Keeping the team focused during rounds
Develop a format and always follow it
Multidisciplinary rounds can be an invaluable tool for the hospital team, but only if they are well-organized and focused, experts say.
After obtaining leadership buy-in, the next step in implementing multidisciplinary rounds is to appoint a steering committee or work group to determine which units should be included, how the rounds should be structured, what disciplines will participate, and who will run the rounds, 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).
"The structure will depend on the facility and the unit. It will be different at every hospital, but the rounds on every unit in the hospital should be as much alike as possible, so when team members work on other units in the hospital, they are familiar with the expectations and structure," he says.
The steering committee should decide what the rounds will cover and lay out the ground rules for participants, Pisarsky says.
The rounds should be held at the same time and place every day, he says. The time depends on when it’s best for nursing and case management. For instance, if nurses pass medications from 9 a.m. to 10 a.m., you might start the rounds at 10:15.
Peggy Rossi, BSN, MPA, CCM, a retired hospital case management director who now is a consultant for the Center for Case Management, recommends against holding rounds in the morning, the busiest time of the hospital day. Instead, she says, hold the rounds at 2 p.m., when the team can focus on what tasks need to be finished that day and what they need to plan for the next day.
"Participants leave the meeting with the tasks they need to do. For instance, nursing knows what orders they need to get from the doctor so the discharge planner can be working on moving the patient to the next level of care and the case managers can focus on which patients need to get the Important Message from Medicare the next day," she says.
The ground rules for the rounds must specify that team members must show up for the rounds every day or send in a substitute. Get buy-in from the leadership of each department to see that a representative attends, Pisarsky says.
For multidisciplinary rounds to be successful, the initiative must be driven from the top, Pisarsky says. "There has to be an executive champion so everyone knows that the multidisciplinary rounds are embraced from the c-suite. In many hospitals, the chief operating officer, the chief financial officer, or the chief nursing officer attend rounds occasionally. Their presence and ownerships demonstrates the importance of the initiative," he says.
Don’t make the mistake of establishing multidisciplinary rounds without educating the staff on their purpose and how they will be conducted, Rossi says.
"The nurses often tend to make the same kind of report they make when the shifts change, and that’s not the purpose of the rounds. They are not teaching rounds and certainly shouldn’t be on the scale of ground rounds. Multidisciplinary rounds are simply a designated period of time to discuss what is needed and what someone must do to move the case along," she says.
The hardest part of multidisciplinary rounds is keeping the staff focused, which means the rounds must be led by an effective leader, Rossi says. "The person in charge has to constantly remind the staff that the team doesn’t need to know the blood pressure or anything else that is normal. What they need to discuss is what poses a barrier to moving the patients along," she says.
Rounds don’t necessarily have to include every patient on the unit. Instead, focus on patients with identified issues or barriers to discharge, Rossi advises.
Before the meeting starts, make sure that staff turn off their cell phones and beepers to avoid constant interruptions, Rossi says.
In most organizations, a representative from nursing or case management leads the discussion. The leader should summarize why the patient is in the hospital, and each member of the team should discuss his or her part in the care. Talk about the plan for the day, the plan for the stay, and the plan for the pay, or how the hospital is going to be reimbursed, Pisarski says. Look at what has to happen before the patient can be discharged. Make a list of issues that need to be addressed for each patient and assign a team member to work on each issue. Appoint a couple of team members to get together later in the day to determine if everything got done, Pisarsky suggests.
"Multidisciplinary rounds should last no more than 30 to 45 minutes, depending on the size of the unit. The person leading the rounds should keep everybody on track and devote one to one-and-a-half minutes to each patient. If the discussion needs to take longer, the disciplines involved should meet after the rounds or plan a team conference," he says.
A team member should document what is discussed in the meeting, items to be followed up, and document accordingly in the patient records, he says. In hospitals with up-to-date electronic systems, it’s effective to have someone sitting at a computer and changing or updating orders or treatment plans as the team members speak and decisions are being made, he says.