608 - Rounding Smarter, Not Harder: Improving Rounding Efficiency Through Workflow Redesign

Publication Number: 2593.608

Tanvi Devi, Cohen Children's Medical Center, new york, NY, United States; Maria Kazmi, Cohen Children's Medical Center, North Bellmore, NY, United States; Ruchi Tejwani, Cohen Children's Medical Center, Demarest, NJ, United States; Aidan Doona, Cohen Children's Medical Center, Garden City, NY, United States; Smiriti Sharma, Cohen Children's Medical Center, New Hydr Park, NY, United States; Sudha Parashar, Cohen Children's Medical Center, Syosset, NY, United States; Preetha Kurian, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Astoria, NY, United States; Nancy Palumbo, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Brooklyn, NY, United States

Background: Inpatient rounding is the foundation to providing patient centered care, communication, and team education​. Less frequent use of family centered rounding (FCR) has led to longer rounding times and decreased nursing involvement. Such inefficiencies can prolong hospitalization rates and ineffective patient care. We opted to design an adaptable workflow to prioritize family centered rounding while balancing rounding efficiency at our institution.

Objective: Through a restructuring of daily rounding workflow, our aims were to 1) increase the percentage of rounds completed by 11:15am from 28% to 50%, 2) institute a goal of family-centered rounding on 60% of patient encounters, and 3) increase nursing presence on rounds from 46% to 70%.

Design/Methods: We used quality improvement methods to evaluate rounds on three pediatric hospital medicine service teams at a tertiary care children's hospital. Resident teams collected three months of baseline data. Interventions included: 1. Identification of medically stable and/or medically ready and dischargeable patients that could be seen by attending physician prior to daily rounds 2. Re-institution of family-centered rounding for 60% of patients on each team 3. Institution of a rounding script with nursing input. 4. Development and distribution of a video demonstrating effective family-centered rounding with a multidisciplinary team

Results: Data was collected from July 2024 to October 2025 by resident teams. One year post-implementation, completion of rounds by 11:15 a.m. increased from 28% to 33% across all three teams. While there was no FCR baseline data, 61% of patient encounters incorporated FCR after the intervention. Nursing presence during rounds increased from 46% to 65% following implementation of the rounding script. The baseline average rounding time per patient was 15.7 minutes, improving to 14.7 minutes over the study period. From October 2024 to April 2025, average rounding time decreased to 13.9 minutes but subsequently increased to 16.9 minutes from July to October 2025 with the start of the new academic year.

Conclusion(s): Implementation of a structured rounding workflow led to modest improvements in rounding efficiency, family-centered rounding frequency, and nursing participation. Improving FCR and nursing participation did not prolong rounding completion time. Although rounding efficiency improved initially, these gains were not sustained, highlighting the need for continued education, multidisciplinary engagement, and consistent use of structured rounding practices.

Monthly Percentage of Rounds Completed by 11:15am
P Chart demonstrating monthly percentage of rounds completed by 11:15 (averaged across 3 hospital medicine teams) by month with annotated PDSA cycles