Background: Interdisciplinary rounds (IDR) have become widely implemented in hospital settings in recent years due to proposed positive impact on various outcome measures such as length of stay, frequency of adverse effects, patient and team satisfaction. However, subsequent studies and data are conflicting. A key contributing factor is the high variability of models that are found across health systems, some of which are likely more effective than others. In our own institution, IDR traditionally has been scheduled in the morning during physician rounds which has been met with varying response and unclear effect.
Purpose: While the verdict regarding the efficacy of IDR is still unclear, we seek to improve the process in general. By adding an additional brief afternoon session, we aim to ensure closed-loop communication throughout the day amongst team members in expectations of improving outcomes regarding early discharges as well as team member satisfaction.
Description: In the four weeks prior to the intervention, IDR proceeded normally on our two dedicated house staff units. From 11 AM to noon the senior resident and attending physician of each team met with the case managers, social workers and nurse managers for IDR. During this time, each team discussed the overall discharge/treatment plan of each patient with a focus on potential discharges of the day and barriers to discharge. We then instituted a four-week trial of additional mini afternoon IDR sessions on one of the two units. In the intervention group, from 3 PM to 3:30 PM, the senior resident of each team touched base with the interdisciplinary team regarding patients of their own discretion with the aim to specifically follow up on active patients/cases such as patients that were identified in the morning as a potential discharge for that day or over the next one to two days.
Our primary outcome was the percentage of patients discharged before noon. On the unit with the intervention, discharges before noon increased from 5.96% to 10.32%. For the same period, the percentage of discharges before noon on the unit without intervention went from 9.7% to 4.79%. Of note, in the intervention period, the unit with the additional afternoon session had twice as many before noon discharges in those four weeks as compared to the unit without the intervention.
Our secondary outcomes included satisfaction among team members involved as measured by a post intervention survey. These results were more mixed. Regarding the perceived effects on team communication, 28.57% of respondents believed that additional afternoon IDR improved communication while 57.15% did not agree. Regarding the perceived effects on patient care, 21.43% believed the intervention improved patient care while 57.15% did not agree. Overall, 78.57% did not feel that an additional afternoon IDR session improved the process overall and 76.92% believed that afternoon IDR should not be implemented in the future.
Conclusions: While subjective response to our study was overall negative, the objective data yielded some interesting positive results. We recognize that there are many confounding and limiting factors to this study, including its small size and short duration, but the positive objective findings suggest that future studies that are larger in scale and longer in duration may help elucidate the impact of additional afternoon IDR. We also recognize that constructing and implementing future renditions of IDR can only be successful with the input of all those involved.