Background:
Interprofessional rounds have the potential to improve patient safety, quality, and experience. Although increasingly implemented, significant variation in rounding practice patterns exist and few data are available to evaluate impact on patients’ experiences. We implemented a novel inpatient collaborative care (CC) model, which includes interprofessional rounds, and also purposely integrates patients and families into the team, utilizes communication boards and safety checklists, and creates time for team reflection.
Methods:
We assessed patient experiences via Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores from January through October 2016. Questions were selected based on expected impacts of our model and recommendations from our Patient Family Advisory Council. We used weighted average scores from other teaching teams as comparators. We compared excess length of stay (LOS) over geometric mean LOS for patients admitted to the CC team versus other teaching teams during the same time period.
Results:
A total of 2,728 patients were discharged from included teams during the observation period. Survey response rate was 443 (16%). Comparing CC vs. other teaching teams, scores were significantly higher for overall rating of hospital with 83.6% of respondents choosing agree or strongly agree (versus 77.8), treated with courtesy/respect by doctors 90.2% (weighted average 86.5), nurses explained things understandably 82.1% (weighted average 75.3) , and staff described medication side effects 67.9% (weighted average 52.4). CC responses were also above the National Research Corporation (NRC) average for these questions. Finally, LOS was 0.3 days less in the collaborative care model (p<0.05).
Conclusions:
Barriers to safe and efficient care are complex and demand structural changes to care delivery beyond incremental adjustments to our usual practice. Our CC model, by focusing on more than just rounds, takes this transformative approach. Our specific structural changes allow all team members, including patients and their families, to form shared mental models. We suspect these shared mental models are the driving forces that have led to our decreased LOS and improving patient’s experiences.