Game on! Applying Athletic Principles to Medical Rounds to Improve Teaching and Patient Car. Reviewed by Gina Lowell
Southwick F et al. Academic Medicine 2014; 89(7):1018–1023
Applying Athletic Principles to Medical Rounds to Improve Teaching and Patient Car.
Reviewed by Gina Lowell
What was the study question?
Can team-based principles used by athletic teams be applied to inpatient rounds to decrease rounding time, shorten hospital length of stay (LOS), reduce readmission rates and improve physician and medical student satisfaction?
How was the study done?
Medical teams on the inpatient, internal medicine service were allocated in a non-random, non-blinded fashion to receiving the team-based intervention or not for a nonconsecutive period of 11 months in 2 phases. The intervention consisted of a 20 minute orientation to the following athletic analogies
1) the “playbook”, which detailed the key role of each player on the team (e.g. Attending=coach, senior resident=quarterback),
2) key relationships (e.g. physician-nurse), and
3) “game-film” mentality, (e.g. responding to feedback, continual improvement). Fundamental principles were emphasized, such as the SOAP or SBAR presentation formats. Rounds were held at the bedside in a “huddle” formation. Outcomes measured were mean time on rounds, mean relative LOS, readmission rates, and physician and student satisfaction. Not all outcomes were measured over both phases.
What were the results?
Mean duration on rounds was 16 minutes shorter for the intervention group (phase 2 only, statistically significant). There was no difference in mean relative LOS during phase 1, but LOS was significantly lower in the intervention group during phase 2. The readmission rate was significantly lower in the intervention group across both phases (~7% vs ~10%). Faculty, residents and medical students all favored the intervention in several measures of satisfaction. There were no differences in patient satisfaction between the two groups.
What are the implications of the findings?
Applying team-based principles used by professional athletic teams to rounding appears to have several benefits. (This study, though, abounds with limitations.) Most general pediatric services where family centered rounds are the standard of care will likely find these principles already adopted in a non-sports analogy fashion. From a July perspective, however, explicitly defining roles with a “playbook” and promoting the senior resident as “quarterback” may help new interns and “new” senior residents enter the wards with more confidence (not measured).
Editor’s note: This study demonstrates that, once again, there is much to be learned from other disciplines. Framing roles and feedback in the context of an athletic team often makes these concepts easier for trainees to understand and accept (SLB).