Background:
Well-designed multidisciplinary rounds (MDRs) focused on stroke patients can reduce mortality by over 30%. Accordingly, the Joint Commission encourages hospitals seeking certification as stroke Centers of Excellence to implement disease-specific MDRs, in which a team of providers jointly develops patient care plans to enhance the quality and efficiency of patient care. However, inefficient MDRs can pull providers away from other key clinical tasks, negatively impacting length of stay (LOS).
Purpose:
At University of Colorado Hospital (UCH), an American Heart Association Comprehensive Stroke Center, our group of 6 medical students participating in an advanced systems improvement program collaborated with hospitalists, neurohospitalists, and the UCH neurosciences unit to enhance efficiency and effectiveness of stroke patient MDRs and the quality of discharge preparation for patients.
Description:
A 360-degree evaluation of existing stroke MDRs was performed via interviews with front line providers who attended or relied upon decisions made at MDRs to develop patient care plans. Simultaneously, a value stream map of inpatient care and discharge planning for stroke patients revealed redundant work, inconsistent attendance, and absence of key decision-makers at MDRs. In addition, MDRs took place in highly trafficked areas, yielded little patient-centered discussion. Lengthy preparation to identify and gather information about stroke patients were required. In the process, patients were spending unnecessary time in the inpatient setting with little insight into their care plan. A multidisciplinary team composed of nursing, social work, case management, physical therapy, occupational therapy, nutrition, and physiatry met twice weekly to discuss patients. During these MDRs, a standard of work script was used to identify key components of information inside each discipline’s expertise. Using this approach, the length of conversation about each patient may vary based on complexity, but can be accomplished in under 5 minutes per patient. Subsequent PDSA cycles focused on enhancing adherence to the script, managing time, improving attendance at MDRs and optimizing the care planning documentation prior to embedding it in the EHR. These efforts markedly reduced time spent on MDRs, expedited patient access to essential stroke rehab services, and reduced stroke patient LOS by 0.65 days/3 months.
Conclusions:
While MDRs are a superb tool for optimizing inpatient care, if poorly structured they can increase waste and decrease care efficiency. Utilizing standard QI tools, our team collaborated effectively with hospital-based providers to enhance productivity of MDRs for stroke patients at UCH.