New app shares physician’s rounding queue with families and nurses

Key takeaways:

• A pediatric hospitalist helped develop software that tells families and nurses where their patient is in that day’s rounding queue.
• With the app, family members can have the hospitalist call them when the team arrives for rounds.
• The use of the rounding app has tripled the number of nurses who attend rounds.

THE “A-HA” MOMENT for Michael Pitt, MD, came almost 10 years ago when, waiting to get a haircut at Great Clips, he realized that the shop kept sending him texts, letting him know where he was in the waiting queue and when it would be his turn.

“We are all given this gift of what we have come to call ‘time transparency,’ ” says Dr. Pitt, a pediatric hospitalist and professor at the M Health Fairview Masonic Children’s Hospital, a part of the University of Minnesota in Minneapolis. “As consumers, we’ve come to expect that in every transaction. When will my package arrive? When’s that pizza I ordered going to be delivered?”

Meanwhile, he knew that health care, particularly hospital rounds, was a complete black box. “During the most stressed, dangerous times of our lives, when our loved ones are hospitalized, we are just held hostage, not knowing when the doctor will arrive,” he notes. Dr. Pitt had started thinking about how to develop software that would treat hospital rounds the same way Great Clips approaches haircuts.

“Hospitalists who have ideas out there should recognize that they have unique insights into problems that many don’t have.”

Michael Pitt, MD
M Health Fairview Masonic Children’s Hospital

He finally got the chance to develop that software in 2019 when he applied for—and won—an internal University of Minnesota grant for $5,000. “It was an incredibly easy pitch: ‘I want to make a Great Clips haircut software program to let patients and families know where they are in the rounding queue.’ But it was an incredibly complex build.”

First versions

The build was complex, Dr. Pitt explains, because of all the variables that go into rounding. “What happens if there is an emergency?” he says, by way of an example. “Or if teams have to be split to see different patients?”

Developing the software became possible when he took his idea to University of Minnesota colleague John Satori, PhD, associate professor of electrical and computer engineering.

Together, they created a first version of what they called Q-rounds that wasn’t even integrated into the system’s Epic EHR. (Now, Dr. Pitt points out, they’re on their third iteration of a completely EHR-integrated program.) For the next big build—to run a 12-week pilot of the software in his hospital’s NICU—he and Dr. Satori received grant funding through the Pediatric Device Innovation Consortium.

“The University of Minnesota is part of that group,” he points out. “It’s a group that recognizes that pediatric solutions often get sidelined for grants. We’re viewed as an orphan solution.” According to Dr. Pitt, “we feel this is not just applicable to peds. But 100% of hospitalized kids need a family member to be updated every day; I can’t tell a three-month old to tell his mom what we talked about. The consortium absolutely supported this.”

During the 12- week NICU pilot, he and his colleagues found that providing real-time text updates to nurses and patients’ families about when to expect the team for rounds led to three times as many nurses attending hospital rounds than before and more than twice as many family members joining rounds as well. Now, two years later, Q-rounds is used daily by the NICU and pediatric hospitalist teams.

How the app works

Here’s how it works (as explained in this two-minute video.) Physicians open the Q-rounds application on their phone and choose the patient list they want to pull from the EHR. They also put in the time they plan to start rounding and how long they expect each encounter to take.

They then mark the patients on that list who are high priority or being discharged that day. The software suggests a rounding order putting discharges and high-priority patients first, but doctors can rearrange the list at any time.

Once the list is ready, physicians hit “Share”—and the schedule is pushed to several places. Families of the patients to be rounded on get a text message with a link to view that morning’s queue dashboard, letting them know where their patient is in that queue. They can click an “RSVP” to have the physician call them once she or he arrives in the patient’s room; they can also (as can the doctor) request an interpreter for that upcoming encounter.

In addition to families, the rounding list is shared to the EHR, letting pharmacy and technicians know when a physician should be with any individual patient. And all relevant nurses receive the list through whatever messaging app the hospital maintains for nurses to use. Once the hospitalist arrives, he or she initiates a conference call to all family members who RSVPed and an interpreter, if needed, with one click. (Dr. Pitt calls it, “Zero to ‘hola!’ in six seconds.”)

Making all those connections a “push” was important, Dr. Pitt says. “We’re faced with all sorts of great ideas in health care, but it’s ‘Download this!’ and ‘Log into that!,’ and that becomes too much for anyone to use.” With Q-rounds, “nurses and families don’t need to download an app or have a password or sign-in. We wanted to mirror what we have out in society with all these other time-transparency experiences.”

Since its broad distribution in the hospital, 20,000 family members have dialed into rounds via Q-rounds. And nurses love it; “I finally know when I can take lunch,” is feedback that Dr. Pitt has received.

Administration appreciates that the software is great for patient experience. And allowing doctors during rounds to connect with more family members and nurses saves them time and improves patient care.

Becoming an entrepreneur

Given that hospitalists are the ones to initiate this entire process, was there any grumbling from them having to do one more task? Dr. Pitt says that the few who grumbled initially later texted him to say they’d been wrong.

In part, that’s because setting up Q-rounds every day and sharing the patient list with families and staff takes only 40 seconds. More importantly, Dr. Pitt explains, “we’re doing this work anyway when we start rounds. Every morning, we decide what order to see patients—and I always want to know, when I’m leaving one room, where I’m headed.”

The university had Dr. Pitt and his team spin Q-rounds off through its tech commercialization platform, and the product became an incorporated company about three years ago. Several health systems are interested, and Q-rounds is being launched this August in the NICU at another health system.

“I used to roll my eyes when I’d see someone on TV identified as an entrepreneur,” Dr. Pitt says, who’s now co-founder (along with Dr. Satori and marketing strategist Chelsea Klevesahl) and CEO of the company. “But once you see the number of jobs you have to do in this role—fundraising, making pitches, sales, design, etc. —I have new respect for the role.”

The grants that Dr. Pitt and the company have received for Q-rounds have allowed him to devote time to the company and to make presentations about the software at national pediatric hospital medicine and medical society conferences.

“It’s been interesting to have to learn how to pivot into presenting at neonatal conferences as a vendor,” says Dr. Pitt. During exhibits, he’s joined by a parent of extremely premature twins who, as a consumer, used Q-rounds for six months and now works part time in sales with the company.

As for Dr. Pitt, he finds that being a physician gives him credibility as an exhibitor.

“So often, you get these external idea people working on this who don’t really understand how hospital rounds work,” he points out. His advice: “Hospitalists who have ideas out there should recognize that they have unique insights into problems that many don’t have.”

The next enhancement

As for future developments of the software, the focus right now is on pediatrics and children’s hospitals, but the potential for adult medicine is there, including for geriatric inpatient and outpatient settings. But the real enhancement that Dr. Pitt and his colleagues want to build into the program next? Looping in consultants in the hospital

“We want to pull in consultants easily,” he says. He points out that the No. 1 question asked in a hospital every day is, “When will the doctor be here?”

“But the No. 2 question,” says Dr. Pitt, “is, ‘Do you all even talk to each other?’ We’re trying to streamline getting all the stakeholders in the room together at the same time as family members and patients. So finding ways to interview consultants and ancillary staff is a big priority.”

Phyllis Maguire has been Executive Editor of Today’s Hospitalist since 2006. Based in Bucks County, Pa., her health care interests are hospital medicine and long-term care options. She also likes zydeco, hiking, and reading memoirs and romances.