IMPLEMENTING EVIDENCE-BASED PRACTICES FOR INTERDISCIPLINARY ROUNDING: PERFORMANCE IMPROVEMENT PROJECT

Weekly interdisciplinary patient care rounds for our inpatient team were based on a two-decade old practice of tradition and a belief that the rounds were only conducted because of regulatory requirements. Practices based on tradition resulted in ineffective and inefficient approaches to coordination of care. Shared interprofessional decisionmaking and patient-centered individualized plans of care were missing from our teams’ interdisciplinary patient care rounding process. The team reviewed literature and, based on that evidence, discussed how to redesign the structures and processes of rounding. The team considered 13 evidence-informed processes for patient care rounds, team centered communication strategies, and how to include the patient and family in the interdisciplinary patient care rounding process. A 4-week pilot was conducted to assess and evaluate the proposed changes in the interdisciplinary patient care rounds. Structured observations and appreciative inquiry debriefings were used to obtain feedback during the pilot period. Feedback was incorporated in each subsequent week’s interdisciplinary patient care rounds. Eleven of 13 evidence-based practices described in the literature were included in the final implementation of the interdisciplinary patient care rounding process. Team members’ roles were defined, a standardized time and location for rounds was determined, and an electronic structured note for patient-centered goal development and documentation were implemented using the “patient story” element in the electronic medical record. Conducting interdisciplinary patient care rounds in a conference room iv setting instead of the previous hallway rounds led to a decrease in interruptions and a reduction in time wasting activities. Leadership style, including team involvement in the development of the new rounding process and frequent team input during the pilot phase were supportive for maintaining team momentum in change implementation. Real-time adjustments based on team feedback led to enhanced team involvement and acceptance of the new rounding process. A reduction of interruptions and distractions with no change in rounding time may have indicated a more patient-centered focus of rounding discussions. Recommendations for the future include actual presence of the patient and family during interdisciplinary patient care rounds to further enhance patient-and-family centered care and team training using an interprofessional communication skills lab to enhance respect between various professionals and invite additional, active participation from all team members. Data collection is in process for outcome evaluation of the new interdisciplinary patient care rounds process and the project on clinical outcomes, such as length of stay, as well as on patient satisfaction, care provider satisfaction outcome measures, and work efficiency outcomes