Background: Multidisciplinary team-based care is a novel concept in hospital medicine where, healthcare team members representing multiple disciplines collaborate to develop patient care plans. Multiple published studies have shown that team-based care is associated with improved length of stay (LOS) and increased staff satisfaction but the data on patient safety and patient satisfaction is conflicting. There are various models of team-based rounding described but significant variability exists in multidisciplinary team design, outcomes, and reporting. Patient-Centered Approach to Health (PATH) team was a redesign of the Structured Interdisciplinary Bedside Rounding (SIBR) model originally started at Emory University by Stein et al. and we added a bridge nurse navigator leveraging the care transitions element. We evaluated the impact of SIBR in a large academic center on outcomes related to readmissions, length of stay and patient satisfaction scores.
Methods: Each team consisted of a Physician and/or Advance Practice Provider (Physician Assistant or Nurse Practitioner), bedside nurse, pharmacist, care coordinator (Social Worker or Case Manager), bridge nurse navigator. Retrospective analysis was performed for a time period of one year prior to and following the initiation of SIBR on the geographic hospital medicine. The primary outcomes compared were LOS, 30-day all-cause readmission and patient satisfaction score from the Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Quantitative patient variables (age, BMI etc.) were matched using the t-test while categorical variables (gender, race, comorbidities etc.) were compared using chi square test. Pre and post intervention, LOS and patient satisfaction scores were compared using t-test while 30 days readmission were compared using chi square test.
Results: Following the intervention there were 1491 encounters and the preceding year (control) had 1410 patient encounters. Post intervention patients were less likely than controls to be readmitted (15.16% vs 19.36%, p<0.0027). LOS in pre-intervention group was 8.01 days (95% CI 7.51, 8.52) compared to post- intervention group of 6.49 days (95% CI 5.91, 7.06) with p value of < 0.0001.
Conclusions: Structured Interdisciplinary Bedside Rounding improved the quality of care by decreasing the 30-day-all-cause readmissions and Length of stay. Also, the care team members found it to be an effective communication strategy to improve patient care transitions and outcomes.