"We're all truly pulling in the exact same direction"

Katarzyna Mastalerz, Sarah Jordan and Nikki Townsley

Overview

A qualitative study at a community teaching hospital affiliated with a large academic center explored physician impressions of structured bedside interdisciplinary rounds (IDR). The findings highlight improvements in patient care, teamwork, and physician empathy, along with some challenges.

“We’re all truly pulling in the exact same direction. Everyone is focused on that patient.” (Attending 1)

Objectives

To perform a qualitative assessment of residents’ and physicians’  perceptions of Structured Interdisciplinary Bedside Rounds (SIBR rounds) including perceived advantages and challenges. 

Methods

12 semi-structured focus groups, 5 1:1 in-depth interviews with resident physicians and 10 1:1 interview with attending physicians were completed between July 2017 and March 2018 at a community teaching hospital affiliated with a large academic medical center. 

Results

1. Patient Care Gains from Bedside IDRs:

Decreasing Unnecessary Care:

• “Pharmacy input does save a lot of medication errors and unnecessary meds.” (Attending 4)

• “We eliminate unnecessary care more often… it makes care more efficient from a utilization and communication standpoint.” (Attending 2)

Screening for Risks and Errors:

• “It was brought to a case manager’s attention right away instead of later on. It brings up barriers and problems that we can triage much earlier.” (Resident 10)

• “Bedside IDR is like a screening tool on where we’re deficient in understanding between providers.” (Resident 27)

Creating a Shared Mental Model of Care:

• “One of the main advantages of multidisciplinary rounds… you don’t have people calling you all day saying, ‘What’s the plan?’” (Resident 38)

• “Bedside IDR allows all team members at one time to explain their problems, concerns, their goals… messages can be crossed.” (Resident 81)

2. Increased Physician Empathy and Understanding:

Increased Understanding of Patient Needs:

• “It makes you consider patients’ priorities more.” (Resident 53)

• “Bedside IDR makes you memorize the patient’s needs better because you’re physically seeing them and hearing them ask about it.” (Resident 10)

Increased Empathy and Understanding of Team Members:

• “You learn perspective of what different teams are worried about, what they’re thinking about.” (Resident 49)

3. Perceptions of Patients’ Experience of Bedside Rounds:

Positive Patient Experiences:

• “Bedside IDR definitely benefits the patient. They feel involved.” (Resident 10)

• “It makes patients happy… it makes them trust that we’re all working on their behalf.” (Attending 8)

Negative Patient Experiences:

• “As a patient, it could be overwhelming to have twelve people in your room at once.” (Resident 18)

4. Challenges Engaging Key Stakeholders:

Engagement and Preparation of Interprofessional Team Members:

• “One pharmacist brings really helpful things to the table; another pharmacist… that’s not helpful.” (Attending 2)

• “When we have new people that are learning how to do IDR, sometimes it does feel like a waste of time when it’s not done well.” (Attending 8)

Engagement of Resident and Attending Physicians:

• “We can buy in to something like this being better for patients if we have time… I don’t know if it’ll ever get as efficient as table rounds.” (Resident 36)

• “Everyone’s concern is that it’s way less efficient… it turns out to be the opposite, far more efficient.” (Attending 1)

5. Navigating Unstandardized Communication in a Standardized Setting:

Concern for Team’s Time:

• “It’s difficult to balance how much you talk to the patient about their concerns during bedside IDR versus later on… I don’t know how to fix it.” (Resident 4)

• “Sometimes IDR makes you self‐conscious about whether to bring something up… it’s a balance and you have to know when it’s appropriate and when it’s not.” (Resident 28)

Patient Centeredness:

• “I’ve always struggled with cutting patients off… if they have any significant questions, you have to say, ‘sorry, we’ll come back and address that later.’” (Resident 50)

• “We don’t really explain [bedside IDR] to people… they just see a group of people who are all doctors that they really want to ask a bunch of questions to.” (Resident 60)

Conclusion

Structured bedside IDR have the capacity to improve patient care, interprofessional teamwork, and physician empathy. However, sustained leadership support and clearly defined rounds goals and objectives are necessary to maximize these benefits and address the challenges of bedside IDR. The study underscores the importance of effective communication, stakeholder engagement, and continuous feedback in enhancing the implementation and outcomes of bedside IDR.

I hope you enjoyed reading these strong results. Unit outcomes like these are achievable within 3 to 6 months using a seasoned implementation methodology:

  1. skillful project management
  2. smooth training and launch, and a
  3. long-term partnership for sustainability.

One option to achieve similar results is to engage our 1Unit experts. Backed by 15 studies like this one, our work has received awards from The Joint Commission, CMS, Clinical Excellence Commission, IHI, BMJ, and the Society of Hospital Medicine.

Whether your unit(s) have current multidisciplinary rounds or not, our experts can guide your unit leaders to launch and sustain the best interdisciplinary teamwork and communication you’ve ever seen on a hospital ward.

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Connect with us if you’d like the “Easy Button” to steadily reduce harm events, discharge delays, and patient and staff dissatisfiers.

Liam Chadwick, PhD