Is certifying staff in interdisciplinary rounds worth the effort?

Introduction

Effective communication and collaboration are critical to delivering high-quality patient care. Interdisciplinary Bedside Rounds (IBRs) offer a platform for healthcare professionals from diverse disciplines to come together to efficiently share information and updates on patient progress. However, because team members come from various educational backgrounds and have different priorities in patient care, the success of IBRs is often compromised without structured training – its value is overlooked and taken for granted that frontline staff can communicate effectively as a group with engaged patients.

The problem: different education and different perspectives

Healthcare professionals often approach patient care from unique angles. For instance, while nurses might focus on immediate care, patient comfort and recent events, pharmacists prioritize medication management, while physicians emphasize diagnosis and treatment plans. Without a shared framework for communication, these varying perspectives can lead to an inefficient exchange of information, or worse the illusion of communication.

Effective communication is the backbone of successful IBRs, yet many healthcare workers have never received formal interdisciplinary communication training. Studies consistently show that teams lacking this type of structured communication experience more frequent misunderstandings, which can lead to delays in care, frustration among team members, and, ultimately, poorer patient outcomes.

Moreover, there’s often a psychological barrier for frontline staff to actively participate in interdisciplinary discussions, especially in front of patients and more senior healthcare professionals. Online and in-person training sessions strengthen team dynamics by enhancing each participant's understanding of the others' roles. Supplemental in-person training methods, such as simulation-based learning and role-playing scenarios, are beneficial, and we have found them to be of crucial importance prior to launch. Hands-on exercises and role-plays provide staff with a safe space to practice their roles, refine their communication techniques, and build confidence.

While each of these learning modalities are important, they do not guarantee success at the frontline of care.

The solution: objective, structured, codified & stakeholder specific certification

At Emory University Hospital (EUH), where Structured Interdisciplinary Bedside Rounds (SIBR® rounds) began, they realized early in the improvement process that a key element of the upskilling process was missing. With new Residents rotating onto the SIBRing units every four weeks, the units needed an expedited way to upskill these physicians in training, who would be taking the SIBR provider lead role for a number of patients each morning during SIBR. EUH staff began a process of interviewing core unit staff, using qualitative research methods to identify which behaviors, attitudes and skills they felt contributed to high-quality SIBR interactions. What initially began as a list of twenty high-performance behaviors (HPBs) for physicians and nurses, was ultimately refined to a set of ten unique HPBs for physicians, ten for nurses and six for allied health participants in SIBR. As part of the EUH improvement program, staff could elect to become SIBR certified by demonstrating the set of specific high-performance SIBR behaviors in 5 of 6 consecutive patients. In time, we have crunched the numbers and have determined that a reduced number of passes is typically sufficient to ensure learning while minimizing the effort required.

The certification process involved an in vivo observed structured clinical exam during the normal routine of SIBR, usually with either a charge nurse or physician acting as preceptor. This process was initially described in the original Journal of Hospital Medicine paper on Accountable Care Units (ACUs). In this paper, the authors stated that all daytime nursing staff and rotating interns achieved SIBR certification within the first two years of the ACU program. Impressively, the EUH units were able to get the Residents up-to-speed with the SIBR lead provider role within days of starting the process, using the certification process.

When staff members are certified in IBRs, they gain a clearer appreciation of how their individual expertise contributes to the overall patient care process. This mutual respect fosters greater collaboration, reduces the likelihood of errors, and ultimately improves patient outcomes.

Summary

Incorporating a formal certification process for frontline staff, based on a structured and codified set of criteria for each stakeholder group, is a vital step in enhancing the efficacy of Interdisciplinary Bedside Rounds. It ensures that everyone involved in patient care is on the same page, leading to more seamless communication, better teamwork, and, most importantly, improved patient outcomes. Certification programs that include these elements ensure that team members are not only knowledgeable but also comfortable and competent in their contributions during real-world rounds. By certifying staff through a structured, objective, and codified program, healthcare organizations can ensure that every participant is equipped with the skills needed to communicate effectively in high-pressure clinical environments, with these benefits extending beyond IBRs to MET/RRT activations and critical handovers to the ICU etc.

Evidence of SIBR rounds implementations have shown the potential benefit of IBRs, but also perhaps explain why other types of IBRs have less consistent outcomes.