P0450 - An Analysis of Neonatal Intensive Care Daily Rounds in a Level IV Unit

Background: The neonatal intensive care unit (NICU) is a fast-paced, complex environment that involves numerous care providers. With each expert contributing to a neonate’s care plan, teamwork and communication are essential to achieve a common goal. A key mechanism in this communication is daily medical rounds. The Society of Critical Care Medicine endorses the utilization of multidisciplinary rounds as they have been proven to reduce both mortality and the rate of adverse events. There is limited published data on daily medical rounds in the NICU.

Objective: To analyze the current structure and system-based processes of daily medical rounds in an academic, level IV NICU.

Method: An observational study was performed of daily medical rounds from January to December 2018, collecting data on attending and fellow presence, overall census, total rounding time and causes of rounding delays. Evaluated time spent on value added and non-value added aspects of rounds and rounding geographic pathway through direct observation of daily medical rounds from February to April 2018. Descriptive statistics were performed to describe rounding times in total, by patient, by attending and by day of the week. An analysis of variance was performed to evaluate differences in rounding time by day of the week and attending provider.

Results: A total of 207 baseline rounding observations were collected with a mean total rounding time of 136 ± 30.6 minutes. There was no statistically significant difference between the mean time spent on rounds, time per patient, and census by day of the week. There was statistically significant variability among attending providers as shown in Figure 1 (p < 0.001). Non-valued added time comprised 33% of the total rounding time through activities other than patient discussion and decision making (Figure 2).

Conclusion: This observational study describes the high degree of non-valued added time spent during daily medical rounds with variation in rounding time based on the attending provider. Initiatives through quality improvement are necessary to increase the effectiveness of daily medical rounds in the NICU.