Convening a conference of involved parties in ICU patient care will enable establishment of multidisciplinary rounds (MDR). There are some barriers to overcome depending on the type of unit.
Open units (non-intensivist-led units in which any physician may admit and write orders) generally will have more challenges to overcome in establishing multidisciplinary rounds. However our experience is that persistence will generate physician buy-in and encourage their respect for the rounding process. Rounds may have to begin without physician input and a summary of recommendations brought to their attention. Over time, many physicians begin to attend the rounds more regularly to learn about best treatment options.
Closed units (intensivist-led units, or units requiring critical care consultation, in which a “team” writes orders only) generally have greater ability to begin multidisciplinary rounds without resistance.
Both types of units will benefit from the changes however. Issues regarding multidisciplinary rounds that need to be resolved before the first meeting include:
Who:
- Intensivists, generalists, ICU nurses, pharmacists, respiratory therapists
- Nutritionists, social workers, case managers
- Family members
What:
-
Patient’s Preferences and Goals: These are essential to identify appropriate care that the patient would choose rather than the providers’ preferences. In ICU care this will often involve meeting with family members who should be invited to attend certain MDR sessions.
-
Patient’s Care Needs: Once a patient’s preferences and goals are understood plans can be made to medically meet those needs.
-
Acuity Assessment and Discharge Planning: Ongoing planning for discharge is critical to ensure the care plan follows through to the wards and then to rehabilitation and home.
Where:
- Rounds are best held at the patient bedside to promote transparency.
- Large teams may need to meet in a separate conference area.
When:
- A daily MDR conference is optimal.
- Two to three times weekly may be an acceptable alternative.
How:
- MDR may be integrated into physicians’ daily patient care rounds.
- If your ICU lacks a daily rounding structure, these rounds can occur independently from such a structure at a designated time.
