The association between implementation of multidisciplinary rounds and clinical outcomes

The Nurses' Role in the Cardiac Rehabilitation Team: Data From the Perfect-CR Study

BACKGROUND

Nurses constitute a central profession in the cardiac rehabilitation (CR) team delivering comprehensive CR to individuals with cardiovascular disease. We aimed to identify specific components reflecting the nurses' role in the CR team associated with attainment of risk factor targets post myocardial infarction.

METHODS

Center-level data (n = 78) was used from the Perfect-CR study, in which structure and processes applied at CR centers in Sweden (including details on the nurses' role) were surveyed. Patient-level data (n = 6755) was retrieved from the SWEDEHEART registry. Associations between structure/processes and target achievement for systolic blood pressure (BP) (<140 mm Hg) and low-density lipoprotein cholesterol (LDL-C, <1.8 mmol/L) at 1 year post myocardial infarction were assessed using logistic regression.

RESULTS

Structure and processes reflecting nurses' autonomy and role in the CR team associated with patients achieving systolic BP and/or LDL-C targets included the following: nurses having treatment algorithms to adjust BP medication (odds ratio [95% confidence interval]: systolic BP, 1.22 [1.05-1.42]; LDL-C, 1.17 [1.03-1.34]) and lipid-lowering medication (systolic BP, 1.14 [1.00-1.29]; LDL-C, 1.17 [1.05-1.30]), patients having the same nurse throughout follow-up (systolic BP, 1.07 [1.03-1.11]; LDL-C, 1.10 [1.06-1.14]), number of follow-up hours with a nurse (systolic BP, 1.13 [1.07-1.19]), having regular case rounds to discuss patient cases during follow-up (LDL-C, 1.22 [1.09-1.35]), and nurses having training in counseling methods (systolic BP, 1.06 [1.03-1.10]).

CONCLUSION

Components reflecting CR nurses' autonomy and role in the team are of importance for patients attaining risk factor targets post myocardial infarction. The results could provide guidance for optimizing nurses' competence and responsibilities within the CR team to improve patient care.

Cost-benefit analysis of pharmacist early active consultation in patients with multidrug-resistant bacteria in China

BACKGROUND

Although Pharmacist Early Active Consultation (PEAC) has demonstrated clinical benefits in patients with multidrug-resistant organisms (MDROs), its cost-effectiveness in China remains insufficiently studied.

AIM

This study aimed to evaluate the cost-effectiveness of PEAC in patients with MDROs from the perspective of the Chinese healthcare system.

METHOD

A historically controlled study was conducted on 100 MDRO-infected patients, including 37 who received PEAC and 63 who did not. The effective treatment rate and duration of the symptoms were assessed. A decision tree model was developed using model inputs derived from the study. The primary endpoints included incremental cost per MDRO treatment and incremental cost-effectiveness ratio (ICER). Uncertainty was evaluated using one-way and probabilistic sensitivity analysis.

RESULTS

The effective treatment rate increased to 89.1% in the PEAC group compared with 62.1% in the no-consultation group. Patients in the PEAC group experienced a 2.1-day shorter duration of symptoms than those without consultation (15.5 days vs. 17.6 days, P = 0.04). The base case analysis estimated that the PEAC group gained 0.189 quality-adjusted life years (QALYs) at a cost of $18,209.7, while the no-consultation group gained 0.177 QALYs at a cost of $23,831.1. The PEAC group was more cost-effective, yielding an ICER of - $475,499.0 per QALY gained. Probabilistic sensitivity analysis indicated that PEAC was cost-effective in 60.1% of cases, with costs remaining below the willingness-to-pay (WTP) threshold, supporting PEAC as a cost-effective strategy for managing MDRO infections.

CONCLUSION

Pharmacist Early Active Consultation was a more cost-effective strategy than no consultation for treating MDRO infections in patients in China.

Impact of a multidisciplinary team model on discharge efficiency and accuracy in internal medicine resident teams

BACKGROUND

Efficient discharge planning is crucial for improving hospital capacity and patient care. Multidisciplinary rounds (MDRs) have been shown to enhance communication and coordination, yet their impact on resident teaching teams' discharge efficiency is less studied.

AIMS

To examine how embedding dedicated case managers (CMs) and social workers (SWs) into internal medicine (IM) resident teams impacts discharge efficiency.

METHODS

We conducted a retrospective cross-sectional study at The Queen's Medical Center comparing two resident multidisciplinary teaching (MDT) teams that included dedicated CMs and SWs with two resident standard care teams over an 8-month period (October 18 2023-June 25 2024). The outcomes assessed included length of stay (LOS), expected discharge date (EDD) accuracy, readmission rates and the rate of conditional discharge orders placed.

