Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit

Experiences and Needs of Core Participants in Surgical Ward Rounds: A Qualitative Exploratory Study

BACKGROUND

Surgical ward rounds (SWRs) are typically led by doctors, with limited involvement from key participants, including patients, family members, and bedside nurses. Despite the potential benefits of a more collaborative and person-centered approach, efforts to engage these stakeholders remain rare.

OBJECTIVE

This qualitative exploratory study examined the experiences and needs of doctors, nurses, patients, and their relatives during SWRs as part of a Participatory Design process.

METHODS

Data were collected through ethnographic field studies, focus groups with the healthcare providers, patients and relatives, and dyadic interviews conducted as part of home visits to patients and their partners after discharge. Field notes and interview data were analyzed using systematic text condensation.

RESULTS

Lack of organization, traditional roles, and cultural norms compromised the quality, efficiency, and user experience of SWRs in multiple ways. SWRs were routine-driven, treatment-focused, and received lower priority than surgical tasks. Unpredictability resulted in unprepared participants and limited access for nurses, patients, and relatives to partake.

CONCLUSIONS

The study identified a gap between the organizational and cultural frameworks governing the SWRs and the experiences and needs of key participants. Digital technologies were perceived as a potential solution to address some of these challenges.

CLINICALTRIAL

Does privatization decrease the structural efficiency in the Chinese hospital sector?

This paper examines the resource mismatch in China's healthcare sector from 2010 to 2019. We use structural efficiency to measure the resource mismatch in the healthcare industry (0.2-0.7). We find that an increase in the proportion of private hospitals decreases the healthcare resource mismatch across provincial regions. This ameliorative effect is evident in non-coastal as well as central provinces. In addition, we also find that an increase in the proportion of private hospitals leads to a greater supply of healthcare resources and the number of healthcare services, which in turn better meets the healthcare needs of local residents and decreases the healthcare resource mismatch between regions in each province.

Enhancing interprofessional ward rounds by identifying factors associated with low satisfaction and efficiency: a quantitative and qualitative national survey of Swiss healthcare professionals

AIMS OF THE STUDY

Interprofessional ward rounds are a cornerstone of patient-centred care for medical inpatients and offer opportunities to discuss and coordinate patient treatment and further management. We aimed to identify factors associated with lower satisfaction and efficiency of interprofessional ward rounds, as reported by physicians and nurses.

METHODS

An anonymous Swiss nationwide online survey of physicians and nurses was conducted in 28 Swiss internal medicine inpatient departments between 9 August and 19 October 2023. Analyses were conducted from November to December 2023. The primary outcome was physicians' and nurses' perceived lower satisfaction with ward rounds, which was assessed using visual analogue scales ranging from 0 to 10, with lower satisfaction defined as scores below the median. The main secondary outcome was perceived lower efficiency using a similar definition. Qualitative analysis was performed through inductive thematic analysis.

RESULTS

The survey had a response rate of 21.6% (547/2530). Of the 547 physicians and nurses included in the final analysis, the median satisfaction was 7 points (interquartile range [IQR] 6-8). A total of 61% of physicians (156/254) and 76% of nurses (224/293) reported lower satisfaction. Lower satisfaction was reported significantly more frequently by nurses (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.58-3.43; p ≤0.001) and female team members (adjusted OR 1.95, 95% CI 1.32-2.9; p <0.01). The median perceived efficiency of ward rounds was 7 points (IQR 5-8), and the nursing profession was associated with lower perceived efficiency (adjusted OR 1.95, 95% CI 1.3-2.93; p <0.01). Adherence to in-house guidelines for ward rounds was associated with satisfaction (adjusted OR for lower satisfaction 0.25, 95% CI 0.16-0.39; p <0.001) and perceived efficiency (adjusted OR for lower efficiency 0.27, 95% CI 0.17-0.43; p <0.001). Both physicians and nurses preferred to perform ward rounds as part of an interprofessional team. The qualitative analysis of the data revealed a preference for structured interprofessional ward rounds and the active involvement of nurses.

CONCLUSIONS

This survey revealed an overall high preference for interprofessional ward rounds. In addition, we identified several factors that were associated with lower satisfaction and efficiency. Structured in-house protocols for ward rounds may increase the satisfaction and efficiency of interprofessional collaboration during ward rounds.

