Improving Patient Safety: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit

1Northwestern University Feinberg School of Medicine, Chicago, IL
2Northwestern University Feinberg School of Medicine, Chicago, IL
3Northwestern Memorial Hospital, Chicago, IL
4Northwestern Memorial Hospital, Chicago, IL
5Northwestern University Feinberg School of Medicine, Chicago, IL
6Northwestern University Feinberg School of Medicine, Chicago, IL
7Northwestern University Feinberg School of Medicine, Chicago, IL
8Northwestern University Feinberg Schoof of Medicine, Chicago, IL
9Northwestern University Feinberg School of Medicine, Chicago, IL
10Northwestern University Feinberig School of Medicine, Chicago, IL

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 102

Background:

Communication among health care providers is critically important to provide safe care, as poor communication represents a major etiology of preventable adverse events (AE) in hospitals. The aim of this study was to assess the impact of an intervention, structured interdisciplinary rounds (SIDRs), on preventable adverse events on a medical teaching unit.

Methods:

The study was a controlled trial comparing an intervention medical teaching unit with a similar control unit at an urban 897‐bed leaching hospital. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. Based on an interdisciplinary working group's recommendation, SIDR took place each weekday at 11:00 am in the unit conference room and lasted approximately 30 minutes. The nurse‐manager and a unit medical director co‐led SIDR, which was attended by all nurses and senior residents caring for patients on the unit, as well as the pharmacist, social worker, and case manager assigned to the unit. Providers used a structured communication tool during SIDR, which was modeled after prior research demonstrating the benefit of daily goals‐af‐care forms. A medical record review of 370 randomly selected patients admitted to the intervention and control units (185 each) in the first 6 months postimplementation of SIDR identified potential AEs using screening criteria adapted from prior research. A resident physician reviewer provided a narrative summary for each potential AE identified. Narrative summaries were reviewed by 2 hospitalists, blinded to patient unit assignment, for confirmation of the presence of AEs and assessment of preventability and seventy. Intenater reliability for the presence (kappa = 0.74), preventability (kappa = 0.58). and severity (kappa = 0.47) of AEs was comparable to those of prior studies. The rate of AEs on the intervention unit was compated to the control unit using multi‐variable Poisson regression models. Models included patient age, sex, and ethnicity as covariates and used backward selection for additional variables, including payer, diagnosis‐related group (DRG) weight, Charison comorbidity index, admission source, night admission, weekend/holiday admission, non‐English speaking, and isolation status.

Results:

Bivariate analyses found no significant differences in patient characteristics between the intervention and control unit. The adjusted incidence rale ratio of totaI and preventable adverse events was significantly lower for the intervention unit as compared to the control unit (see Table 1).

Conclusions:

SIDR significantly reduced the adjusted rate of total and preventable AEs on a medical teaching unit. Further study is required to assess the types of AEs that account for these differences.

Author Disclosure:

K. O'Leary, none; R. Buck, none; C. Haviley, none; M. Slade, none; M. Landler, none; N. Kulkarni, none; J. Lee, none; S. Cohen, none; D. Wayne, none; M. Williams, none.

To cite this abstract:

O'Leary K, Buck R, Haviley C, Slade M, Landler M, Kulkarni N, Lee J, Cohen S, Wayne D, Williams M. Improving Patient Safety: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 102. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/improving-patient-safety-impact-of-structured-interdisciplinary-rounds-on-a-medical-teaching-unit/. Accessed May 26, 2019.

« Back to Hospital Medicine 2010, April 8-11, Washington, D.C.