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 and the outcomes of their patients. Methods: Two types of data were collected: 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 data 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 occurring during the stay and after discharge. Results: A data-gathering style was associated with higher quality of care as judged by both process and outcomes. The data gatherers were more likely to comply with the "stability of medications before discharge" criterion (86% of the data gatherers' cases vs 73% of others', p=0.07), and their patients were less likely to have unanticipated problems, in that fewer required 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 less likely to be readmitted within 30 days (14% vs 38%, p<0.01). Conclusions: A data-gathering work-rounds style is associated with better process and outcome. Residency programs should provide formal instruction to trainees in the conduct of work rounds.