Background: Rising inpatient census, limited physical space and unpredictable admission rates introduce communication inefficiencies among doctors, nurses and patients.
Purpose: At UC San Diego Health System, we aimed to streamline communication among physicians, patients and other care team members.
Description: Two operational changes were made: 1) establishment of team-based geographic cohorting and 2) segregation of admitter and rounder roles. This work-flow was the platform for the creation of a team-based unit with a consistent subset of interdisciplinary staff. This framework also allowed successful implementation of a novel rounding work-flow coined “Focused Interdisciplinary Team (FIT)” rounding (Figure 1). We used pre and post intervention surveys to assess communication amongst the multiple disciplines participating in FIT rounds. Comparison of staff surveys (using a 10-point Likert-type scale) pre and post implementation showed statistically significant improvement in mean scores (range 1-10) for communication among team members (6.29 vs. 7.29, p<0.001), satisfaction that concerns raised on FIT rounds were addressed in a timely manner (6.48 vs. 8.04, p<0.001), and understanding of daily care plans by all team members (7.21 vs. 8.07, p<0.05). Furthermore, improved estimates of discharge date by Care Managers (35% versus 51% pre and post FIT implementation respectively) indirectly reflected improvement in team communication.
In addition, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient Experience Survey data collected before and after FIT rounds implementation showed improvement in percentile rank for Top Box Scores in multiple composite topics: communication with physicians and nurses; communication about medicines, discharge information, and care transitions; and likelihood patients would recommend the hospital to others (Table 1).
Conclusions: Co-implementation of geographic cohorting and an admitter/rounder model created an operational ecosystem for a standardized multidisciplinary and patient centered rounding work-flow. The significant impact of FIT on communication is reflected in improved patient and care team satisfaction scores. Future directions of this effort include linkage to enhanced quality outcomes and utilization metrics. As inpatient health care systems expand in size and complexity, hospitalists can drive continued evolution of integrated delivery and communication models.
To cite this abstract:Horman, SF; Frederick, W; Bouland, DL. GETTING FIT: A NOVEL FRAMEWORK TO IMPROVE COMMUNICATION. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 37. https://www.shmabstracts.com/abstract/getting-fit-a-novel-framework-to-improve-communication/. Accessed February 25, 2020.