Implementation and function of interdisciplinary rounds: An observational multisite hospital study from project ACHIEVE

Abstract

Background: Interdisciplinary rounds (IDR) are increasingly employed by hospitals; however, there is no formal definition, structure, or framework.Objective: The purpose of this observational study was to document the heterogeneity of IDRs and assess the different characteristics associated with IDR functions.Designs, Settings, and Participants: Observation of IDR occurred at 27 hospitals that were purposively selected to ensure a mix of the following criteria: geographic region, provider type, for-profit status, population (e.g., urban, rural), and teaching status.Hospitals identified general medical floors covered by hospitalists for IDR observations. Intervention:The study team conducted hospital site visits to observe the implementation of IDR. A checklist was developed to record IDR structure and processes, content, and outcomes. Data from two content expert observers were reconciled, and a consensus was attained. Main Outcome and Measures:The study measures include two IDR functions: topics discussed during IDR (changes in medical treatment, responsibilities and shared understanding of goals and expectations, anticipation of discharge date and needs, anticipating follow-up care and service needs), and effective communication.Results: Hospitals varied significantly in IDR implementation. 51.9% included the "core" team (i.e., a physician, nurse, pharmacist, and case manager/social worker), though all included a case manager or social worker. Most (81.5%) occurred before noon. Content chiefly focused on medical care (74.1 to 92.6%) with patient responsibilities and preferences being less frequently discussed (25.9 to 40.7%). Bivariate analyses revealed that afternoon rounds were more likely to include dischargeȐrelated topics, such as patient/caregiver preferences (100% vs. 27.3%, p = .003) and follow-up needs (100% vs. 36.4%, p = .010).When IDR occurred at bedside, financial resources were more often assessed (100% vs. 34.8%, p = .015) and patient's ability to obtain medication was more often anticipated (75% vs. 21.7%, p = .031).

Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds

“…IDRs have been widely implemented as a strategy to allow all members involved in patient care to voice their concerns and collaborate on treatment plans to decrease the errors in teamwork and communication that increase adverse outcomes 4,23 . However, studies demonstrate significant heterogenity in hospital IDR implementation in terms of structure, processes, content, and outcomes 24,25 . This study sought to use direct observation to define specific IDR structures and behaviors of team members associated with increased communication during bedside IDR.…”

“…4,23 However, studies demonstrate significant heterogenity in hospital IDR implementation in terms of structure, processes, content, and outcomes. 24,25 This study sought to use direct observation to define specific IDR structures and behaviors of team members…”

Embracing carers: when will adult hospitals fully adopt the same practices as children’s hospitals?

“…An observational study of 27 participating US adult hospitals noted widely varying structure, participants and content in implementation of interdisciplinary rounds; only 4 hospitals (15%) included patients and carers in some of their rounds. 16 ACHIEVE also included a large qualitative study (focus groups and key informant interviews) to determine what matters most to patients and their carers as they go through the hospital discharge care transition. 17 The diverse sample clearly communicated what they want when leaving the hospital and how healthcare providers can help achieve their goals (box 1).…”