Background:
Multiple barriers exist to improving patient safety during regular rounds on an internal medicine inpatient unit: lack of standardization, limited time because of high patient turnover, and reduced communication with all members of the health care team. Studies suggest that adverse drug reactions, poor lab results follow‐up, and miscommunication increase the probability of patient harm during the inpatient stay or in transitions to the outpatient setting. Multidisciplinary rounding has been used successfully in specialized areas such as the intensive care unit to improve patient care outcomes.
Purpose:
The goals of the study were to implement multidisciplinary collaborative rounding by using a simple standardized intervention to prompt physicians and nurses to regularly evaluate patients for potential safety risks and to create an infrastructure of daily standardized communication among health care providers.
Description:
In early 2005, a 1‐page rounding tool was developed by a multidisciplinary team (nursing, case management, residents, teaching faculty, hospitalists, and administration). The tool was based on institutional initiatives and known clinical core measures. In September 2005, one general internal medicine teaching unit piloted multidisciplinary collaborative rounding for a 4‐month period. During teaching rounds, the staff regularly reviews and documents compliance with universal core measures for each patient. At the conclusion of teaching rounds each day, the senior resident facilitates a collaborative discussion with teaching faculty, nursing, and other allied heath providers using the additional checklist on the rounding sheet as a template for discussion with documentation of daily goals. The tool and discussion serve as a communication infrastructure to evaluate patients daily for safety risks during hospitalization and prior to discharge. After evaluation and input from those participating in the pilot, modifications were made to the tool, and collaborative rounding was extended to 2 other general internal medicine teaching units in February 2006.
Conclusions:
Multidisciplinary collaborative rounding has now become a regular part of clinical teaching and rounding in the department of medicine at the institution. In addition to the 3 general internal medicine teaching services, the initiative has spread to the inpatient subspecialty teaching services and nonteaching hospitalist services, totaling nearly 250 beds. Initial analysis suggests increased patient satisfaction and improvement in certain inpatient core measures such as glycemic control. The process has been well received by all members of the inpatient health care team. In addition, the initiative has served as an ongoing effort to teach and evaluate systems‐based practice core competency for our resident staff.
Author Disclosure:
P. Y. Watson, None; D. Anderson, None; J. Jeffries, None; A. Curry, None; J. Lamar, None; C. Savage, None; Y. Williams, None; M. Schreiber, None.