn.edu.

© 2017 by the Association of American Medical Colleges