Geographic Rounding on Young Adults With Childhood-Onset Chronic Conditions: A Mixed Methods Retrospective Observational Cohort Study

Background Geographic rounding has been associated with improved efficiency and quality of care on inpatient general medicine services. Young adults with childhood-onset chronic conditions (COCC) often experience longer lengths of stay and higher readmission rates than other general medicine populations. To evaluate whether geographic rounding could improve outcomes for this group, these patients were transitioned to a geographic team. Methods We conducted a retrospective observational cohort study comparing length of stay (LOS) and 30-day readmission rates for hospitalized young adults with COCC before and during geographic rounding. Nursing workforce data and workload during the geographic period were analyzed, using a comparable non-specialty geographic unit as a reference. A limited qualitative analysis of a nursing survey was performed to assess attitudes and experiences related to caring for this specialty population. Results LOS was significantly longer during the geographic period (event time ratio=1.29, 95% CI: 1.04 - 1.57). There was no statistically significant difference in readmission rates (risk ratio: 1.45, 95% confidence interval (CI): 0.85 - 2.41). Although measured nursing workload on the geographic unit was similar to that of other geographic units, nurses reported substantial burnout, challenging patient dynamics, and inadequate resources to meet the complexity of patient needs. Conclusions In this specialty population of young adults with COCC, geographic rounding was associated with worse efficiency and was accompanied by unintended workforce challenges. These findings suggest that geographic rounding may not be universally effective for medically and socially complex populations. Implementation of geographic models for specialty cohorts should include early partnership with nursing staff and appropriate training and resource allocation to support both patient care and workforce sustainability.