Moving Rounds from the Bedside: Improving patient care delivery in the NICU by reducing noise

Purpose:
This feasibility trial analyzes sound levels during bedside rounding and sound levels while rounding with a Cisco Telemedicine Cart allowing the medical team could be physically located at an adjacent office in an effort to reduce noise.

Relevance/Significance:
Bedside rounding has been the main way to bring the patient care team and patient families together on a daily basis to participate in the decision-making process that occurs during daily rounds. The benefits of continuing these practices must be examined in the presence of persistently elevated noise levels and the obstruction to patient care due to the number of persons on rounds along with their respective portable computers.

Strategy and Implementation:
Reducing noise levels and decreasing obstruction to patient care delivery was addressed by conducting daily rounding utilizing the Cisco Telemedicine cart. The nurse and respiratory therapist remained at the bedside while the medical team were located in an alternative location. The cart was moved by the nurse from bedspace to bedspace. A two way camera allowed the nurse to have visualization of medical team encouraging eye to eye discussions while the medical team could view the nurse and the infant. Discussions were easily held, noise levels were reduced and there was no impedance to care due to number of people on rounds along with rolling computers. Families present during rounds remained at the bedside and participated easily. Future development of this project will include video chatting with family. Cisco cart has three way camera capabilities. Family can remain home while visualizing infant/nurse at bedside and medical team in adjacent office. Encourages family participation

Evaluation:
The sound levels consistently exceed noise level recommendations, especially during bedside rounding. Tele Rounding reduced the rounding noise by approximately 10 decibels, improving the daily noise pollution that bombards the unit daily. Families were present during rounds on average 4.6% of the times. This is important to point out since family inclusion is a main goal of bedside rounds.

Implications for Practice:
Nurses can easily participate in daily rounds while remaing at the patients bedside while the medical team is in an alternate location. This will help reduce noise levels, reduce impedence to care delivery and encourage unobstructed face to face interactions with families.