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 rounds for 169 patients (nusual=84, nRRT=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.

中文翻译：

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基于EHR的舍入工具对交互式通讯的影响：一项前瞻性观察研究。

目的结构化的舍入工具已显示可提高整体效率，并提高对舍入过程的满意度。但是，关于EHR集成的舍入工具如何影响舍入过程中通信的内容，结构和交互性知之甚少。方法我们使用两种舍入工具进行了前瞻性的事前评估：两个基于Microsoft Word的可填充舍入工具（常用工具）和一个与EHR集成的舍入报告工具（RRT）。两个小组的27名临床医生参加了169例患者的检查（常规= 84，nRRT = 85）。在回合中，我们使用对话分析方法对通信进行录音和编码。使用编码的交流互动，我们研究了两种工具之间的差异：讨论的临床内容，提出的问题以及互动交流中的故障。另外，我们通过后续访谈收集了有关四舍五入工具的临床医生观点。结果我们发现，与通常相比，RRT的使用与患者标识符（例如姓名）和行动项目（例如待办事项清单）的讨论更多，而成像（例如X射线）的讨论则更少工具。RRT还与较少的问题相关（t = 3.1，p = 0.03），相应地，较少的响应（t = 3.2，p = 0.02）。在使用RRT期间，与错误响应相关的通信故障更少（t = 0.5，p = 0.01）。两种工具之间的四舍五入时间没有统计上的显着差异。结论我们的研究结果表明RRT影响了舍入工作流程：在预舍入过程中，通过节省时间和精力从多个来源收集信息；在四舍五入期间 通过使用结构化的RRT模板简化对话的内容；在四舍五入过程中，通过支持明确讨论患者任务和行动项目以进行患者护理计划和管理。