A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours

• HIT Description: Electronic communication More info...
  
• Purpose of Study: To determine the impact of a computerized rounding and sign-out system on the continuity of inpatient care and resident work efficiency
  
• Years of study: 2003
  
• Study Design: Randomized controlled trial
  
• Outcomes: Impact on health care effectiveness and quality, Impact on efficiency, utilization and costs
  

• Settings: Two hospitals: a 450-bed tertiary care university hospital and a 368-bed Level 1 trauma center
• Intervention: A centralized Web-based computerized rounding and sign-out system.
• Evaluation Method: Surgical and medical residents were randomized to use a web-based computerized rounding and sign-out system as alternative systems with crossover of groups after 7 weeks; self-reported number of patients initially missed on rounds, self and observer-reported resident time spent during pre-rounds, and self reported assessment of impact on continuity of care.
• Description: The University of Washington Computerized Rounding System (UWCores) uses the internet and a database to deliver information to any authorized user. Residents may organize patient lists and enter detailed sign-out information and Òto doÓ lists about patients.
• Interoperability: Recent vital signs and laboratory values are automatically downloaded from the hospital clinical information systems.
• Strategy: All impatient care teams were invited to use the system for a 6-weeks run-in period. In that time, residents familiarized themselves with the system and it was modified to better fit needs.
• Quality of Care and Patient Safety Outcome: System reduced the number of patients missed on resident rounds by half (from 5 to 2.5 patients per team per month, p.001).
• Changes in efficiency and productivity: System reduced the mean portion of pre-rounding time spent hand-copying vital signs and lab values from 24% to 12% (p.001). Junior residents reported that they could then spend more time seeing patients before rounds. The largest benefit to the surgical services was the ability to sort patient list by location.