RESULTS

A total of 1944 patients were included. The MDT teams showed significantly improved EDD accuracy (72.0% vs 66.7%, P = 0.0120) and more frequently placed conditional discharge orders (61.7% vs 43.8%, P < 0.0001) compared to standard care teams. No significant difference was observed in LOS or readmission rates.

CONCLUSION

Embedding dedicated CMs and SWs within resident teams improved EDD accuracy and the rate of conditional discharge orders placed, suggesting an opportunity to integrate MDRs as a standard within IM residency training to enhance discharge planning efficiency.

The Future of Hospital Medicine in Japan: Lessons From the United States Hospital Medicine System

Purpose

To compare hospitalist roles and training systems between the United States (US) and Japan, identifying strengths and challenges to guide development of Japan's emerging hospital medicine program.

Methods

A qualitative, descriptive narrative study was conducted during a 10-day observational site visit to the Veterans Affairs Ann Arbor Healthcare System and University of Michigan Hospital in October 2022. Two experienced Japanese hospitalist authors independently observed clinical rounds, interprofessional meetings, and educational sessions. Data were collected through direct observation and structured discussions focusing on care-team structures, workflows, multidisciplinary collaboration, educational approaches, and quality improvement activities. The authors subsequently developed a comparative analysis report of Japan-US differences. Guided discussions based on this report were conducted with experienced US hospitalists and a pioneer physician of General Medicine in Japan to obtain expert commentary on the analyses. No quantitative data analysis or specific analytical software was utilized for this narrative comparison.

Results

The US hospitalist model demonstrated group practice approaches with shift-based schedules supporting work-life balance. Multidisciplinary teams actively incorporated residents and students in patient care, quality improvement, and teaching. Japan's traditional attending physician model emphasized continuity of care but showed high workloads and limited multidisciplinary integration. Japanese hospitalists faced challenges including extensive work hours, fewer specialized training opportunities in quality improvement and patient safety, and less robust team-based learning environments.

Conclusion

Incorporating elements from the US model-such as group practice with shift-based systems, enhanced multidisciplinary collaboration, and structured educational and quality improvement initiatives-could address workload issues and foster professional development in Japan's hospital medicine system while preserving valued aspects of continuity of care. These findings provide specific actionable guidance for healthcare administrators, medical education directors, and policymakers involved in developing Japan's hospitalist system, as well as to practicing Japanese hospitalists seeking to enhance their professional practice environments and educational frameworks.

Healthcare professional perspective on barriers and facilitators of multidisciplinary team working in acute care setting: a systematic review and meta-synthesis

OBJECTIVE

A multidisciplinary team is essential to providing high-quality, patient-centred care. However, its effectiveness can be either hindered or facilitated by various factors, such as the need for rapid decision-making, which may compromise patient outcomes despite individual efforts. The aim of this study is to synthesise the factors that may act as barriers and facilitators to the work of multidisciplinary teams in managing labour within acute care settings.

DESIGN

A systematic qualitative review and meta-synthesis was conducted following the five-step methodology proposed by Sandelowski et al.

DATA SOURCE

Three databases (Medline, Embase and Scopus) were systematically searched without time restrictions up to 25 May 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative studies exploring perspectives, experiences and other similar factors were included. These studies were assessed for methodological quality using the Critical Appraisal Skills Programme.

DATA EXTRACTION AND SYNTHESIS

The reviewers independently searched, screened and coded the results of the included studies. Data were synthesised using the method proposed by Thomas and Harden.

RESULTS

Seventeen studies were included in the meta-synthesis. Four key dimensions emerged, reflecting both the barriers and the facilitators of multidisciplinary team performances: (1) organisational variables, (2) individual variables, (3) collaborative variables and (4) role variables. A total of 36 variables were identified, which could function as barriers (n=6; eg, high staff turnover), facilitators (n=6; eg, strong listening skills) or both (n=24; eg, team climate), depending on the context.

CONCLUSIONS

This meta-synthesis identifies specific barriers and facilitators and variables that can act as both. Understanding these factors enables targeted interventions to enhance the performance of multidisciplinary teams in clinical practice, particularly in acute care settings.

PROSPERO REGISTRATION NUMBER

CRD42022297395.

Plan of Care Visits: Implementation During Hospitalization and Association With 30-Day Readmissions in a Large, Integrated Health Care System

BACKGROUND

Plan of Care of Visits (POCV), including the patient, nurse, and hospital provider were implemented across an integrated health system to improve provider-patient communication during hospitalization and patient outcomes.

OBJECTIVES

To assess POCV adoption after implementation, patient characteristics assosites were classified as teachsites were classified as teachsites were classified as teachsites were classified as ciated with POCV completion, and association of POCV with 30-day readmissions.

