Traditional interdisciplinary rounds are unstructured and take place in a conference room. To promote optimal communication among all team members and engage patients in the daily plan and disposition process, we transformed our rounds from a conference room format to a structured bedside model. Though a mobile model for interdisciplinary rounds has the potential to improve patient safety, the efficiency of care, and patient centeredness, the model requires a dramatic change in workflow for all team members so requires high‐quality evidence to demonstrate the effectiveness and promote widespread adoption.
A team of stakeholders led by a hospitalist developed Mobile Interdisciplinary Care Rounds (MICRO) on a non‐teaching ward at an academic medical center. The ward is geographically separated into two sections. The MICRO intervention has been implemented on one section and the other section serves as the concurrent control group, which allows for a quasi‐randomized design as patients are assigned to the ward from the Emergency Department and the section is based solely on bed availability. Bedside rounds occur daily at 10:00am and include the Unit Medical Director, Nurse Manager, hospitalist, NP, nurse, social worker, and case manager. Roles are scripted to ensure rounds are completed in <1 hour. Patients are asked for their main priority for the day and a patient safety checklist is reviewed at each encounter. There are no exclusion criteria; all patients are enrolled. The primary outcome is Clinical Deterioration, defined as death, transfer to a higher level of care, or development of a pre‐specified hospital‐acquire complication. Secondary outcomes are length of stay and patient satisfaction based on the HCAHPS survey. A research coordinator attends rounds and records events daily for the intervention and control units. The study was evaluated by the institution’s IRB and full review was waived.
Preliminary data after the initial 2 months of this 12 month trial are presented. A total of 600 patients have been enrolled (336 in the intervention and 264 in the control groups, respectively). There has been trend towards a decrease in the primary endpoint of Clinical Deterioration (9.1% vs. 6.8% in the control and intervention groups, respectively) and in transfer to a higher level of care (5.7% vs. 3.6%). There has also been a trend towards decreased length of stay (5.6 vs. 5.2 days). Due to the interim sample size, these results did not reach statistical significance. Too few HCAHPs surveys have been received to compare results for patient satisfaction.
This preliminary analysis suggests that transforming interdisciplinary rounds from a conference room to a bedside model has the potential to improve patient safety and decrease length of stay. The full trial results will determine whether these benefits are sustained, the impact on patient satisfaction, and whether the mobile interdisciplinary rounds model should be implemented more widely.
To cite this abstract:Dunn A, Reyna M, Osio T, Colgan C, Parides M, Radbill B, Hunt C, Kaplan H. Mobile Interdisciplinary Care Rounds (Micro). Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 105. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/mobile-interdisciplinary-care-rounds-micro/. Accessed April 7, 2020.