Interdisciplinary Rounds

Halm, Margo A.; Gagner, Steven; Goering, Mary; Sabo, Julie; Smith, Maureen; Zaccagnini, Mary

doi:10.1097/00002800-200305000-00013

Cited by 63 publications

(9 citation statements)

References 10 publications

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“…Previous research has suggested that staffing patterns and multidisciplinary rounds may influence patient survival. 18,19 In our analyses, we adjusted for patientdoctor ratio and the patient-dialysis staff ratio at facilities, but not for the quality of care by nonphysician staff. The quality of contacts between patients and staff may also be more relevant than its quantity.…”

Section: Discussionmentioning

confidence: 99%

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Kawaguchi

Karaboyas

Robinson

et al. 2013

Journal of the American Society of Nephrology

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It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean 6 SD estimated duration of a typical interaction between patient and physician was 7.765.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Kawaguchi

Karaboyas

Robinson

et al. 2013

Journal of the American Society of Nephrology

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“…In fact, a large number of the facilities that we studied (35 clinics [47%]) did not have sit-down rounds, and the larger units in our cohort (more patients per provider and/or more shifts) were less likely to have regular sit-down rounds. Another study showed that resistance of team members to spending time away from the patient was frequently encountered in a hospital setting (3). Such reluctance may also exist in the hemodialysis unit.…”

Section: Discussionmentioning

confidence: 99%

“…It has been postulated that collaborative or interdisciplinary rounds, in which all members of a patient care team discuss each patient's status and develop short-and long-term patient care goals, improve patient care and decrease medical errors in a variety of settings (1)(2)(3). However, most of the evidence that such rounds actually improve patient outcomes is anecdotal in nature.…”

mentioning

confidence: 99%

Frequency of Sit-Down Patient Care Rounds, Attainment of Clinical Performance Targets, Hospitalization, and Mortality in Hemodialysis Patients

Plantinga¹,

Fink²,

Jaar³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Sit-down patient rounding in hemodialysis units allows providers to focus collectively on each patient's needs and may affect patient outcomes positively. The objective was to examine whether sit-down rounding practices improve patient outcomes in a cohort of 644 adult hemodialysis patients from 75 outpatient dialysis clinics in 17 states throughout the United States who survived at least 6 mo after enrollment (average follow-up, 3.2 yr). Achievement of well-accepted 6-mo clinical performance targets of albumin (Ն3.5 g/dl), hemoglobin (Ն11 g/dl), calcium-phosphate product (Ͻ60 mg 2 / dl 2 ), dose (Kt/V Ն1.2), and vascular access type (fistula); hospitalization rates; and all-cause mortality served as outcomes. Monthly or more frequent sit-down rounds were conducted in 36 (48%) of 75 clinics, representing 287 (45%) of 644 patients. More frequent sit-down rounds were positively associated with an increased chance of achieving the 6-mo clinical performance target for albumin compared with less frequent rounds (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.12 to 3.15); patients who were treated at clinics with more frequent rounds also had nearly twice the odds of achieving more of the five performance targets (OR, 1.95; 95% CI, 1.11 to 3.42). After adjustment for potential confounders, patients who were treated at clinics with more frequent sit-down rounds were 32% less likely to be hospitalized (incidence rate ratio, 0.68; 95% CI, 0.51 to 0.91), had fewer hospital days per year (rate ratio, 0.50; 95% CI, 0.26 to 0.98), and were 29% less likely to die (relative hazard, 0.71; 95% CI, 0.53 to 0.95). Adjustment for some clinical performance targets attenuated the statistical significance of the association with hospitalization. More frequent sit-down rounds in hemodialysis units are associated with better patient outcomes, including an increased chance of meeting the albumin clinical performance target, decreased hospitalization, and decreased risk of mortality. This association may be due to the positive effect of collaborative discussion by the patient care team of short-and long-term care goals for individual patients.It has been postulated that collaborative or interdisciplinary rounds, in which all members of a patient care team discuss each patient's status and develop short-and long-term patient care goals, improve patient care and decrease medical errors in a variety of settings (1-3). However, most of the evidence that such rounds actually improve patient outcomes is anecdotal in nature. Although a few substantive studies of patient rounds and outcomes have been conducted, the results are somewhat inconsistent. For example, in the intensive care unit setting, not having daily physician rounds resulted in an increase in mortality, cardiac arrest, and other adverse outcomes in patients who had undergone abdominal aortic surgery (4), but interdisciplinary rounds were not studied in this setting. One study showed that both cost and length of stay were decreased in inpatient medical wards w...

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“…15 It is for these reasons that some work in this area has focused on the individual level of analysis. 6 Despite the need for effective communication in multidisciplinary health care teams, traditional communication tools such as case conferences, interdisciplinary rounds, 30 and discharge planning meetings 31 are often poorly attended or not attended at all by doctors, leaving nurses to take command, sometimes by default rather than by design. Time limitations are often cited as the reason for non-attendance at such planning meetings, however the underlying cause may be an absence of a safety culture that values open communication and holds the team in high regard.…”

Section: Ward-based Teamsmentioning

confidence: 99%

Evaluating multidisciplinary health care teams: taking the crisis out of CRM

Sutton¹

2009

Aust. Health Review

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High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. To date, CRM within the health sector has been restricted to use with "crisis teams" and "crisis events". The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design nontechnical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level ALTHOUGH CONSIDERABLE WORK has been undertaken within other industries, a sound theoretical basis for team work in the health care sector is still emerging. Group structures persist within the workplace because they improve the working environment of employees and because results obtained 5 and decisions made 7 within the group context are often superior to those of Evaluating multidisciplinary health care teams: taking the crisis out of CRM Gigi SuttonWhat is known about the topic? Crew resource management (CRM) training programs emerged in the 1980s to improve the non-technical skills of aviation crews 1 and other high-reliability teams by addressing skills which do not relate directly to clinical or psychomotor skills, but to cognitive and interpersonal skills that impact on team processes. The earliest adaptation of crew to crisis resource management within the field of health focused on high-reliability teams working within "crisis" units of intensive care, operating rooms and emergency rooms. 2,3 To date, application of CRM has not extended to health care teams operating outside a "crisis" environment. What does this paper add?This discussion paper identifies a gap in team evaluation and training methodology, and positions CRM as a meaningful framework to guide the development of assessment and training tools for use with multidisciplinary ward-based health care teams, hereafter referred to as ward teams. Secondly, the paper compares and contrasts ward teams and "crisis" teams and highlights the need to develop domain-specific evaluation tools for acute, non-crisis health care teams. Finally, I assert the need for all health care teams to focus on the acquisition of nontechnical skills required for effective everyday function beyond the time-limited crisis. What are the implications for practitioners?To improve the effectiveness of ward teams, change agents need to develop a better understanding of the way in which team effectiveness can be operationalised within acute health care team settings by drawing on behavioural marker method...

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Interdisciplinary Rounds

Cited by 63 publications

References 10 publications

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Frequency of Sit-Down Patient Care Rounds, Attainment of Clinical Performance Targets, Hospitalization, and Mortality in Hemodialysis Patients

Evaluating multidisciplinary health care teams: taking the crisis out of CRM

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