The effect of geographic rounding on hospitalist work experience: a mixed-methods study

ABSTRACT

Objectives

To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as ‘geographic rounding,’ and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction.

Methods

The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout.

Results

Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p < 0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p < 0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p < 0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p = 0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction.

Conclusion

Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.

KEYWORDS:

• Geographic assignment
• unit based rounding
• patient care team
• hospitalists
• burnout
• provider satisfaction
• quadruple aim
• teamwork
• interruptions
• quality improvement

Acknowledgments

None stated.

Disclosure of financial/other conflicts of interest

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of funding

No funding was received for the production of this manuscript.