Multidisciplinary rounds have become a must, experts say
Executive Summary
Multidisciplinary rounds are a good way to improve throughput, reduce length of stay and readmissions, and improve patient satisfaction, experts say. They add:
• The meetings help the care team identify what is needed for discharge and get all of the disciplines on the same page.
• The structure and participants will vary by organization, but nursing, case management, finance, and pharmacy should be represented.
• The meetings should be at the same time and place every day and should last no more than 45 minutes.
Meet daily to discuss discharge needs
If your hospital doesn’t have regular, well-organized multidisciplinary rounds, you could be missing out on an opportunity to improve patient throughput, reduce length of stay, and prevent readmissions, experts say.
The rounds may be called multidisciplinary, transdisciplinary or interdisciplinary, depending on the facility, but they all have the same purpose — to get the entire team caring for the patient together so everybody knows what everybody else is doing.
"Multidisciplinary rounds can affect many aspects of the patient stay including finances, length of stay, quality, and patient satisfaction. If everybody is on the same page and works together to move the patient safely and efficiently through the system, hospitals will experience fewer denials and cut down on readmissions," says Brian Pisarsky, RN, MHA, ACM, senior managing consultant at Berkley Research Group and Centers for Medicare & Medicaid Services (CMS) alumni faculty for the Community-based Care Transitions Program (CCTP).
When the multidisciplinary team meets regularly to discuss patients, the team knows what has to happen before discharge so the patient doesn’t have to stay longer while tests or procedures are ordered or post-acute services are put in place, Pisarsky says. "Everyone on the multidisciplinary team is aware of any psychosocial or medical issues that are barriers to discharge and can develop a work plan to overcome them. The patient and family are told the anticipated discharge date up front so they don’t need to scramble to arrange to pick up the patient or get the home ready at the last minute," he says.
"With stakes so high these days and with emphasis on bringing down the length of stay and preventing readmissions, it’s important for all the disciplines to act as a team and address the barriers to moving patients safely through the continuum," adds Peggy Rossi, BSN, MPA, CCM, a retired hospital case management director who now is a consultant for the Center for Case Management.
Multidisciplinary rounds offer an opportunity for colleagues to get together as a team and discuss what needs to be done for each patient to make sure they will be ready for discharge when the physician writes the order. They keep everyone on the team focused on what’s going on with the patients and what has to happen to ensure a safe and timely discharge, she says.
"Having nursing in the meeting is extremely important because it gets them involved in discharge planning from the beginning, as discharge planning is everyone’s responsibility and starts at admission," Pisarsky says.
Eliminating silos
Yes, the rounds take time out of busy clinicians’ day, but they allow the team to work smarter and not harder, Rossi says. "They organize the plan so the team knows what tasks need to be done instead of wondering what to do next. Clinicians get so involved in tasks, they sometimes forget the big picture," she says.
The rounds help eliminate last-minute scrambling to get everything done because the team is addressing discharge needs and getting them out of the way, Rossi adds. For instance, a discussion of a newly diagnosed diabetic and what he needs for discharge could remind the nursing staff to teach him how to give himself insulin.
"I don’t know how many times I’ve seen nurses trying to teach patients to inject themselves as they were about to go out the door. Clinicians are so busy they don’t always think of everything that needs to be done," she says.
The rounds eliminate the silos that healthcare professionals often operate in because everyone on the team is talking to each other on a regular basis, Pisarsky points out.
"When the rounds end, the team members are aware of what they’re supposed to do in order to move the patient through the continuum. The players cover all of the bases rather than waiting until the patient is ready to leave to get the discharge plan enacted. The multidisciplinary rounds drive patient care from admission to discharge," he adds.
There’s no one-size-fits-all formula for multidisciplinary rounds. Their structure will vary with the size and culture of the hospital, the size of the unit and the acuity and diagnoses of the patients being treated on that unit, Pisarsky says.
The core team for multidisciplinary rounds should be a nursing representative, a social worker, the discharge planner, the utilization review nurse, and a financial counselor, according to Rossi. It’s also critical to have a pharmacist participate, she says.
Other disciplines may vary according to the unit, Rossi says. It may not be necessary for some disciplines, such as physical therapy or respiratory therapy, to participate in rounds on every unit, but it may be essential that they participate on some units, she points out. For instance, rounds on a rehab unit should include representatives from occupational therapy, physical therapy, and speech therapy. The intensive care unit should include respiratory therapy in the rounds. When patients are on many different diets, it helps to have a dietician on the team as well, she says.
Start with your core team and bring in other disciplines depending on the unit and the patients you are discussing that day, she says. "Having representatives from every department participate in rounds on every unit is not the best approach because it is almost impossible to assemble a large contingent of personnel, especially on a daily basis," she says.
In some hospitals, a representative from clinical documentation is present to discuss the working DRG and the geometric mean length of stay to help the team assign a discharge date, Pisarsky says. In some organizations, members of the quality team attend to check on whether the core measures are in place, he adds.
Pisarsky and Rossi agree that the rounds are most effective when physicians attend, but it’s hard to get them to attend due to office hours and surgery times.
"Sometimes the only person who knows the plan is the physician. Even if physicians don’t attend the rounds, the team can assign one person to call them, which eliminates a lot of phone calls for the physicians," Pisarsky says.
If physicians don’t participate in the rounds, Pisarsky suggests having the nurses who are caring for each patient come in and speak about the plan for the patient.
"Cycling the nurses through rather than having every nurse stay for the entire meeting seems to work best. They should talk about their patients, answer questions, and go back to their assignments," he says.
An alternative is to have one representative from nursing report on the entire unit, Rossi says.
Physicians, especially hospitalists, who attend the rounds find out that their presence saves time in the long run, Pisarsky says. "Physicians can give their plan and their directions to the entire team instead of getting calls from the individual team members. If they spend a half hour in the rounds, it saves them much more time than that during the day," he says.
