CLINICAL PRACTICE
As a nurse, you know that high-quality healthcare involves so much more than the “patient/physician” relationship. All members of a patient’s healthcare team need to work in collaboration to enhance patient experience and patient outcomes.
This kind of efficient and effective collaboration simply cannot happen without appropriate communication. In fact, interdisciplinary communication is so important that a growing number of hospitals and other healthcare settings now implement multidisciplinary rounds (sometimes referred to as MDR). Research shows that multidisciplinary rounds offer several benefits to both the patients and the clinical team. You’ll get a chance to learn about these benefits shortly.
Of course, even if you can readily see the benefits of multidisciplinary rounds for your patients, this awareness isn’t always enough to make sure rounds go smoothly. Nursing shifts get incredibly busy, and taking time away from your other duties to round with the team can be hectic and stressful.
How can healthcare facilities improve multidisciplinary rounds and make sure they remain an effective and time-efficient way to boost patient care? Time to round up what the research says.
Multidisciplinary patient rounds typically include a range of individuals who represent relevant disciplines involved in a patient’s care. While the rounding process can and does vary widely between facilities (and in some cases, even within facilities, depending on the care unit or floor), team members present at rounds may include:
Depending on the setting and situation, clinical students (e.g., nursing students, physical therapy students) may also be invited to attend. Additionally, patients and their loved ones may be invited, as well, who can provide a tremendous amount of insight for coordinating and continuing care.
Frequency and duration of rounds are also highly variable. Teams may formally round on their patients a few times per week or even once a day, sometimes for up to an hour or more. The rounds themselves may be held at the patient’s bedside, on the unit, in a conference room, or anywhere that sensitive health information can be discussed privately.
Multidisciplinary rounds can be led by any team member, but are typically run by the attending physician, resident, or nurse. During these rounds, team members usually get a chance to update the rest of the team on how the patient is progressing within their related scope of care. Topics of discussion may include the results of recent or pending medical procedures (including imaging studies and lab work), plan of care priorities, discharge plans, barriers to discharge, and goals.
Of course, getting the whole team together for formal communication certainly sounds like a good idea. But, are rounds actually effective?
Overall, yes! At least according to the available literature. By enhancing communication between clinical team members, virtually everyone involved stands to benefit.
Specifically, multidisciplinary rounds in hospital settings have been shown to:
So, there’s good evidence to show that multidisciplinary rounds improve patient outcomes. But as you may know, not all rounds were created equal. Some multidisciplinary rounds seem to run smoothly and seamlessly. Others can seem disorganized, repetitive, or inefficient.
How can rounds be improved while still optimizing patient care and respecting the team members’ time and productivity? These four tips can help:
Establish an order for when each team member speaks or has the opportunity to speak, if necessary. This greatly streamlines rounds and reduces the risk of tangential conversation and lapses in communication. In the experience of this article’s author, for example, team members during intensive care unit rounds speak in the following order: attending physician, nurse, respiratory therapist, occupational or physical therapist, pharmacist, nutritionist, quality assurance, and case management. Remember that the chief perspective during rounds is relatively “big picture.” If a patient, family member, or another member of the team has specific questions that require a more in-depth conversation, these questions should be addressed after, not during, rounds.
Put those active listening skills to use—pay attention, don’t interrupt, ask clarifying questions as appropriate, mute your cell phone, and don’t have side conversations with other team members, especially while another person is talking. If the patient is present, make sure he or she is treated with dignity and can meaningfully participate to the best of their ability—mute the television, ensure they are properly clothed or covered with linens, talk to them rather than about them, and do whatever else is appropriate to make them feel comfortable and able to join in.
There’s no question that multidisciplinary patient rounds are an essential component of high-quality healthcare. As a nurse, your role is particularly valuable because you spend so much intimate time with the patient and his or her family members. Know that you are a key member of the interdisciplinary team and that your input can make a dramatic difference in a patient’s plan of care and overall outcomes.
Are you a regular part of patient care rounds at your facility? Share these pointers with your team so you, your fellow staff members, and your patients can get the most out of this cost-effective and value-based strategy.