Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

O’Leary, Kevin J.; Haviley, Corinne; Slade, Maureen; Shah, Hiren M; Lee, Jung Hwa; Williams, Mark

doi:10.1002/jhm.714

Cited by 91 publications

(93 citation statements)

References 26 publications

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“…15,16 SIDR combines a structured format for communication, similar to a goals-of-care form, 17,18 with a forum for daily interdisciplinary meetings. Though no effect was seen on length of stay or cost, SIDR was associated with significantly higher ratings of the quality of collaboration and teamwork climate, and a reduction in the rate of adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, published studies evaluating the benefits of SIDR reflected a pilot study occurring on 2 units. 15,16,19 The current study emphasizes the need to ensure that interventions proven to be effective on a small scale are implemented consistently when put into place on a larger scale. Despite good reliability for assessing teamwork during SIDR across units, domains, and most subteams, we found poor inter-rater reliability for the physician subteam.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of teamwork during structured interdisciplinary rounds on medical units

O’Leary

Boudreau

Creden

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR.OBJECTIVE:To evaluate and characterize teamwork during IDR.DESIGN:Cross‐sectional observational study.SETTING:Six medical units which had implemented structured interdisciplinary rounds (SIDR).MEASUREMENTS:We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool.RESULTS:We conducted 7–8 independent observations for each unit (total = 44) and 20 joint observations. Inter‐rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53–0.68) and subteams (rho = 0.53–0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9–4.9) for the lowest and 5.4 (5.3–5.5) for the highest performing unit (P < 0.01). Domain scores differed, with leadership receiving the lowest (median [IQR] = 5.0 [4.6–5.3]), and cooperation/backup behavior and monitoring/situational awareness receiving highest scores (median [IQR] = 5.4 [5.0–5.5] and 5.4 [5.0–5.7]). Differences across subteams were of borderline significance (P = 0.05).CONCLUSIONS:The adapted OTAS instrument demonstrated acceptable reliability for assessing teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of teamwork during structured interdisciplinary rounds on medical units

O’Leary

Boudreau

Creden

et al. 2012

Journal of Hospital Medicine

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“…Though hospital interdisciplinary rounds aim to increase collaboration and reduce LOS, costs, and readmissions, these rounds do not typically include outpatient care providers. 21 Improved communication and collaboration between social work with both inpatient and outpatient care teams to address nonmedical issues contributing to long stays are likely to improve care and transitions, though rigorous studies examining specific communication models across venues are lacking. This study found that delay in nursing facility placement was the most common reason for prolonged hospitalization for long-stay cases.…”

Section: Discussionmentioning

confidence: 99%

“…As has been demonstrated in other interdisciplinary efforts, increased collaboration among physicians, social workers, discharge planners, and other disciplines may help address current gaps in patient care with regard to LOS. 20,21 Future studies should determine which homebound patients are at highest risk for prolonged hospitalization due to nonmedical factors to help design focused strategies and interventions for this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population

Foer

Ornstein

Soriano

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Prolonged length of stay (LOS) is a major concern for hospitalized populations at risk for adverse events. Homebound patients are at particular risk for long stays and may have unique discharge needs because of their commitment to be cared for at home despite poor functional status.OBJECTIVE:The goal of this study was to describe factors contributing to long hospitalizations in the homebound population.DESIGN:This retrospective observational pilot study included all 2007 discharges that occurred for patients at The Mount Sinai Hospital enrolled in the Mount Sinai Visiting Doctors Program.MEASURES:Long‐stay patients were defined as those having an LOS 2 standard deviations above the mean. Hospitalization days were defined as “nonmedical” when patients medically ready for discharge remained in the hospital. Patients discharged immediately after determination of medical readiness were characterized as “medical stay” cases. The University HealthSystems Consortium Database was used to calculate expected LOS and the LOS ratio. Chart reviews were performed to describe long‐stay cases as nonmedical or medical.RESULTS:The average LOS for 479 discharges was 7.84 days, with a mean LOS Ratio of 1.23. Seventeen cases were determined to be long stays. Eight of these cases (47%) were defined as nonmedical stays. These accounted for 136 days of hospitalization and 32% of total long‐stay days. The most common reason for a nonmedical stay was nursing facility placement delay.CONCLUSIONS:Nonmedical factors accounted for nearly one‐third of all long‐stay days in the hospitalized homebound population. Increased interdisciplinary collaboration may help address homebound patient LOS. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine.

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“…The literature reports that interdisciplinary rounds effectively establish and maintain teamwork, 1,2 improve patient 3,4 and financial 5 outcomes, and increase job satisfaction. 6 …”

Section: Introductionmentioning

confidence: 99%

Neonatal Respiratory Therapist-Led Rounds Can Improve Staff Satisfaction and Timeliness of Respiratory Interventions

Genet¹,

Firestone

Volsko³

2014

Respir Care

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BACKGROUND: Interdisciplinary rounding is used to establish and communicate patient care goals and monitor progress toward goal attainment. This study describes staff satisfaction and process outcomes associated with respiratory therapist (RT)-led interdisciplinary rounds in the neonatal ICU. We hypothesized improved staff satisfaction, execution of orders within 30 min of order entry into the electronic medical record, and communication of accurate and complete data during rounds to the interdisciplinary team. METHODS: Nurses, RTs, nurse practitioners, residents, and attending physicians completed the 13-question survey eliciting demographic information and evaluating staff engagement and professional satisfaction. The survey was anonymous and confidential, and informed consent was implied. Process data were collected for a 10-d period at 2 intervals through direct observation of the rounding process and electronic medical record review. Descriptive statistics reported patient demographics, responses to job satisfaction and engagement survey questions, the number of patients who were visited in daily rounds, the number and type of orders given during rounds, and the number of respiratory orders that were addressed in multidisciplinary teaching rounds rather than during respiratory rounds. The chi-square test was used to determine differences in the proportion of inaccurate and incomplete data communicated during rounds between the 2 data collection periods. The Mann-Whitney U test was used to determine differences in the timeliness of electronic medical record order entry and time to order completion. RESULTS: A 94.8% survey response rate (n ‫؍‬ 55) was obtained. Seventy-six percent of participants reported improved communication. Sixty-nine percent of participants reported improved teamwork. Eighty-six percent of orders were implemented immediately after electronic medical record entry. Correct information was provided on 95% and 99.3% of patients (P < .066) and complete information on 93% and 96% of patients (P ‫؍‬ .41). CONCLUSIONS: Implementation of respiratory rounds improved staff satisfaction and the timeliness of completing respiratory orders. Spot monitoring at intermittent intervals verified process sustainability.

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Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

Cited by 91 publications

References 26 publications

Assessment of teamwork during structured interdisciplinary rounds on medical units

Assessment of teamwork during structured interdisciplinary rounds on medical units

Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population

Neonatal Respiratory Therapist-Led Rounds Can Improve Staff Satisfaction and Timeliness of Respiratory Interventions

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