The Impact of Portable Electronic Devices on Attending Rounding Behaviors of Inpatient Internal Medicine Teams at an Academic Medical Center

INTRODUCTION: The advancement of mobile technologies is changing the way medicine is practiced. Portable devices give health care professionals access to electronic resources and patient health records without restricting them to stationary computers. However, little exists in the literature on how these devices impact the rounding behavior of health care teams at academic medical centers. There is general concern that the EHR will compel caregivers to spend less time with their patients; there is significant evidence in a prior unpublished study to support this unintended consequence. In this study the authors sought to identify whether the availability of tablet computers to inpatient internal medicine teams would combine the best of both previous rounding behaviors. METHODS: Research was conducted over a period of 28 days, consisting of observation of internal medicine teams randomized into intervention, who were provided with tablet computers, and control groups. Two observers recorded behaviors on a standardized checklist, which included domains of patient care, EHR use, and distractions. RESULTS: 323 patient encounters were recorded in the context of eighteen health care teams, fourteen control (160 encounters) and four intervention (163 encounters). General characteristics of each arm of the study are summarized below: Variable Control Intervention p-value Tablet Used (y/n) 18.13% 50.31% < 0.0001 Tablet Use Count 0.29 1.18 < 0.0001 Total Tech Use Count 2.01 2.00 0.3637 Tablet Distraction Count 0 0.26 < 0.0001 Total Distraction Count 1.84 2.60 0.0045 % Rounds on Wards 34.38% 71.17% < 0.0001 Time per Patient (minutes) 12.37 10.62 0.0118 Time at Bedside (minutes) 3.28 3.71 0.6358 DISCUSSION: Tablet possession is associated with increased ward rounding with the same level of access to EHR as would be offered by room rounding, shorter time spent discussing each patient, but increased time spent at the patient's bedside. This constellation of findings may suggest increased efficiency. Intervention teams experienced more distractions than control teams, as is expected due to the increased amount of ward rounding. However, the tablets themselves contributed to the number of distractions. These results can shed light on the role that tablet computers will play as we enter the electronic age of medicine.