2551. Optimizing Rounding Efficiency on the Infectious Diseases Inpatient Service: A Multi-Generational Conversation

BACKGROUND: To optimize faculty and trainee wellness without compromising patient care and trainee education, it is important to develop efficient team rounding strategies. This quality improvement project describes rounding practices and suggestions for optimizing rounding efficiency on Infectious Diseases (ID) inpatient consult services at a large academic institution. METHODS: An anonymous survey on rounding strategies was distributed to the ID Section at Baylor College of Medicine in February 2019 as part of a facilitated discussion on optimizing clinical education for fellows. RESULTS: Twenty-seven members of the ID section completed the survey (17 faculty, 10 fellows). Fellows reported rounding for a median of 4 hours per day (range 3–5), while faculty reported 4.5 hours (range 2–5.5). When asked what time fellows should start their workday, the median response was 7:30 am from both fellows (range 6:30–8 am) and faculty (range 7–8 am). When asked what time fellows should end their work day, the median response was 5:30 pm from both fellows (range 5–6 pm) and faculty (range 5–7 pm). Fellows reported signing their last note at 5:30 pm (range 5–9 pm), vs. 9 pm for faculty (range 6–11 pm). Regarding rounding method, most respondents (100% of fellows and 77% of faculty) preferred a combination of traditional rounding at patient bedside and “table” rounds. Regarding teaching method, most faculty (64%) preferred bedside teaching, while most fellows (60%) preferred teaching presentations in the work room (P = 0.011, Fisher’s exact). Both fellows and faculty had many suggestions for optimizing rounding efficiency; the most common was to avoid having fellows see all patients twice daily (“double rounding,” suggested by 80% of fellows and 30% of faculty). CONCLUSION: Overall, the reported behaviors of fellows regarding the structure of their days on inpatient ID services coincided with faculty expectations, although preferences differed between fellows and faculty regarding teaching methods. Avoiding “double rounding” was the most common suggestion to optimize efficiency. Larger studies are needed to better understand rounding behavior and strategies that will optimize the efficiency and effectiveness of inpatient ID consult teams. DISCLOSURES: All authors: No reported disclosures.