Multidisciplinary rounds are the key to improving communication among all disciplines on the treatment team and facilitating collaboration on the patient’s plan of care, says Jean Maslan, BSN, MHA, CCM, ACM, managing consultant for Berkeley Research Group, with headquarters in Emeryville, CA.
“Rounds are a time to get all of the disciplines on the same page so everyone will have the same message to patients. Having daily multidisciplinary rounds should increase quality metrics and increase patient and staff satisfaction,” she says.
Multidisciplinary rounds remove the silos in which clinicians often operate because everyone is talking to each other, says Peggy Rossi, BSN, MPA, CCM, a retired hospital case management director who now is a consultant for the Center for Case Management.
“In today’s healthcare environment, it’s important for all the disciplines to act as a team and collaborate on patient care and moving patients safely through the continuum. They make the discharge process smoother because everyone is aware of the barriers to discharge and works to remove them,” she adds.
Rossi suggests that hospitals develop two types of rounds: daily rounds that focus on length of stay and a safe discharge, and complex rounds for high-risk patients with multiple comorbidities and complex needs.
The daily rounds should be quick and efficient and include a one-to-two minute discussion of each patient, including what happened in the last 24 hours, why they still need to be in the hospital, and what other medical milestones needs to be met before discharge, Rossi adds.
The entire team has to be engaged for the process to work, says Patricia Hines, PhD, RN, managing director for Novia Strategies, a national healthcare consulting firm.
The team should review the plan of care, what needs to happen that day, determine what indicators physicians are looking for in order to progress the patient along the continuum, and what the barriers are to discharge. They should determine what the patients will need for discharge, and assign someone to address discharge needs, she says.
“Most case managers can identify what the barriers are. They know the organizational challenges and can discuss them in the daily meetings,” Hines adds.
Rounds on complex patients should include every clinician who cares for the patients, including representatives from therapy, nutrition, pharmacy, chaplaincy, and finance counseling, Rossi says. Look at the patients’ financial situations and what payers they have and make sure the plan of care takes into account all of the barriers to a successful discharge so that there are no surprises on the day of discharge.
“Complex rounds are crucial, especially for drilling down to find the causes of readmissions. The team needs to take a close look at the cause and come up with ways to prevent the patient coming back,” she says.
As she consults with hospitals across the country, Toni Cesta, RN, PhD, FAAN, partner and consultant in New York-based Case Management Concepts, hears a lot of excuses for not having multidisciplinary rounds.
“People say they don’t have time, but rounds actually save time. The nurses, case managers, and other participants are giving up less than 10 minutes a day and they learn a lot about the patients that isn’t in the medical record. It also saves the time they waste trying to find physicians and other staff to ask questions,” she says.
Once the rounds are up and running and the team is hardwired, the participants find that the rounds save time because everyone is getting the same information at the same time, she says.
For rounds to be successful, hospitals have to invest the time to develop a structure for the rounds, educate staff on how to participate, and measure performance, Maslan says.
Start by determining what team members need to attend rounds and what contribution each can have. Then get buy-in from the heads of all departments involved, Cesta says.
Map out your goals and outcomes for the rounds and get the support of the chief nursing officer and the physician advisor, Hines advises.
Set a firm time and place for the rounds and make them mandatory, Cesta says. Then have mini rounds in the afternoon and go over everything you identified in the morning, she says.
Stagger the times each unit holds rounds so staff such as pharmacy, dieticians, and therapy that cover several units can be present, Maslan says.
Rounds should be led by a facilitator, often the charge nurse on the unit. “If there isn’t a designated charge nurse, a case manager is a good backup. Case managers work across all disciplines and can bring a broad view of the patient,” Maslan says.
Structure rounds to give each team member time to have input, Rossi recommends. Alert participants ahead of time so they can prepare, she adds.
“It’s very important to have a structure with talking points from each discipline. The direct care team has to be present for these rounds. If the rounds are just nurse-to-nurse or nurse-to-physician reports, it’s not beneficial for everyone,” she says.
In order for the rounds to be successful, they have to be meaningful for the participants, Maslan says. “Strong, consistent leadership is crucial. If you don’t have that, you won’t get buy-in from the team,” she says.
After rounds have been in place for a while, conduct audits to determine how successful you are at starting rounds on time, whether the entire team attends, how discharge barriers are addressed, and how you are doing in meeting your performance improvement goals, Hines suggests.