Background: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys allow patients to reflect on their hospital stay and provide standardized metrics for hospitals to improve the quality of care they provide. hospital administrators have a vested interest in earning strong HCAHPS scores, as this information is publicly available. One theorized way to improve satisfaction is through streamlining patient care with the use of a multidisciplinary team. The collaboration of members from various disciplines allows for the care team to address the acute medical complaint, initiate discharge planning early, and prepare for changes that will occur on the floor.
Purpose: As more members become involved in the primary care team, there exists several opportunities for lapses in effective communication. Thus, the efficiency of the team may falter, and patients may begin to remark, “do you even talk to each other?” Dyad rounding is a rounding modality that focuses on making a concerted effort to utilize all members of the multidisciplinary team during morning rounds. This allows essential team members to be present together and not receive second-hand accounts about a patient’s progress. The purpose of this initiative was to improve HCAHPS scores by streamlining patient care through effective multidisciplinary communication. To create buy-in for the initiative, surveys were utilized to adapt the hospital-wide roll out to the needs of the principal members.
Description: Dyad rounding was implemented in an acute care community hospital with the Internal Medicine, Family Medicine, Hospitalist Services, and private teaching groups. This rounding modality focused on the collaboration between the attending, the senior resident, the unit nurse, and case manager. This team would round on their patients, with all four members in the patient room. The attending would discuss updates with the patient, while the nurse documented the plan on a whiteboard. The case manager would discuss discharge planning. Before leaving the patient room, concerns from any member of the interdisciplinary team, and the patient, were addressed. After rounds, the attending and senior resident would complete an anonymous survey, reflecting on their experience. Initially, dyad rounding was implemented on one floor per service. After five months, dyad rounding was implemented on every floor, for every service.
Conclusions: Survey responses from physicians and residents showed that dyad rounding led to an improvement in workflow (n=130, 64%), with 79% of responses (n=159) reporting it to be a beneficial change. However, this did come at the cost of removing the case manager from rounds as it proved to not be time effective. Initially, surveys were collected daily, but collection was changed to a weekly basis due to survey fatigue. Preliminary HCAHPS scores were obtained for the first three months of dyad rounding. Physicians’ ability to share information in a way that the patient can understand was in the 16th percentile in the four months prior to the implementation of dyad rounding. The monthly percentiles during the first three months of dyad rounding, were 36th, 72nd, and 79th, respectively. Ultimately, preliminary data appears to point towards an improvement in some HCAHPS domains, as well as an improvement in overall workflow. The conscious effort to coordinate and round with a multidisciplinary team, through the form of dyad rounding, may prove to be a simple change for vastly improved patient satisfaction.