The Impact of Patient-Centered, Structured Interdisciplinary Bedside Rounds on Medical Staff Satisfaction, Education, and Experience

Background Daily interdisciplinary rounds in hospitals are becoming standardized to maximize the multidisciplinary approach to hospitalized patient care. We hypothesize that structured Interdisciplinary Bedside Rounds (IDRs) increase the satisfaction, education, and experience of medical staff and thus detail actionable recommendations for IDR implementation or delineate measurable long-term impacts. Methods This observational study was performed in a 300-bed community hospital. Participants included internal medicine physicians, nurses, case managers, social workers, physical therapists, clinical pharmacists, and nurse leaders. Surveys were used to assess the impact of structured IDRs on medical education, clinical skills, and experience. Results We sent 100 surveys and received 72 completed surveys. Results varied among healthcare providers (physicians, nurses, pharmacists, and case managers), reflecting that physicians and nurses reported the highest benefits. There was a positive response on the impact of multidisciplinary rounds on medical staff education, skills, and experience. Conclusion Structured IDRs positively impact healthcare providers' (physicians, nurses, pharmacists, and case managers) medical education, clinical skills, and experience, as reported by participants' responses. Implementing IDRs in the health care system and medical school curriculum may impact medical education, clinical skills, experience, and patient care. However, more studies are required to examine the long-term impact of IDRs.

"We're all truly pulling in the exact same direction": A qualitative study of attending and resident physician impressions of structured bedside interdisciplinary rounds

BACKGROUND

Physicians often hold leadership roles in implementing interdisciplinary rounds (IDR) in clinical settings, thus understanding physician perspectives of bedside IDR is crucial.

OBJECTIVE

To understand physicians' perspectives of structured bedside IDR.

DESIGN

Qualitative descriptive study.

SETTING AND PARTICIPANTS

Medical and transitional year resident and hospitalist physicians participating in structured bedside IDR in a community teaching hospital affiliated with a large academic center.

METHODS

We conducted semi-structured interviews and focus groups with study participants about their experiences with participating in structured bedside IDR between July 2017 and April 2018. All interviews were recorded and professionally transcribed. We used thematic analysis to identify key themes.

RESULTS

We interviewed 41 resident physicians and 10 hospitalist physicians and discovered five key themes that highlight physician impressions of bedside IDR. Bedside IDR decreased unnecessary care, screened for risks/errors, created a shared mental model of care, and increased physician empathy for the patient and the interprofessional care team. Physicians felt patients valued the streamlined communication they experienced but questioned the intrusiveness of large healthcare teams. Challenges to bedside IDR included the meaningful engagement of key stakeholders and, particularly for resident physicians, the difficultly of managing unstandardized communication in a standardized time-sensitive setting.

CONCLUSIONS

Structured bedside IDR have the capacity to improve patient care, interprofessional teamwork, and physician empathy for patients and the interprofessional team. However, sustained leadership support and clearly defined rounds goals and objectives are necessary ingredients to maximize the benefits and address the challenges of bedside IDR.

A comprehensive analysis of different types of clinical rounds in hospital medicine

Table rounds and bedside rounds are two methods healthcare professionals employ during clinical rounds for patient care and medical education. Bedside rounds involve direct patient engagement and physical examination, thus significantly impacting patient outcomes, such as improving communication and patient satisfaction. Table rounds occur in a conference room without the patient present and involve discussing patient data, which is more effective in fostering structured medical education. Both bedside and table rounds have pros and cons, and healthcare professionals should consider the specific requirements of their patients and medical trainees when deciding which approach to use. This research utilized a comprehensive search to identify relevant resources, such as university website links, as well as a PubMed search using relevant keywords such as 'bedside rounding,' 'table rounding,' and 'patient satisfaction.' Relevance, publication date, and study design were the basis for inclusion criteria. This study compared the effectiveness of these two methods based on physician communication, medical education, patient care, and patient satisfaction.

Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity: A Nonrandomized Controlled Trial

IMPORTANCE

Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial.

OBJECTIVE

To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022.

INTERVENTION

After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning.

MAIN OUTCOMES AND MEASURES

Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals.

RESULTS

There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time.

CONCLUSIONS AND RELEVANCE

In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN83274049.