Communications in health systems are notoriously fragmented, particularly as patients get handed off between shifts and various caregivers. Research has shown that interdisciplinary rounds can be an effective tool for improving that communication to both reduce the overall length of stay in an inpatient facility, as well as total care costs.
One study that compared outcomes for patients receiving interdisciplinary arounds as opposed to traditional rounds found that length of stay was reduced from 6.1 to 5.5 total days, for an overall cost reduction of 17%, with no documented changes to patient outcomes.
Given the budgetary constraints in nearly every healthcare facility in the nation, these are important savings that most cannot afford to leave on the table, especially as providers focus on clinical transformation and highly-reliable care delivery.
How Interdisciplinary Rounding Works
Interdisciplinary rounding (IDR) is a structured approach for integrating care provided by the staff nurse, hospitalist/attending physician, care manager and patient/family, creating a structure for more streamlined communication and planning.
IDR should occur at a consistent time each day, with participants playing a specific role based on their discipline. For instance:
- The staff nurse’s emphasis is on the “plan for the day,” providing specific clinical milestone goals for the next 24 hours.
- The hospitalist/attending physician’s focus is on the “plan for the stay,” detailing the overall patient treatment plan for the hospitalization.
- The care manager provides the “plan for the way,” resolving discharge barriers while facilitating the patient transition to post-acute services/support.
While the daily discussion is a positive patient experience tactic, the value is within the team’s approach to progressing the patient’s care. Addressing the plan for the day, stay and way results in tighter care team communication, smooth patient handovers and appropriate care transitions.
Building an Effective IDR Program
Of course, not all IDR programs are successful. To be effective, providers should implement the following strategies for success.
- Structure. IDRs must be tightly structured and formally planned around a standard set of outcomes criteria. Failure to do so can lead to rounds that drift into off-topic conversations and end up taking much longer than they should. Structure can be accomplished by creating a simple tool of standard questions that must be asked during the rounds, sample talking points for each participant and a standard process for assigning follow-up items and ensuring their completion.
- Facilitation. Consider assigning a strong facilitator to the IDRs that is responsible for guiding the conversation and keeping it productive. If conversations aren’t achieving outcomes that are useful to the participants, members of the care team will push back against them and “check out” on the process. Most IDRs should be completed in five minutes or less, a goal that is achievable if the facilitator maintains focus the entire time.
- Involve patients and their families. Have the rounds in the patient room, alert patients in advance of the time they will take place, and encourage family input and questions. Not only will this improve overall satisfaction, it will ensure that patients and families are aware of how to properly manage their care after discharge.
- Rotation. It can be hard to pull the team together and change the workflow when care teams are doing so many tasks for so many different patients. IDRs need to be mindful of people’s time and rotate in nurses, for instance, to provide updates on their patients, cycling new ones in as the IDR moves through the unit.
- Pass the mic. Everyone on the care team should have a role, and be prepared to talk to their expertise. When efforts fail, it’s usually because one personality takes up too much air time or is too dominant, and others fall back into silence. It’s important for everyone participating in IDRs to value the perspectives of others, and for everyone to contribute their thoughts.
Robust IDRs can be an effective way to reduce length of stay because they can help patients know and stay focused on achieving the expected date of discharge, support the early identification of complex post-discharge needs, help clear barriers that may impede success, and support end-of-life planning for patients with chronic, terminal illnesses. The net outcome is smooth patient flow and the delivery of more appropriate levels of care across the healthcare continuum.
In addition, more face-to-face time across the care team helps ensure fewer chart reading snafus, better overall safety and increased satisfaction among those providing care.
Effective IDR programs can play an important role in becoming a high-reliability organization (HRO). Read more on how high reliability efforts can improve care delivery.
Brigid Byrne has 38 years of experience in various facets of healthcare operations as a chief operations officer, practitioner, health consultant, medical economist and strategist. In joined Premier’s Population Health with expertise in Clinical Integration, Care Management and PCMH service lines. She is a gerontologist with a background in nursing, post-acute/community medical management and experience as a practitioner in neurology, sleep medicine, pain management, occupational and internal medicine. She currently volunteers as PCP and serves on the Board of Agape Clinic of Dallas.
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