Multidisciplinary Rounds Redesigned

Multidisciplinary Rounds Redesigned to Shorten Length of Stay

By Barbara Kenney, MS, RN, ACM, CCM

Director of Care Management AdventHealth Hendersonville

A few years ago, AdventHealth Hendersonville launched interdisciplinary rounds, which involve a full complement of service providers including physicians, care managers, a charge nurse and an administrative supervisor, as well as team members from therapies, dietary, pharmacy and palliative care.

Our challenge was to expand the focus of our rounds to address patient throughput that stood to impact hospital efficiency. Efficient patient throughput identifies and removes barriers so a hospital can function at optimal speed. As a result, we redesigned multidisciplinary rounds to address readiness for discharge, missing elements to a successful execution of the discharge, and barriers to discharge for each patient.

The AdventHealth corporate office provided a comprehensive packet of tools to get us started. The project team, lead hospitalist, director of nursing and director of care management to review the toolbox, outline goals and draw a timeline. Additionally, we formed a taskforce to socialize the idea of involving the bedside nurse as a pivotal member of daily rounds. While the charge nurse and RN care manager had a broad knowledge of each patient’s care, the bedside nurse was an unleveraged asset. The bedside nurse is most aware of the patient’s current condition. To our delight, the taskforce generated excitement around this idea and designed a strategy to tee up each nurse to present their patients in an efficient manner.

Like any process improvement project, we didn’t quite meet our goals with the first iteration of the plan but learned and adjusted along the way. As the project unfolded, experienced nurse champions served as role models for less experienced nurses. The initiative provided each nurse with a forum through which to relay patient safety concerns resulting in prompt adjustments to the care plan. Team members from therapies, respiratory, pharmacy and palliative care offered their expertise when relevant, and RN care managers took the lead to facilitate meetings to help keep the group on task with concise reporting.

To further increase efficiency, the participating hospitalist set a goal of an additional two discharges before noon each day, while remaining flexible and proactive in anticipating the discharge day so the care team could plan accordingly.

Overall, the initiative to redesign multidisciplinary rounds has proven to be an advancement for patient safety and multidisciplinary teamwork, and it continues with the goal to identify and remove barriers that impede patient progression of care. This should lead to improved patient outcomes and result in appropriate lengths of stay.