Background: Structured, interdisciplinary plan of care (IPOC) rounds appear to augment coordination of care and communication among health care workers and may offer additional benefits to patients, their families, and providers in the inpatient setting. However implementation of IPOC rounds in a large, busy tertiary center with a high acuity of illness is challenging.
Purpose: Our objective was to operationalize standard IPOC rounds daily on all patients cared for by hospitalists in a 716-bed academic, tertiary medical center. The goal was to ensure that the patient care team discussed all relevant aspects of clinical care daily at the bedside with patient and family participation.The process required rapid scale-up on a busy hospitalist service responsible for approximately 320 inpatients daily and more than 11,000 patient encounters per month.
Description: IPOC rounds is a process in which hospitalist, nurse, case manager, and unit nurse director make daily bedside rounds to review the patient’s plan of care for the day and discuss patient/family concerns and to identify and mitigate barriers for a successful transition of care. A written plan of care, “My Plan” is provided to each patient following rounds. These IPOC rounds are in addition to the hospitalist clinical rounds and issues requiring prolonged discussions are handled outside of IPOC. Past efforts to implement interdisciplinary rounds struggled to gain traction because hospitalists historically covered patients in numerous noncontiguous units. This was recently addressed by instituting geographic rounding where each hospitalist is assigned to a specific unit. Additional challenges included getting the care team to embrace and accept the concept of IPOC rounds. We initially piloted non bedside IPOC on one unit, trialing it for 3 months in a charting room using a standard script with all the team members. The team quickly saw the value of the rounds, and we then transitioned to bedside on the pilot unit. After one month of successful IPOC rounds on the pilot unit we used simulation lab to produce a video demonstrating successful interdisciplinary collaboration that was made available to all the staff across all the units. The unit triads [unit medical director, nurse director and case manager], and hospitalists were educated with help of the video and staff meetings. Nurse educators educated staff on all the medical units. After 2 weeks of training, IPOC rounds were rolled out on all the floors simultaneously. We now have been carrying out bedside IPOC rounds for the past 4 months. For the recent month 2229 patients participated in IPOC. “My plan” was given to 2078 (93%) patients and anticipated discharges were discussed for 2092 (94%) patients. The average time spent for each patient was 3 minutes. These results demonstrate high levels of fidelity with IPOC goals, but also highlight the challenge of ensuring that rounds are carried out on all patients. Early informal feedback from Hospitalists, Nurses and case managers showed improved collaboration, communication, unified plan of care, patient satisfaction.
Conclusions: We found that geographic rounding, the use of videos for training, triad model of unit leadership, and nurse educators were effective strategies for implementing multi-disciplinary rounds. Anticipated benefits of the interdisciplinary approach to patient care include improved care coordination and greater perception by patients that their care is being managed by a team leading to improved patient satisfaction and HCAHPS scores.