The Impact of Bedside Interdisciplinary Rounds on Length of Stay and Complications

Abstract

BACKGROUND: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement. OBJECTIVE: To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model. DESIGN: Controlled trial. SETTING: 2 geographic areas of a medical unit using a clinical microsystem structure. PATIENTS: 2005 hospitalizations over a 12-month period. INTERVENTIONS: A bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist. MEASUREMENTS: The primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital-acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre-and postimplementation.RESULTS: There was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model. LIMITATIONS:The trial was performed at a single hospital.CONCLUSIONS: Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.

Implementing bedside rounds to improve patient-centred outcomes: a systematic review

“…Likewise, a non-bundled intervention by Gausvik et al 56 resulted in an improvement in 30-day readmission for patients discharged to a skilled nursing facility (SNF) (11.68% vs 14.7%, p<0.05), decreased LOS for patients discharged to an SNF (5.24 days vs 7.26 days, p<0.001) and decreased LOS for patients discharged to home (3.73 days vs 4.21 days, p=0.001). However, bundled interventions involving BR by Dunn et al 39 and Saint et al 48 did not result in a statistically significant difference in LOS when compared with control units.…”

“…Likewise, a bundled BR intervention by Stein et al 28 led to a decrease in unadjusted mortality (1.1% vs 2.3%, p=0.004). However, Dunn et al 39 found no statistically significant effect of BR on composite outcomes of clinical deterioration or hospital-acquired conditions (7.7% vs 9.3%, p=0.46). Other results in this domain included no statistically significant effect of BR on adherence with outpatient follow-up appointments (9.5% vs 14.3%, p=0.63) 26…”

Bedside Assessment of the Necessity of Daily Lab Testing for Patients Nearing Discharge

“…Bedside IDR focuses on the daily plan and patient safety by utilizing a scripted format. 3 Our multifaceted intervention included prompting the hospitalist physician during bedside IDR, education of the clinicians, and regular data review for the hospitalists and unit staff.…”

Perceptions of interdisciplinary rounding practices

“…In a 2015 study, Gausvik et al found higher agreement on team communication, perceptions of safety and job satisfaction amongst practitioners using IDR compared to a physician‐centric model (). Similarly, nurses and physicians noted improved efficiency and patient safety with bedside IDR in a 2017 study (Dunn et al, ). Consistent with these results, (Henkin et al, ) noted improved agreement in physicians and nurses’ perceptions of interdisciplinary collaboration after the introduction of IDR.…”