THE ASSOCIATION BETWEEN RESIDENTS WORK-ROUNDS STYLES AND THE PROCESS AND OUTCOME OF MEDICAL-CARE

Objective: To determine whether the manner in which residents conduct work rounds is associated with the adequacy of their care processes an d the outcomes of their patients. Methods: Two types of data were coll ected: time and motion data for residents (n = 12) during work rounds, and clinical and outcome data for the patients they cared for during the observation period (n = 211). Five residents were classified as da ta gatherers because they spent twice as much time gathering clinical data about their patients as they spent engaging in other activities. Three physicians blinded to the resident's identity rated the quality of the care process and assessed the frequency of undesirable events o ccurring during the stay and after discharge. Results: A data-gatherin g style was associated with higher quality of care as judged by both p rocess and outcomes. The data gatherers were more likely to comply wit h the ''stability of medications before discharge'' criterion (86% of the data gatherers' cases vs 73% of others', p = 0.07), and their pati ents were less likely to have unanticipated problems, in that fewer re quired calls from nurses (20% vs 37%, p < 0.01) and visits by on-call housestaff (33% vs 50%, p = 0.01). The data gatherers' patients were l ess likely to be readmitted within 30 days (14% vs 38%, p < 0.01). Con clusions: A data-gathering work-rounds style is associated with better process and outcome. Residency programs should provide formal instruc tion to trainees in the conduct of work rounds.