Background: Interprofessional rounding has improved patient safety and provider engagement (1). Our institution implemented interdisciplinary patient rounds (IPR) similarly described in the literature (2). Despite praise for our nursing safety checklist, declining emphasis on bedside teaching and brief patient interactions lead to provider dissatisfaction.
Purpose: To provide high-quality patient care, foster interprofessional collaboration, and provide bedside medical education, we aimed to improve our IPR model to allowing flexibility for medical education. An online survey was delivered to nursing staff on the general medicine units and the attending and resident physicians who worked on the geographic-based units in the 3 months prior to the launch of the new IPR model. Perceptions of communication and teamwork were assessed on a 5-point Likert scale. Survey responses were dichotomized, and a chi-square test was used for analysis. Free text responses were grouped into themes for qualitative analysis. Unit leadership, hospitalists, and residency program representatives designed the new IPR model, which focused on integrating teaching into interdisciplinary rounds, completing a nursing safety checklist, and setting discharge milestones.
Description: Twenty-five physicians and forty-three nurses completed the survey. More nurses than physicians agree that nurse-physician rounding will improve patient safety (p=0.02). Although both physicians and nurses feel that nursing input is encouraged during rounds, nurses disagree that nursing input is well received (p=0.02). Compared to physicians, nurses disagree there is clarity in patient’s care plans (p=<0.001) and that they are aware of clinical issues needing to be addressed (p=0.002). Nurses disagree that communication between nurses and physicians occurs after rounds (p=<0.001). Physicians disagree that the number of phone calls and texts between nurses and physicians is appropriate (p=0.01). Qualitative data themes focused on improving communication and teamwork between physicians and nurses, improving efficiency, and minimizing disruptions.
Conclusions: Effective communication and teamwork are paramount to improve patient safety. Perceptions of communication and teamwork on general medical units vary largely among nurses and physicians prior to implementation of a new interdisciplinary bedside rounding model at our institution. With our new IPR model, we aim to improve the educational experience of rounding, improve nursing involvement and patient safety metrics, and decrease length of stay with ongoing evaluations.
1. Gausvik C, et al. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. J Multidiscip Healthc. 2015;8:33-7.
2. Stein J, et al.Reorganizing a Hospital Ward.J. Hosp. Med 2015;1;36-40.