• Sandeep Gangadharan, Brian Belpanno, and Peter Silver.
• J Healthc Qual. 2017 Mar 1; 39 (2): 122-127.

ObjectiveTo complete an objective analysis of the activities that occur during the course of daily rounds in a high acuity academic tertiary care pediatric intensive care unit (PICU).DesignProspective observational work sampling design.SettingTertiary care academic Children's Hospital Pediatric Intensive Care Unit.SubjectsMultidisciplinary PICU teams.InterventionsNone.MethodsIntensive care unit rounds were observed as part of an initiative to improve efficiency over a 2-month period. The number of observations required was determined by Neibel's work sampling method. Rounds were broken into various constituent events and then later classified as "value-added/essential," "value-added/nonessential," and "nonessential" based on whether the observed event was essential to the core mission of PICU rounds.ResultsThe mean time spent per patient for all observed teams was 17.9 min (SD 1.3 min). Teams spent 64% of their time doing value-added/essential tasks (11.2 min, SD 2.2 min) and 13% of their time doing value-added/nonessential tasks (2.4 min, SD 0.9 min). Teams spent 23% of their time on non-value-added activities (4.1 min, SD 2.3 min). The top three non-value-added activities conducted during rounds were travel, waiting, and interruptions regarding care of other patients. Given the consistency of time spent on value-added activities among attendings, these non-value-added activities might explain the significant variability observed among attendings in total time spent rounding.ConclusionsThis was an observational study to characterize the activities that occur during the course of a routine PICU work rounds. Although there was significant consistency in the time spent per patient in value-added activities, there was significant disparity in time spent on nonessential activities, such as travel and waiting. A dedicated attempt to reduce time spent on nonessential activities can substantially reduce rounding times and improve the efficiency and value of rounds.

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