• Rebecca Blankenburg, Joan F Hilton, Patrick Yuan, Stephanie Rennke, Brad Monash, Stephanie M Harman, Debbie S Sakai, Poonam Hosamani, Adeena Khan, Ian Chua, Eric Huynh, Lisa Shieh, and Lijia Xie.
• Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA. rblanke@stanford.edu.
• J Hosp Med. 2018 Jul 1; 13 (7): 453461453-461.

BackgroundShared decision-making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM.ObjectiveTo assess overall quality, provider behaviors, and contextual predictors of SDM during inpatient rounds on medicine and pediatrics hospitalist services.DesignA 12-week, cross-sectional, single-blinded observational study of team SDM behaviors during rounds, followed by semistructured patient interviews.SettingTwo large quaternary care academic medical centers.ParticipantsThirty-five inpatient teams (18 medicine, 17 pediatrics) and 254 unique patient encounters (117 medicine, 137 pediatrics).InterventionObservational study.MeasurementsWe used a 9-item Rochester Participatory Decision-Making Scale (RPAD) measured team-level SDM behaviors. Same-day interviews using a modified RPAD assessed patient perceptions of SDM.ResultsCharacteristics associated with increased SDM in the multivariate analysis included the following: service, patient gender, timing of rounds during patient's hospital stay, and amount of time rounding per patient (P < .05). The most frequently observed behaviors across all services included explaining the clinical issue and matching medical language to the patient's level of understanding. The least frequently observed behaviors included checking understanding of the patient's point of view, examining barriers to follow-through, and asking if the patient has any questions. Patients and guardians had substantially higher ratings for SDM quality compared to peer observers (7.2 vs 4.4 out of 9).ConclusionsImportant opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.© 2018 Society of Hospital Medicine

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