Wall-mounted folding chairs to promote resident physician sitting at the hospital bedside

Background: Sitting at the bedside may improve patient-clinician communication; however, many clinicians do not regularly sit during inpatient encounters. Objective: To determine the impact of adding wall-mounted folding chairs inside patient rooms, beyond any impact from a resident education campaign, on the patient-reported frequency of sitting at the bedside by internal medicine resident physicians. Design, Setting, and Participants: Prospective, controlled pre-post trial between 2019 and 2022 (data collection paused 2020–2021 due to COVID-19) at an academic hospital in Baltimore, Maryland. Folding chairs were installed in two of four internal medicine units and educational activities were delivered equally across all units. Main Outcome and Measures: Patient-reported frequency of sitting at bedside, assessed as means on Likert-type items with 1 being “never” and 5 being “every single time.” We also examined the frequency of other patient-reported communication behaviors. Results: Two hundred fifty six and 206 patients enrolled in the pre and post-intervention periods, respectively. The mean frequency of patient-reported sitting by resident physicians increased from 1.8 (SD 1.2) to 2.3 (1.2) on education-only units (absolute difference 0.48 [95% CI: 0.21–0.75]) and from 2.0 (1.3) to 3.2 (1.4) on units receiving chairs (1.16, [0.87–1.45]). Comparing differences between groups using ordered logistic regression adjusting for clustering within residents, units with added chairs had greater increases in sitting (odds ratio 2.05 [1.10–3.82]), spending enough time at the bedside (2.43 [1.32–4.49]), and checking for understanding (3.04 [1.44–6.39]). Improvements in sitting and other behaviors were sustained on both types of units. Conclusions: Adding wall-mounted folding chairs may help promote effective patient-clinician communication.