Timing of Physician Rounds for Antepartum Patients
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexFemale
Age18+
SponsorDuke University
About this trial
This study will include patients admitted to the Antepartum service at Duke University Hospital, many of whom are managing high-risk pregnancies that require extended hospital stays and frequent physician interactions. Currently, two rounding methods are used interchangeably for patients who do not have pregnancy or delivery complications that would preclude participation in delayed daytime rounding. This randomized controlled trial will compare two rounding models: the standard model, in which patients receive two rounds (an early morning bedside encounter and a later team discussion), and the intervention model, which consolidates both rounds into a single, later-morning bedside encounter following the team's review of clinical data. The primary objective is to assess whether consolidating physician rounds into a single, later-morning encounter-referred to as discovery rounding-improves patient satisfaction with communication.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Pregnant women greater than 20 weeks gestation admitted to the antepartum list at Duke University Hospital
Disqualifiers
Stillbirth
ICU admission
Admission to off-service unit
Active magnesium sulfate administration
Trial design
Design model
Parallel
Treatments tested in this trial
Discovery Rounding
BehavioralFor certain patients with appropriate clinical risk factors, our service has adopted a policy of "discovery rounding". This method involves solely electronic health record chart review prior to the 8am attending-led Antepartum team discussion where the patient's overnight events are "discovered", clinical courses discussed, and daytime plans proposed. "Discovery rounding" consolidates bedside physician-patient encounters to one mid-morning interaction, forgoing early morning disturbances.
Standard Rounding
BehavioralThe current standard of rounding on the Antepartum service involves a preliminarily bedside encounter with patients between 5-7am by a resident +/- medical student before an attending physician-led Antepartum team discussion from 8-9am. The patient is then rounded on for a second time in the late morning by the entire Antepartum team where patient concerns are heard and care plans for the day are relayed/reiterated/cemented.
Treatment groups
200 Participants
are divided into 2 treatment groupsGroup A: Standard RoundingActive comparator 1 intervention
Group B: Discovery RoundingExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Proportion of items rated as "Excellent" on the Communication Assessment Tool (CAT)
The CAT measures patients' perceptions of physician communication across 15 specific behaviors, such as listening carefully, showing respect, explaining information clearly, and spending sufficient time with the patient. Each item is rated on a 5-point Likert scale ranging from "Poor" to "Excellent." By focusing on the frequency of "Excellent" ratings, the CAT provides a robust, patient-centered measure of the effectiveness and impact of physician communication during hospitalization.
Time frame
One of the following timepoints (whichever comes first for that patient); Hospital day 6 or the immediate postpartum period: postpartum day 0 or 1, depending on the time of deliverySecondary outcomes
1
Edinburgh Postnatal Depression Scale (EPDS)
A 10-item self-report questionnaire, validated for both postpartum and antepartum use, in which each item is scored 0-3 (total 0-30), with higher scores indicating greater depressive symptoms and a common cut-off of ≥13 suggesting possible clinical depression.
Time frame
At the 6 week postpartum visitSponsors and contacts
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Source ClinicalTrials.gov