Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Department of Speech and Hearing Sciences, University of Washington, Seattle, WA.
Crit Care Med. 2020 Apr;48(4):507-514. doi: 10.1097/CCM.0000000000004205.
Team rounding in the ICU can tax clinicians' finite attentional resources. We hypothesized that a novel approach to rounding, where patients are seen in a decreasing order of acuity, would decrease attentional attrition.
Prospective interventional internal-control cohort study in which stop signal task testing was used as a proxy for attentional reserves. Stop signal task is a measure of cognitive control and response inhibition in addition to performance monitoring, all reflective of executive control abilities, and our surrogate for attentional reserves.
The ICUs of Vanderbilt University Medical Center (site 1) and the University of Pennsylvania (site 2) from November 2014 to August 2017.
Thirty-three clinicians at site 1, and 24 clinicians at site 2.
Acuity-based rounding, in which clinicians round from highest to lowest acuity as determined by Sequential Organ Failure Assessment score or an equivalent acuity score.
The stop signal task results of ICU staff at two sites were compared for conventional (in room order) versus novel (in decreasing order of acuity) rounding order. At site 1, the difference in stop signal reaction time change between two rounding types was -39.0 ms (95% CI, -50.6 to -27.4 ms; p < 0.001), and at site 2, the performance stop signal reaction time was -15.6 ms (95% CI, -29.1 to -2.1 ms; p = 0.023). These sub-second changes, while small, are significant in the neuroscience domain.
Rounding in decreasing order of patient acuity mitigated attrition in attentional reserves when compared with the traditional rounding method.
重症监护病房（ICU）的团队查房可能会消耗临床医生有限的注意力资源。我们假设，按照疾病严重程度从高到低的顺序进行查房的新方法可以减少注意力损耗。
前瞻性干预性内部对照队列研究，使用停止信号任务测试作为注意力储备的替代指标。停止信号任务是一种认知控制和反应抑制的测量方法，除了绩效监测外，还反映了执行控制能力，是我们对注意力储备的替代指标。
范德比尔特大学医学中心（第 1 站点）和宾夕法尼亚大学（第 2 站点）的 ICU，时间为 2014 年 11 月至 2017 年 8 月。
第 1 站点有 33 名临床医生，第 2 站点有 24 名临床医生。
根据序贯器官衰竭评估评分或同等严重程度评分，按照从高到低的严重程度对患者进行基于严重程度的查房。
比较了两个站点 ICU 工作人员在常规（按房间顺序）和新型（按严重程度降低顺序）查房顺序下的停止信号任务结果。在第 1 站点，两种查房类型的停止信号反应时变化差异为-39.0ms（95%CI，-50.6 至-27.4ms；p<0.001），在第 2 站点，表现性停止信号反应时为-15.6ms（95%CI，-29.1 至-2.1ms；p=0.023）。这些亚秒级的变化虽然很小，但在神经科学领域具有显著意义。
与传统的查房方法相比，按照患者严重程度从高到低的顺序进行查房可以减轻注意力储备的损耗。
