CLINICAL QUESTION: Does the simple “nudge” of placing a chair near a patient’s bedside influence how often hospitalist physicians sit during consultations and improve patient satisfaction?
BACKGROUND: While sitting at the bedside is known to improve patient trust and communication, busy clinicians rarely sit, often doing so in fewer than 20% of encounters. Previous research has shown that “choice architecture” (altering the physical environment) can influence behavior, but its impact on physicians’ bedside manners was previously unclear.
STUDY DESIGN: Single-center, double-blinded, randomized, controlled, deception trial
SETTING: Parkland Memorial Hospital, a public county hospital in Dallas, Texas
SYNOPSIS: This study observed 125 patient encounters involving 51 hospitalist physicians. Encounters were randomized to either chair placement (chair positioned less than three feet from the bedside and facing the patient) or the usual chair location (typically stored in a closed cupboard). Physicians in the chair placement group were 20 times more likely to sit compared to the control group (63% versus 8%; OR, 20.7; P <0.001). This intervention led to significantly higher patient satisfaction and communication scores (3.9% increase in Tool to Assess Inpatient Satisfaction with Care from Hospitalists scores; P=0.01). Crucially, there was no difference in the actual or perceived time spent in the room. Limitations include the single-center design and early termination due to recruitment challenges. These findings are highly relevant as they provide a low-cost strategy to enhance the patient’s experience.
BOTTOM LINE: Placing a chair near the bedside is an effective, no-cost nudge that dramatically increases physician sitting and improves patient satisfaction without increasing the time spent on rounds.
CITATION: Iyer R, et al. Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial. BMJ. 2023;383:e076309. doi: 10.1136/bmj-2023-076309.
Dr. Ruiz is the chief of the clinical medicine department at Hospital Aleman in Buenos Aires, Argentina.