Written by Clay Smith
Rounding on critically ill patients by acuity and not by room order may optimize our limited attentional resources. This has relevance for ED handoffs as well.
Why does this matter?
We have a finite amount of attention. Fatigue, boredom, workload, sleep deprivation, and distractions all conspire against us. But our patients deserve our best. Some patients are complex and acutely ill; some are simple to manage and require less attentional resources. Prior study has shown that patients at the end of rounds have less time spent on them than those at the beginning. Would it make sense to round by acuity rather than by room order?
I’m sorry…what did you just say?
This was an observational study of two U.S. ICUs, 57 clinicians in total, comparing stop signal task testing (SST) as a proxy for attentional resources. Briefly, SST shows a visual stimulus in which you must respond quickly. This is followed by the same visual stimulus followed by a “stop” stimulus in which you must inhibit your response. It is hard! Here is a demo. This study compared SST scores at the beginning and end of rounding by acuity (SOFA score) vs rounding by room order and found that clinicians at Vanderbilt were 39 msec faster in response time with acuity-based rounding and 15.6 msec faster at Penn. These millisecond difference may not seem like much, but in neuroscience this is a big deal. I will grant, SST is a proxy measure of attention. However, I would make three observations. First, this study objectively shows attention to a difficult task is better with acuity-based rounding. Second, it makes logical sense. Third, it means the sickest patients get orders and a plan of care first, which is a good thing. Given these points, it seems to me that acuity-based rounding is a good idea. This has import for the ED as well. Each shift we sign out our patients. Why not start with the sickest one?
Observational Study of Clinician Attentional Reserves (OSCAR): Acuity-Based Rounds Help Preserve Clinicians’ Attention. Crit Care Med. 2019 Dec 24. doi: 10.1097/CCM.0000000000004205. [Epub ahead of print]
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