Methods: With the At-The-Bedside Walking Interdisciplinary Rounds initiative, every patient is visited by the entire interdisciplinary team each afternoon. The interdisciplinary team consists of the Hospitalist, the unit nurse manager, the bedside nurse, the care manager, the social worker and the medicine resident. Each visit takes 3-5 minutes and is led by the resident, who starts by introducing every member of the team. Importantly, the patient is surrounded by every person on the team (a design to be literally and figuratively patient centric). Rounds are structured around four simple questions designed to effectively communicate the diagnosis, the milestones for discharge and the discharge disposition and date. Updated information is written on the patient’s white board, located at the foot of the bed. Patients and caregivers have an opportunity to ask clarifying questions. Moreover, the patient can experience first-hand the collaboration that takes place amongst the team members with a streamlined and unified message. The team will use a video language access network for interpreter services for those patients who feel more comfortable speaking in their native language. For those patients who prefer not to discuss discharge planning in large groups, members of the team will return individually.
Results: When comparing pre (Q1CY2016, N = 81) and post (Q2CY2016, N = 80) intervention top box HCAHPS patient satisfaction scores, the results were mixed. Care transitions improved slightly from 46% to 48% and communication with doctors increased from 74% to 75%. Communication with nurses decreased from 78 to 75%. Discharge information, however, improved from 78% to 84%.
Conclusions: While these early results are disappointing, we believe that patient centered care starts with streamlined communication at the bedside with the interdisciplinary team. We will be tweaking how to better contextualize these rounds for patients in the future.