Interdisciplinary rounds must be quick and orderly — otherwise, key members of the team won’t join in, says Jean Maslan, BSN, MHA, CCM, ACM, senior managing consultant for Berkeley Research Group, with headquarters in Emeryville, CA. You need to develop a formal plan, she adds.
The structure for the rounds has to be carefully laid out and the rounds themselves must be well-thought out, Maslan says. The rounds won’t be effective if your team decides to have them one day and skip the next day, she adds.
Toni Cesta, RN, PhD, FAAN, partner and consultant in North Bellmore, NY-based Case Management Concepts, recommends that hospital leadership appoint a committee to create a formal plan for rounds based on how the process will work best in each individual hospital. The committee should start by identifying the goals for the rounds, and then creating a structure for the rounds. Develop a short, simple tool with standardized questions to guide the rounds.
Develop key talking points for each discipline, create a plan for assigning responsibility for follow-up items, and designate someone to make sure the items are completed, Maslan advises.
Scripting is very important for rounds to be productive, Cesta points out. “One of the biggest reasons that attempts at interdisciplinary rounds fail is that participants don’t stay on the subject, the rounds take too long, and people drift away,” she says.
Interdisciplinary rounds need a strong facilitator to keep the team on the subject, Maslan adds. “Someone has to keep the team on track and ensure that they are respectful of everybody’s time. If there are a lot of extraneous conversations and people don’t find them worthwhile, they will stop coming,” she says.
In addition, to be effective, the idea of interdisciplinary rounds must be championed by senior hospital management and hardwired into the treatment team’s daily routine, Cesta says. The rounds should be held every day and attendance must be mandatory, she adds.
The rounds should focus on the plan of care, expected outcomes of care, barriers to care, transitions within levels of care in the hospital, and discharge, Cesta says. Review the patient’s current status, clarify the patient and family’s long-term goals and desired outcomes, and create a comprehensive plan of care. Set a daily goal for each patient and write it down. Identify any safety risks and the need for patient and/or family education.
The case manager should discuss the expected length of stay, the status of the discharge plan, any barriers to discharge, or reimbursement issues, Cesta says.
Explain what medical milestones the patient needs to reach for discharge, and what details in the discharge plan need to be completed, Maslan adds.
“Because advocacy is the care manager’s primary ethical obligation, multidisciplinary rounds are the best venue to discuss resource utilization and make sure the team avoids placing the patient/family in any clinical or financial risk,” says Stefani Daniels, RN, MSNA, CMAC, ACM, founder and managing partner of Phoenix Medical Management, a Pompano Beach, FL, hospital case management advisory firm.
Discuss whether the test or procedure being ordered by the physician is appropriate for this patient, and whether it reflects the patient’s or family members’ preference, Daniels advises. Is it excessive, wasteful, duplicative, or potentially harmful? Does the patient have the resources to pay for it?
“Not only is this a ‘best practice’ for care coordination, it also helps team members start thinking in terms of patient advocacy,” Daniels adds.
Keep a list of tasks to be completed, and follow up, Cesta says.
Rounds should last no longer than one to two minutes per patient, Maslan says. “If the team doesn’t have a structure, the rounds will last a long time. Clinicians are so busy. If they don’t find the rounds helpful, they’ll find reasons not to show up and a key member of the team will be missing,” she says.
Don’t forget to review your progress, Cesta advises. Outcomes to measure include reduction in length of stay, reduction in ICU stays, lower morbidity and mortality, and increase in patient and staff satisfaction.