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Effect of bedside patient case presentation compared to outside the room case presentation on patient perception of quality of care and patient outcomes: a randomized-controlled, multicenter trial

Research Project
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01.10.2018
 - 31.03.2021

Patient-centered care may be defined as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Involving patients in all steps of the healthcare process is thus important. Yet, best presentation of patients' cases during ward rounds remains unknown. During outside the room patient case presentation, the medical team discusses difficult patient or medical issues in the team, and later presents a "patient-friendly" synthesis to the patient. Bedside patient case presentation, on the other hand, allows a patient to be part of the whole team discussion. Yet, there is concern that patients may be unable to cope with the magnitude of medical information and misunderstandings may occur. Currently, there is equipoise regarding both possibilities of patient case presentation with an important lack of trial data. We thus aim to compare the effect of bedside patient case presentation with outside the room patient case presentation during ward rounds ("Chefarztvisite") on different patient- and physician-related endpoints.General aim: To test the hypothesis that bedside patient case presentation compared to outside the room patient case presentation results in better outcomes across different dimensions including patients' understanding and perception of quality of care as well as patient outcomes, physicians' preferences, perception of quality and effectiveness, and timing of the ward rounds, respectively. Methods: pragmatic, multicenter, randomized-controlled, superiority trial Patient population: Consecutive adult medical inpatients during their first ward rounds are eligible independent of main diagnosis. We will exclude patients with dementia/delirium, paracusia, and if unable to complete questionnaires or follow the ward rounds. Intervention: In both groups, the ward rounds will follow the usual ward round procedures (i.e., the junior physician presents the case with discussion of differential diagnoses, further diagnostic tests and therapeutic options). In the bedside group, the case presentation will be at bedside with direct involvement of the patient. In the outside the room group, the main presentation will be outside followed by the team entering the room to inform the patient about the medical situation. Endpoints: The primary endpoint is patients' subjective understanding of disease and its management defined as the average of the visual analog scale (VAS) score across the following three dimensions rated by the patient after the ward round: (I) Patients' understanding of the disease, (II) Patients' understanding of the therapeutic concept; (III) Patients' understanding of the next steps. Secondary endpoints are (a) each of the three individual components of the above mentioned primary endpoint; (b) patients' perception about how well the current ward round improved the understanding of these components; (c) objective patients' understanding of disease and management (compared to medical chart information); (d) patients' perceived overall quality of care; (e) patients' perceptions and outcomes after 30 days of study inclusion (e.g., readmission rates); (f) perception of the physician and nursing staff with ward rounds; (g) timeliness (duration) of the ward round. All communication items will be coded and taped for later analysis of communication-specific items (secondary projects)..Sample size and statistics: The inclusion of 760 patients will provide 90% power to detect a difference in the primary combined endpoint of 5% (average VAS score of 84±17 vs 80±17 points). We will first compare the two conditions in the overall population, and later focus on effects in predefined subgroups by main diagnoses (i.e., cancer, cardiovascular, infection, psychiatric patients, alcoholics), type of patient (gender, age, socio-economic status), need for breaking bad news, need for shared decision making, number of patients per hospital room. Ancillary projects: We will audio-tape the conversations during rounds for detailed analysis of communication patterns to better understand how well these pattern predict patient outcomes (i.e., understanding and perception of the quality of rounds). Discussion: Although ward rounds are a cornerstone of inpatient care, there is a lack of randomized data investigating the most appropriate approach for patient involvement. This multicenter trial is the first to systematically investigate this important question. It will help to close this gap and give important insights into preferences of patients and caregivers regarding ward rounds and thus move closer to patient-centered care.

Funding

Effect of bedside patient case presentation compared to outside the room case presentation on patient perception of quality of care and patient outcomes: a randomized-controlled, multicenter trial

SNF Projekt (GrantsTool), 10.2018-09.2020 (24)
PI : Hunziker, Sabina.
CI : Schütz, Philipp.

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Sabina Hunziker

Principal Investigator