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Hosp Pediatr. 2019 Nov;9(11):867-873. doi: 10.1542/hpeds.2019-0094. Epub 2019 Oct 18.

Improving Efficiency of Pediatric Hospital Medicine Team Daily Workflow.

Author information

Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;
Division of Hospital Medicine.
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
James M. Anderson Center for Health Systems Excellence, and.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
Children's Hospital Colorado, Aurora, Colorado.



Workflow inefficiencies by medical teams caring for hospitalized patients may affect patient care and team experience. At our institution, complexity and clinical volume of the pediatric hospital medicine (HM) service have increased over time; however, efficient workflow expectations were lacking. We aimed to increase the percentage of HM teams meeting 3 efficiency criteria (70% nurses present for rounds, rounds completed by 11:30 am, and HM attending notes completed by 5 pm) from 28% to 80% within 1 year.


Improvement efforts targeted 5 HM teams at a large academic hospital. Our multidisciplinary team, including HM attending physicians, pediatric residents, and nurses, focused on several key drivers: shared expectations, enhanced physician and nursing buy-in and communication, streamlined rounding process, and data transparency. Interventions included (1) daily rounding expectations with prerounds huddle, (2) visible reminders, (3) complex care team scheduled rounds, (4) real-time nurse notification of rounds via electronic platform, (5) workflow redesign, (6) attending feedback and data transparency, and (7) resource attending implementation. Attending physicians entered efficiency data each day through a Research Electronic Data Capture survey. Annotated control charts were used to assess the impact of interventions over time.


Through sequential interventions, the percentage of HM teams meeting all 3 efficiency criteria increased from 28% to 61%. Nursing presence on rounds improved, and rounds end time compliance remained high, whereas attending note completion time remained variable.


Inpatient workflow for pediatric providers was improved by setting clear expectations and enhancing team communication; competing demands while on service contributed to difficulty in improving timely attending note completion.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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