Use of Multidisciplinary Rounds to Simultaneously Improve Quality Outcomes, Enhance Resident Education, and Shorten Length of Stay

O’Mahony, Stephen; Mazur, Eric Michael; Charney, Pamela; Wang, Yun; Fine, Jonathan

doi:10.1007/s11606-007-0225-1

Cited by 110 publications

(100 citation statements)

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“…12 The other used a pre-post study design which may not account for unmeasured confounders affecting LOS and cost. 13 A third, smaller study found no effect on LOS and cost with the use of IDR. 15 No prior study has evaluated the effect of IDR on LOS and cost in a nonteaching hospitalist service setting.…”

Section: Discussionmentioning

confidence: 95%

“…Two prior studies demonstrated a reduction in LOS and cost with the use of IDR. 12,13 One study was conducted approximately 16 years ago and included patients with a longer mean LOS. 12 The other used a pre-post study design which may not account for unmeasured confounders affecting LOS and cost.…”

Section: Discussionmentioning

confidence: 99%

“…10 Interdisciplinary Rounds (IDR) serve as one option to assemble patient care unit team members to collaborate on a patient's plan of care. [11][12][13][14] Use of IDR has been associated with improved ratings of collaboration on the part of physicians, 13,14 but these studies did not adequately assess the effect of IDR on nurses' ratings of collaboration and teamwork. One IDR study did not assess nurses' perceptions, 13 while others used instruments not previously described and/or validated in the literature.…”

mentioning

confidence: 99%

“…[11][12][13][14] Use of IDR has been associated with improved ratings of collaboration on the part of physicians, 13,14 but these studies did not adequately assess the effect of IDR on nurses' ratings of collaboration and teamwork. One IDR study did not assess nurses' perceptions, 13 while others used instruments not previously described and/or validated in the literature. 12,14 Previous studies also indicate variable effects of IDR on length of stay (LOS) and cost with 2 studies finding a reduction in LOS and cost with the use of IDR, 12,13 while another did not.…”

mentioning

confidence: 99%

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

O’Leary

Haviley

Slade

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Effective collaboration and teamwork is essential in providing safe and effective care. Research reveals deficiencies in teamwork on medical units involving hospitalists.OBJECTIVE:The aim of this study was to assess the impact of an intervention, Structured Inter‐Disciplinary Rounds (SIDR), on nurses' ratings of collaboration and teamwork.METHODS:The study was a controlled trial involving an intervention and control hospitalist unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We asked nurses to rate the quality of communication and collaboration with hospitalists using a 5‐point ordinal scale. We also assessed teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost using both a concurrent and historic control.RESULTS:A total of 49 of 58 (84%) nurses completed surveys. A larger percentage of nurses rated the quality of communication and collaboration with hospitalists as high or very high on the intervention unit compared to the control unit (80% vs. 54%; P = 0.05). Nurses also rated the teamwork and safety climate significantly higher on the intervention unit (P = 0.008 and P = 0.03 for teamwork and safety climate, respectively). Multivariable analyses demonstrated no difference in the adjusted LOS and an inconsistent effect on cost.CONCLUSIONS:SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a hospitalist unit, yet no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

O’Leary

Haviley

Slade

et al. 2011

Journal of Hospital Medicine

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“…7,8 Interdisciplinary rounds (IDR), also known as multidisciplinary rounds, provide a means to assemble hospital care team members and improve collaboration. [9][10][11][12][13] Prior research on the use of IDR has demonstrated improved ratings of collaboration, 11,12 but inconsistent effects on length of stay and cost. 10,12,13 Notably, the format, frequency, and duration of IDR in prior studies has been variable and no studies, to our knowledge, have evaluated teamwork performance during IDR.…”

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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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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Structured Interdisciplinary Rounds in a Medical Teaching Unit

O’Leary¹,

Buck²,

Fligiel³

et al. 2011

Arch Intern Med

109

105

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Use of Multidisciplinary Rounds to Simultaneously Improve Quality Outcomes, Enhance Resident Education, and Shorten Length of Stay

Abstract: Resident-centered MDR is an effective process using no additional resources that simultaneously improves quality of care while enhancing resident education and is associated with shortened length of stay.

Cited by 110 publications

References 20 publications

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

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

Assessment of teamwork during structured interdisciplinary rounds on medical units

Structured Interdisciplinary Rounds in a Medical Teaching Unit

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