Impact of EHR-based Rounding Tools on Interactive Communication: A Prospective Observational Study

Abstract Objective Structured rounding tools have shown to improve the overall efficiency and perceived satisfaction with the rounding process. However, little is known about how EHR-integrated rounding tools impact the content, structure and interactivity of communication during rounds. Method We conducted a prospective pre-post evaluation with two rounding tools: a Microsoft Word-based fillable rounding tool (usual tool), and an EHR-integrated rounding report tool (RRT). 27 clinicians across two teams participated in the rounding for 169 patients ( n usual = 84, n RRT = 85). We audio-recorded and coded communication during rounds using conversational analysis methods. Using the coded communication interactions, we investigated differences between the two tools on: clinical content discussed, questions raised, and breakdowns in interactive communication. Additionally, we gathered clinician perspectives on the rounding tools through follow-up interviews. Results We found that the use of RRT was associated with significantly more discussion of patient identifiers (e.g., name), and action items (e.g., to-do list) and significantly less discussion of imaging (e.g., X-rays) than the usual tool. RRT was also associated with fewer questions ( t  = 3.1, p  = 0.03), and correspondingly, fewer responses ( t  = 3.2, p  = 0.02). Communication breakdowns related to incorrect responses was fewer during the use of RRT ( t  = 0.5, p  = 0.01). There were no statistically significant differences in the time spent for rounding between the two tools. Conclusions Our findings showed that RRT impacted rounding workflow: during pre-rounding, by saving time and effort in gathering information from multiple sources; during rounding, by streamlining content of the conversations using the structured RRT template; and during post-rounding, by supporting explicit discussion of patient tasks and action items for patient care planning and management.