Asking the generalist - evaluation of a General Practice rounding and consult service

BACKGROUND

Vascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications.

METHODS

The GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz' qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional "as needed" GP-consult service.

RESULTS

15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes.

CONCLUSIONS

A GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults.

TRIAL REGISTRATION

Not applicable.

Frontline healthcare workers' perspectives on interprofessional teamwork during COVID-19

Effective interprofessional teamwork serves an important role in successful crisis response. Responses to past public health crises have relied on interprofessional communication and trust to support healthcare worker (HCW) resiliency. To understand interprofessional interactions and perceptions of teamwork during the COVID-19 response, we conducted in-depth semi-structured interviews with 18 inpatient HCWs (11 bedside nurses, 5 care coordinators, and 2 pharmacists) from one VA Medical Center between March and June 2020. Using thematic analysis, we identified four key themes that describe the strengths and challenges of interprofessional teamwork, communication, patient care, and organizational response during the initial COVID-19 surge. Interprofessional teams were fragmented. HCWs who transitioned to remote work lost their status on inpatient teams and struggled to provide pre-pandemic levels of quality of care. Conversely, interprofessional teamwork improved for HCWs who continued to work on inpatient units, where study participants described a decline in interprofessional hierarchies and an increase in mutual support. Participants described the need for timely, accurate, transparent communication as they faced new patient safety and communication challenges brought on by the pandemic. HCWs expressed a desire for sustained leadership support and inclusion in institutional decision-making. The challenges to teamwork, communication, and patient care reported in this study highlight the need for consistent, transparent communication and organizational response from hospital leadership during times of crisis.

The impact of residents sitting at the bedside on patient satisfaction during team rounds

OBJECTIVES

Patient satisfaction ratings are a priority for academic medical centers. Sitting during patient encounters has been recommended as a "best practice."¹ A prior study showed that hospitalists had higher-rated communication skills when sitting compared to standing at the bedside during rounds.² It is unclear whether the same is true of resident-led team rounds.

METHODS

We performed a cluster-randomized crossover trial assigning 18 internal medicine residents to sit or stand at the bedside during rounds.

RESULTS

A total of 347 patients were surveyed to assess physician communication skills. Standing residents received higher ratings than sitting residents on 2 of 5 survey items and rounding duration did not differ. These results differ from prior work that suggests sitting is superior to standing^2-6.

CONCLUSION

We suspect that one rounding member sitting, while all others stand, is not enough to impact patients' perceptions. These results suggest that initiatives to optimize patient satisfaction on resident-staffed units should be focused elsewhere.

PRACTICE IMPLICATIONS

Patients do not have better impressions of physician communication skills when one team member is sitting and the rest are standing.

Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: Mixed qualitative-quantitative study

BACKGROUND

Interprofessional collaboration is a key requirement for safe and effective care delivery in the critical care setting. To promote collaboration between care providers, intensive care unit interdisciplinary rounds have been introduced by multiple institutions and subsequent subjective improvements in interprofessional collaboration have been reported. However, only limited data are currently available regarding the impact of these rounds on objective patient care outcomes.

OBJECTIVES

The study had two main goals: (i) to evaluate the impact of introducing an interdisciplinary rounding format that formalised the participation of nurses in rounds on the effectiveness of interprofessional collaboration, specifically between nurses and physicians; and (ii) to evaluate a possible impact of adopting these rounds on measurable patient care outcomes.

METHODS

General surgery rounds were introduced in our 32-bed medical-surgical intensive care unit. The impact of the rounds on the quality of collaboration was measured using anonymous web-based surveys of nurses and surgeons. Rates of falls and self-extubations (adverse events) were compared during five month pre- and post-intervention periods (August 2014-Jun 2015).

RESULTS

Both nurses and physicians reported subjective improvement in collaboration following the introduction of interdisciplinary rounds. Additionally, a decline in both rates of falls and self-extubations was observed in the post-intervention period; however, due to the rarity of these events, neither trend reached statistical significance.

CONCLUSIONS

Interdisciplinary rounds provide an attractive model for improving interprofessional collaboration in critical care. Our findings add support to the growing evidence that interdisciplinary rounds improve collaboration and have a positive impact on the quality of patient care delivery.