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Completed

NCT Number: NCT03210987

Effects of Bedside Compared to Outside the Room Case Presentation

Patient case presentations during ward rounds can take place at the bedside or outside the room. The best approach to patient case presentation is yet unclear. Thus, the overall aim of this multicenter, randomized-controlled study is to test the hypothesis that outside the room patient case presentation compared to bedside patient case presentation results in better outcomes across different dimensions including patient 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.

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Key information

Conditions

Bedside Patient Case Presentation Behavior Communication Outside-the-room Patient Case Presentation

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University Hospital Basel

Basel, 4056, Switzerland

About this study

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.

Therefore, this randomized controlled trial aims to test the hypothesis that outside the room patient case presentation compared to bedside patient case presentation results in better outcomes across different dimensions including patient 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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Consecutive adult (>18 years) medical inpatients during their first ward round independently of their underlying disease and reason for hospital stay.

Exclusion criteria

  • Patients with cognitive impairment, such as dementia/delirium
  • Patients with paracusia.
  • Patients who do not understand local language(s).
  • Patients already included in this study

Treatment and study plan

patient case presentation bedside

Procedure

Patient case presentation in absence or presence of Patient at bedside.

Other names: teaching round, bedside round, ward round

patient case presentation Outside-the-room

Procedure

Patient case presentation Outside-the-room.

Primary outcomes

  1. Subjective understanding of disease and management

    Time frame: post ward round up to 36 h

    average of the visual analog scale (VAS) score across the following three dimensions rated by the patient (0 "I have no knowledge at all about the situation" to 100 "I have best possible knowledge about the situation": I. Patients' subjective understanding of the disease II. Patients' subjective understanding of the therapeutic concept III. Patients' subjective understanding of the next steps

Secondary outcomes

  1. Improvement understanding

    Time frame: post ward round up to 36 h

    Patients' perception about how well the current ward round improved the understanding of each of these three components, i.e., current disease, therapeutic concept, and next steps (VAS, 0-100)

  2. Objective understanding of disease and management

    Time frame: post ward round up to 36 h

    Comparison of patients' recall information regarding current main diagnosis, main therapeutic measures and next steps (qualitative information) with medical chart information.

    Answers regarding current main diagnosis will be categorized as: (1) patient correctly states both pathophysiology and localization, (2) patient correctly states either pathophysiology or localization, (3) patient states neither pathophysiology nor localization (correctly) but correctly states symptoms, (4) patient correctly states that the current diagnosis is still unclear, (5) patient states incorrect information, (6) patient correctly states a secondary diagnosis relevant for the current hospitalization Answers regarding main therapeutic measures and next steps will be categorized as: (1) correct (regarding main diagnosis), (2) incorrect (regarding main diagnosis), (3) correct (regarding secondary diagnosis), (4) incorrect (regarding secondary diagnosis)

  3. Overall quality of care

    Time frame: post ward round up to 36 h

    Patients' perception (each rated on a VAS 0-100) regarding: comprehensibility of information during ward round, satisfaction with care, confidence in the medical team, perceived competence of the medical team, perceived interpersonal behavior during ward round, affective response of the patients, adequacy of ward round duration (includes two additional questions asking for patients' estimations on how much time the medical team spent on their case within the ward round as well as on average per day (estimates in minutes))

  4. Follow up health status

    Time frame: 30 days follow up after study inclusion

    Patients' perceived health status (EuroQol five dimensions questionnaire)

  5. Follow up understanding

    Time frame: 30 days follow up after study inclusion

    Patients' subjective (VAS 0-100) and objective (recall as compared to objective medical chart information) understanding

  6. Follow up quality of hospital care

    Time frame: 30 days follow up after study inclusion

    Patients' overall perspective of hospital care (Hospital Consumer Assessment of Healthcare Providers and Systems, HCAHPS)

  7. Follow up readmission

    Time frame: 30 days follow up after study inclusion

    Patients' readmission rate since study inclusion

  8. Follow up duration of hospitalization

    Time frame: 30 days follow up after study inclusion

    total duration of hospitalization

  9. Treating team satisfaction

    Time frame: post ward round up to 96 h

    The treating team's satisfaction with ward round (rated on a VAS 0-100)

  10. Treating team performance

    Time frame: post ward round up to 96 h

    The treating team's perceived performance in the ward round (each rated on a VAS 0-100): time management of the ward round, interaction within the medical team and with the patient during ward round, perceived time management and feasibility

  11. Treating team affect

    Time frame: post ward round up to 96 h

    The treating team's affective response (rated on a VAS 0-100)

  12. Treating team preference

    Time frame: post ward round up to 96 h

    The treating team's preference of bedside compared to outside the room patient case presentation (rated on a semantic differential ranging from 1 "I prefer bedside ward rounds" to 6 "I prefer ward rounds outside the room")

  13. Timeliness

    Time frame: during ward round which may last from 5 up to 30 minutes

    duration of the ward round (minutes)

  14. Communication-specific items during ward rounds

    Time frame: during ward round which may last from 5 up to 30 minutes

    Rated by investigator (nominal 3-point scale (1 = yes; 2 = no; 3 = not applicable): structuring of conversation, use of patient-centered techniques, use of physician-centered techniques, dealing with emotions, conveying of complex information, negotiation of shared concepts of disease and treatment, realization of shared decision making, breaking bad news

Sponsors and collaborators

Lead sponsor

University Hospital, Basel, Switzerland

Other

Collaborators

  • Kantonsspital Aarau
  • Kantonsspital Liestal

Registry information

Official study title

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

Important dates

Study start
2017
Primary completion
2019
Study completion
2019
First posted
Jul 7, 2017
Registry last updated
Jan 23, 2020

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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