Background: Interdisciplinary rounds (IDR) have been used in hospitals to improve throughput, reduce readmission rates and improve patient satisfaction.They have been shown to improve teamwork and communication.The composition and structure of IDR vary widely from institution to institution and within the same institution.
Purpose: In our institution, traditional IDR involved a care team of physicians, nursing leadership, case manager, social worker, pharmacist, convening in conference rooms to discuss patient’s care plan and discharge needs .We noted that the traditional model of IDR frequently led to redundant discussion with no scope for patient input and prolonged discussions with no tangible solution. We proposed bedside IDR which would involve the care team conducting bedside, discharge focused discussion with a checklist of items geared towards medical readiness and support needed at discharge . It would be led by nursing leadership with an opportunity for patient input. We proposed that this would increase patient centeredness, improve patient satisfaction, reduce overall time and improve throughput by identifying barriers to discharge well in advance.
Description: Bedside IDR was created with input of key stakeholders within the interdisciplinary team, on two 24-bed acute general medicine units located on the same floor with hospitalist physicians as the patient’s primary team. Each unit had their own social worker, nursing leadership team, and case manager. However the hospitalist physicians had inconsistent patient assignments which created the need to have assigned time slots for the physicians in 15-minute increments . The physicians begin one at a time starting with their patient in the “lowest” room number. Once a physician finishes on Unit 1, they transition to Unit 2. Unit 1 then begins with the next physician, this workflow continues until all physicians complete. To ensure efficient and impactful discussion, a standardized script was created including pointed questions to better understand where the patient is at in the treatment plan, when the patient is medically ready to discharge, what is needed from the care team to support a safe and timely discharge. These questions were created to involve all aspects of the interdisciplinary team creating accountability and ownership of the complex discharge process. By discussing discharge needs at bedside with an emphasis on including the patients , it increased patient awareness and satisfaction regarding their discharge process. We also implemented nursing leadership rounding before IDR on new admissions to the unit with scripting to inform patients on the bedside IDR process and what to expect.A feedback survey was given to all participating members within the care team, results of which were discussed weekly with key stakeholders.
Conclusions: Success of the new process has continued to be measured through several factors: patient length of stay (LOS), patient satisfaction and staff satisfaction. Currently there has been a 1.7% decrease in LOS and a 9% increase in patient likelihood to recommend our facility. Due to subjectivity in individual perception, staff satisfaction scores have not changed. The implementation and sustainment of this process has taken change management within the interdisciplinary teams to create “buy-in” of this process. However with promising preliminary results positively impacting patient satisfaction and LOS, bedside IDR has been successfully implemented on other units within the institution.