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Total Posts: 13
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Multidisciplinary Rounds
4/29/2004 4:41:16 PM
Posted here are excerpts from a listserv discussion among members of IHI's Improving Flow Through Acute Care Settings Collaborative regarding use of multidisciplinary rounds to improve flow:
Has anyone instituted multidisciplinary rounds on general medicine wards?
If so, (1) who attends rounds? (2) what is discussed (i.e. does anyone have a template of questions)?, (3) what creative strategies are there to get buy-in (attendance) particularly among residents?, and what improvements have you seen?
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
Here at No. Brooklyn we call it case management Rounds and all disciplines, are represented. The good thing about it is that it is Attending Physician driven and all aspects of the patient needs and care are discussed. The result has been predictability and improvement in our flow process.
- North Brooklyn Health Network, Brooklyn, New York, USA
At Queens Hospital Center the Director of Medicine implemented daily discharge planning rounds a little over a year ago.
Every day he's there, as well as an Intern or Resident from all of the teams, Social Work, Discharge Planning, Pt Accts, Admitting, Home Care,
Psychiatric consult, Pastoral Care and Nursing. In addition, Dietary sends a list of all pts suffering from any kind of malnutrition, so it can be documented in the chart.
All of the day’s discharges are discussed, as well as future discharges and any possible social work or placement problems.
The result has been a drop of ALOS from five to 4.3 days.
Buy-in was a breeze: with the service director running the meetings, no House Officer dares miss it.
- Queens Hospital, Jamaica, New York, USA
We instituted physician led multidisciplinary rounds on a general medical floor in an attempt to increase core measure compliance. We call it Crucial Care. We did not have a paid medical director or any one physician that could commit to rounds forever, but we did have 21 of our top admitters who agreed to do two-week rotations over the next year. We struggled with how to get optimal productivity from the rounding physician in the one hour they were willing to give us. We settled on having the physician round on all protocol patients primarily CHF, AMI, and CAP. In preparation we began to cohort as many of those patients as possible on one floor in order to move rounds along quickly. The multidisciplinary team consists of:
Physician
Case Manager
Patient's Nurse
Charge Nurse
Dietician
RT
Pharm D
Cardiac Rehab
Social Service
The team rounds on all identified patients and leaves a team note for the attending physician to address on his next visit. The rounding doctor does not write orders but he does enforce protocols which have already been approved by the medical staff as a whole. The project has done several things: drastically improved core measure compliance,
decreased ALOS, educated the bedside nurses as to the protocols and rationale behind them, educated our top admitters re core measure compliance in preparation for the day they will be publicly reported,
created a center of excellence for these DRG's.
We have now spread to our second floor and hope to take the same approach to our post surgical population and use our surgeons to address SIP protocols. The rounding doc does not chart in the progress notes but rather leaves messages of items that need documenting for the attending. Each one of the physicians that have rounded with us has brought a new style and something else to the table but the experience has been very educational for all.
- Baptist Memorial Hospital – DeSoto, Southaven, Mississippi, USA
We are a 135 bed community hospital and we instituted Interdisciplinary
Rounds in 2003. The "regulars" for rounds are:
Clinical Nurse Specialist
Primary Nurse for each patient
Charge Nurse
Case Manager
Rehab
Pastoral Care
We occasionally have an attending physician or one of the hospitalists (we notify them if we are reviewing their patients), a pharmacist, a respiratory therapist, social worker, or behavioral health specialist. They are always "on call". In 45 minutes, M-F, we review 3-4 patients who are high risk for adverse events. We have criteria for "triaging" patients and usually the CNS confers with the off-going night staff as well as the on-coming team leaders, the charge nurse, and the case manager assigned (in 2 week blocks) to the unit. We start rounds on two med-surg units at 1:15 PM. Rounds on CCU are held at 8:00 AM.
- Cooley Dickinson Hospital, Northampton, Massachusetts, USA
At the Boston VA Healthcare System we have a daily interdisciplinary meeting (30 minutes). We have 6 medical teams on 5 medical and/or surgical units so communication was a major issue. Now we have a nurse, nurse discharge planning coordinator and social work care manager from each on the 5 units come to one central location. Each on the group sits at their own table (we have the 2 surgical groups at one table; they only have medical patients if they are boarding on those units so they tend to have fewer medical patients. A resident from each of the 6 teams comes and goes around to each of the tables; quickly runs thru the plan for his/her patients which inlcudes:
General plan (tests planned etc)
Discharge plans (? date, VNA etc)
Barriers to discharge
?continue need for telemetry (if indicated)
It usually only takes 1/2 hour to get thru it all. That was our goal, to have it seen as helpful but not a hindrance from a time perspective.
Many times the attendings may also come thru. We've been able to identify many common issues across units which may not have surfaced if each unit was only being rounded on in isolation. For example, we identified that PT was a delay in discharges and that there are common travel related issues. Rehab medicine now comes to the meeting (at least a couple of times a week, although we'd like it better if it were daily) and have also initiated periodic meetings with our contract ambulance company.
- VA Boston Health Care System, Boston, Massachusetts, USA
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Cherelyn Roberts
Total Posts: 2
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Re: Multidisciplinary Rounds
8/29/2004 8:46:21 PM
We will be starting multidisciplinary rounds on our med surg unit . We will be utislizing some of the same disciplines already mentioned. We will be using a daily goal sheet placed in the chart for all disciplines to read, document and keep track of accomplished goals and make suggestions of any new goals . I would like to use a dry erase board in the room as well so the patient can be part of the goal identification and also be aware of the goal for the day. Does anyone have any experience already with med surg goal sheets ?
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Cherelyn Roberts
Total Posts: 2
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Re: Multidisciplinary Rounds
10/28/2004 7:08:30 PM
We have been doing multidisciplinary rounds now for over a month with good results. Most disciplines arrive everyday at 1045 to begin. Pt , RT, Pharm, Clinical Coordiantor, RN, Case Management, Crisis team. ANy discipline who might be involved with the patient. Communication has improved among teh team to recommend any therapies or treatments needed for the patient prior to discharge. A goal sheet is used between nurses shifts which has been "tweeked" twice already to fit the nurses needs. A recommendation sheet is then left in the Doctor's progress notes with any recommendations for him/her to adress. So far Docs have been very receptive and utilizing the recommendation sheet to facilitate decreased lenght of stay by ordering services and /or making changes to the patients plan of care before the day of discharge so all needs are adressed immediately. A goal sheet and a multidisciplinary sheet will be submitted for all to utilize if needed.
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Re: Multidisciplinary Rounds
4/14/2005 10:52:48 AM
I would like to start multidisciplinary rounds on my orthopedic unit. Do you have a template of your Daily Goal Sheet I can see?
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Total Posts: 1
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Re: Multidisciplinary Rounds
2/28/2006 2:49:19 PM
I am curious about what tools you use to expedite the rounds. How do you know who to focus on.
right now we are doing daily rounds but the "pre-work" for Nursing team leaders and social work is taking too long.
thanks.
Judy Pratt, RN, MA
Center for HealthCare Improvement
St. Joseph Hospital
Bellingham, WA
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Alison Whittaker
Total Posts: 1
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Re: Multidisciplinary Rounds
8/15/2006 1:17:35 AM
If you are sent a template of a daily goal sheet, please send me one.
Thanks, Alison
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Total Posts: 1
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Re: Multidisciplinary Rounds
8/15/2006 7:22:54 AM
Same here. I'd love to see a goals template also. Robert
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Total Posts: 1
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Re: Multidisciplinary Rounds
4/4/2007 4:32:49 PM
Have you received any tools to help with these rounds that you would be willing to share with us?
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