Background: Managing the complex environment of a general medicine ward requires high performing interdisciplinary teams.(1) In 2016, an Accountable Care Unit (ACU) was implemented on a 35-bed medicine ward at a community based teaching hospital to develop high performing interdisciplinary teams. One of the four features of an ACU is Structured Interdisciplinary Bedside Rounds (SIBR)(2), a scripted interdisciplinary communication procedure used by the interdisciplinary care team to cross-check and communicate with the patient and each other. SIBR includes a status update from each team member present, a safety quality checklist for common preventable complications (VTE prophylaxis, urinary catheter, vascular access, food intake) and the creation of a 24-hour care and discharge plan. SIBR is a core communication and care coordination process on an ACU. In 2017, a SIBR certification program was implemented for hospitalists, medical residents, nurses, and other interdisciplinary team members. In order to facilitate this process a video recording protocol was developed.
Purpose: The purpose was three-fold: 1) to use video to facilitate SIBR certification and education; 2) to create a common standard of performance and understanding of SIBR for each team member and; 3) to grow the skill set of integrating the information at the bedside into a “structured care narrative” (1) that involves the patient.
Description: Video recordings can be used for preparing and improving clinicians. Skills for performing SIBR were taught and assessed via a standard certification score. Both patients and clinicians consented prior to being recorded at SIBR. A standard protocol was used and only the clinicians are seen in the recording. Clinician’s performance was assessed by a SIBR certified clinician typically from the same professional background as the candidate clinician. A standard online scoring tool with free text areas for feedback was used. Results of this score were automatically emailed to the clinician. If possible the teaching clinician would meet with the candidate clinician to review the recording and demonstrate the rationale for their score and give suggestions for improvement for both their process skills and their knowledge base. Once a clear standard and score were achieved the clinician was awarded SIBR certification. The overall educational value of the SIBR videos was recognized. Therefore, they were incorporated into the ACU education day for new unit staff of all disciplines. This involved using two recordings: 1) a novice group of clinicians performing SIBR and; 2) a more experienced group of SIBR certified clinicians. The differences in their skill and understanding were compared for teaching purposes. Furthermore, a teaching module with SIBR recordings is currently in development and planned to be part of an interdisciplinary communication curriculum at a university in the fall of 2023.
Conclusions: Recording clinical examples of interdisciplinary communication, care and process provides opportunities for teaching and learning SIBR. Video is a powerful medium to capture teachable interactions, skills and knowledge that can improve interdisciplinary team communication and collaboration to optimize patient care. Future application includes continued maintenance of SIBR skills, knowledge and auditing. There may be potential research opportunities using video to study interdisciplinary teamwork in the complex medicine environment at the patient’s bedside.