An Analysis of the Daily Work-Rounding Process in a Pediatric Intensive Care Unit

OBJECTIVE: To 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). DESIGN: Prospective observational work sampling design. SETTING: Tertiary care academic Children's Hospital Pediatric Intensive Care Unit. SUBJECTS: Multidisciplinary PICU teams. INTERVENTIONS: None. METHODS: Intensive 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. RESULTS: The 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. CONCLUSIONS: This 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.