Background: Multidisciplinary rounds occurs in various formats. On our medical wards, centralized multidisciplinary team huddles are conducted daily to ensure the entire care team is engaged and contributing to care plan development. Often times this precludes bedside team rounds. Given the dynamic fluidity of an inpatient care plan and our desire to enhance patient and family-centered (PFC) care, daily nurse-physician rounds at the patient’s bedside is imperative to ensure that the frontline stakeholders of care development, delivery and receipt are communicating effectively.
Prior studies have supported nurse-physician bedside rounds and have shown improved nurse-physician coordination, teamwork, staff satisfaction, patient satisfaction, patient safety climate, and decreased length of stay. This evidence supported the need to prioritize this initiative at my institution.
Methods: In order to capture a large audience of providers, a 20 minute interactive small group workshop was developed and conducted at the medical campus simulation lab during new physician orientation. Each workshop consisted of an explanation of the session, 8 question pre-test, joint nurse-physician rounds background and points of emphasis discussion, viewing of a joint nurse-physician rounds video, SP interactive nurse-physician rounds simulation, de-brief and 8 question post-test.
The background information presented consisted of an explanation of what, why, when, where and how regarding joint nurse-physician rounds. The video was created by my institution and demonstrates three acceptable variations of how nurse-physician rounds could occur on the wards. During the SP simulation, participants were provided a mock case and were asked to role play as either an attending, resident or nurse. A nurse-physician rounds facilitator was present during each SP encounter to help guide teams and “stop the line” at any teachable moments.
Results: Two primary end-points, test performance and participant feedback, were measured to determine the success of the workshop. Differences in pre-test and post-test scores were measured with significant improvement being noted. Score improvement was seen for the 6 out of 8 questions that registered at least 1 incorrect response. Overall, total incorrect were 24% to 11% on pre-test and post-test respectively. Independent Samples Mann-Whitney U Test was performed with a statistically significant difference between means of pre-tests and post-tests (p <0.0005). There was homogeneity of variances, as assessed by Levene’s test for equality of variances (p = .700). Additionally, participant survey evaluations reflected above-average satisfaction with the workshop format in presentation style and retention of information.
Through the results of the post-test, my team was able to extrapolate knowledge gaps which are being addressed through on-going education and curricular revision.
Conclusions: Patient and Family-Centered care is a pillar of the Institute of Medicine’s aims for healthcare improvement. Active, on-going and frequent engagement of care team members, the patient and patient’s caregiver is essential to achieve this improvement. Inpatient care plans change often and in order to optimize chances of success, open lines of communication between the care team and the patient or patient’s surrogate are imperative and information should flow constantly. Patient and Family-Centered Nurse-Physician Rounds training is a necessity in order to enhance this open dialogue.