How much time are physicians and nurses spending together at the bedside?

I recently came across a very interesting study conducted by a group of investigators at Stanford University ("How much time are physicians and nurses spending together at the patient bedside?").  The investigators took advantage of the hospital's real-time locator system using radio frequency identification (RFID) to measure the amount of time physicians spent on rounds in three acute medical/surgical units.  Both the attending physicians and nursing staff wore the RFID locators.

The physician rounding teams (attending physician, residents, medical students) were encouraged to include the patient's bedside nurse on rounds, but this was not mandatory.  The study was conducted over 90 consective days, leading to a total of 739 different rounding events.

On average, physicians spent close to seven minutes at each bedside.  There were no differences in the duration of rounds between weekdays or weekends.  Of the physician rounding events observed in single-patient rooms (i.e., double patient rooms were excluded from the analysis), a nurse was present during rounds only 30% of the events.  The duration of physician-nurse overlap in each room was only about three-and-a-half minutes.  There was no difference in physician-nurse overlap between weekdays and weekends.

All three of the medical/surgical units had the same configuration - nineteen beds in a linear layout,  There was a central nursing station across from the 10th patient room.  Of note, for each additional room farther away from the nursing station, the likelihood that the nurse attended rounds decreased by almost 2%.

Studies have consistently shown that when physicians and nurses round together, patient care improves.  Interdisciplinary rounds (physicians rounding with the nurses present at the bedside) have been shown to improve the perception of teamwork, reduce the number of pages for the physician team, better involve the patient in developing a plan of care, and decreasing the hospital length of stay.  Better communication and teamwork also improves patient satisfaction, as well as nurse satisfaction and retention.  Nurse retention is particularly relevant considering the current nursing staffing crisis (there are not enough nurses to go around).

Clearly, including the nurse on rounds is a win-win!  The natural question follows - why do physician rounding teams continue to round in isolation?  I completely admit that this is just one study, but there are others that show even worse nurse inclusion in physician rounds.  Another   study using medical students as observers showed that the physician teams communicated with the nurses during rounds only 12% of the time!  In full disclosure, another study showed that multidisciplinary rounds were much more common (physician-nurse overlap was 63% to 81%).

We need to do a better job of including the patient's bedside nurse on rounds.  Will it make rounds last longer?  Probably (and at least in the study above, it did increase the average duration of rounds from 5.68 minutes per patient to 9.56 minutes per patient).  However, if care is better, patients are happier, and nurses are happier, this doesn't seem like all that much of a sacrifice.  Just as important, if including the nurse also leads to less pages for clarifications or questions later in the day, the efficiency of physician rounds AND physician satisfaction will improve.

Health care is a team sport.  And we do better when everyone on the team works together.  More hospitals should bring the physician rounding teams and bedside nurses together at the bedside.