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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Rounding | Active Comparator | The 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. |
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| Discovery Rounding | Experimental | For 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Discovery Rounding | Behavioral | For 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 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 delivery |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | At the 6 week postpartum visit |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hannah Kelly, MD | Contact | 832-967-7998 | hannah.kelly@duke.edu | |
| Rachel Wood, MD | Contact | rachel.wood@duke.edu |
| Name | Affiliation | Role |
|---|---|---|
| Hannah Kelly, MD | Duke University Hospital | Study Director |
| Rachel Wood, MD | Duke University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Duke University Hospital | Not yet recruiting | Durham | North Carolina | 27710 | United States |
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| ID | Term |
|---|---|
| D003142 | Communication |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| Standard Rounding | Behavioral | The 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. |
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| Duke University Hospital | Recruiting | Durham | North Carolina | 27710 | United States |
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