METHODS

This retrospective cohort study utilized electronic medical record (EMR) data of 237,430 adult patients discharged to home from 11 hospitals from January 2020 to December 2022. POCV completion was a discrete EMR variable. POCV adoption was estimated monthly by hospital as proportion of patients with at least 1 POCV during hospitalization, with variation among hospitals measured using the Variance Partition Coefficient (VPC). Multivariable logistic regressions assessed factors associated with POCV completion and POCV association with 30-day readmission.

RESULTS

POCV adoption increased from 69% to 94% (2020-2022) and varied by 50% across hospitals (VPC 0.50, 95% CI: 0.29-0.70). Odds of a discharge-day POCV were lower among older patients (≥65 vs. 18-34 y, OR 0.81, CI: 0.79-0.83), and higher among female (OR 1.06; CI: 1.04-1.07), Asian (vs. White, OR 1.13; CI: 1.06-1.21), Hispanic (OR 1.09; CI: 1.05-1.13), and surgical patients (vs. medical, OR 1.33; CI: 1.30-1.35). Patients completing discharge-day POCV had lower 30-day readmission odds (2022 OR 0.76, CI: 0.73-0.79). Patients with POCV on ≥75% of hospital days had similar readmission odds trends.

CONCLUSIONS

POCV implementation was successful, and POCV completion was associated with fewer 30-day readmissions. Future work should focus on increasing POCV adoption while reducing hospital variation.

An interdisciplinary approach to rehabilitation in Parkinson's disease: case series

Interdisciplinary care is increasingly promoted to enhance satisfaction and outcomes for individuals with complex medical conditions, such as Parkinson's disease (PD). However, there is little research on the feasibility or efficacy of interdisciplinary care in clinical settings. And, while the use of an integrated team of allied health professionals has the potential to provide significant health benefits to individuals with PD, there are educational and logistical barriers to the use of interdisciplinary care in clinical settings. An interdisciplinary care model was described that aimed to facilitate these benefits and alleviate some of these known clinical feasibility challenges. Three cases are also provided to exemplify how this approach to collaborative care was used to address individual needs and to highlight some of the successes and challenges associated with the implementation of an interdisciplinary and person-centered care model via telehealth. These cases may help clinicians adopt techniques to facilitate greater collaboration across disciplines or aid in the development of a feasible interdisciplinary program in their own clinics. Further research is needed to further enhance individual outcomes and integrate other disciplines into the care team.

Social Determinants of Health and Associations With Outcomes in Pediatric Patients With Brain Tumors

BACKGROUND AND OBJECTIVES

Social determinants of health (SDOH) are nonmedical factors that affect health outcomes. Limited investigation has been completed on the potential association of these factors to adverse outcomes in pediatric populations. In this study, the authors aimed to analyze the effects of SDOH disparities and their relationship with outcomes after brain tumor resection or biopsy in children.

METHODS

The authors retrospectively reviewed the records of their center's pediatric patients with brain tumor. Black race, public insurance, median household income, and distance to hospital were the investigated SDOH factors. Univariate analysis was completed between number of SDOH factors and patient demographics. Multivariate linear regression models were created to identify coassociated determinants and outcomes.

RESULTS

A total of 272 patients were identified and included in the final analysis. Among these patients, 81 (29.8%) had no SDOH disparities, 103 (37.9%) had 1, 71 (26.1%) had 2, and 17 (6.2%) had 3. An increased number of SDOH disparities was associated with increased percentage of missed appointments ( P = .002) and emergency room visits ( P = .004). Univariate analysis demonstrated increased missed appointments ( P = .01), number of postoperative imaging ( P = .005), and number of emergency room visits ( P = .003). In multivariate analysis, decreased median household income was independently associated with increased length of hospital stay ( P = .02).

CONCLUSION

The SDOH disparities are prevalent and impactful in this vulnerable population. This study demonstrates the need for a shift in research focus toward identifying the full extent of the impact of these factors on postoperative outcomes in pediatric patients with brain tumor.

Synergistic strategies: Optimizing outcomes through a multidisciplinary approach to clinical rounds

Multidisciplinary rounds (MDR) constitute a patient-centered care model wherein professionals from diverse disciplines collaborate in real time to provide specialized expertise. The MDR team, encompassing care partners, hospitalists, nurses, pharmacists, and more, employs a collaborative approach that optimizes patient care through shared goals, electronic record access, regular reviews, and patient involvement. MDRs have evolved to reduce patient mortality, complications, length of stay, and readmissions, and they enhance patient satisfaction and utilization of ancillary services. Family engagement in MDRs further transforms relationships from adversarial to collaborative, leading to improved comprehension of treatment strategies and smoother navigation of challenging conversations. Despite challenges such as time constraints, limited patient coverage, and hierarchical barriers, MDRs are being increasingly conducted across healthcare settings, with positive outcomes.