There is almost universal agreement that conducting multidisciplinary rounds is a good idea. It’s putting them into practice that has some hospitalists scratching their heads and wondering if the payoff is worth the effort.
Multidisciplinary rounds, in a perfect world, would bring together all care providers every morning to discuss each patient’s condition and the occurrences of the past 24 hours while collaboratively planning for the day ahead. Physicians, nurses, case managers, social workers, respiratory, physical and occupational therapists, pharmacists, and the patient’s family would join in face-to-face communication and share decision-making.
In practice, many hospitals are redefining the term by bringing together only a core group of caregivers or rounding on a selected group of patients each day. Even this seems more likely to happen in hospitals that geographically segregate patients by condition, level of care, or attending physician.
“The term, multidisciplinary rounds, is vague and can even be used to refer to any two types of caregivers talking to each other on a regular basis, which almost all hospitalists regularly do,” says John Nelson, MD, medical director of the hospitalist group at Overlake Hospital Medical Center in Bellevue, Wash., and a consultant to hospitalist practices across the country. “But there are few places that bring together a larger group.”
At the minimum, multidisciplinary rounds should include physicians, bedside nurses and case managers, and ideally, everyone involved in a patient’s care, says Joseph Li, MD, director of the hospital medicine program at Beth Israel Deaconess Medical Center in Boston and assistant professor of medicine at the Harvard Medical School. Dr. Li, also a member of SHM’s Board of Directors, has been doing multidisciplinary rounds on his teaching service for more than seven years and on his non-teaching service for almost three years. “I am a huge advocate of multidisciplinary rounds, and I think that all hospitalists should do them,” Dr. Li says. “They are not an option for me because they are one of the ways hospitalists can improve patient care.”
—Ethan Cumbler, MD, director of the acute care for the elderly service, University of Colorado Hospital
Dr. Li’s rounds are done early in the day on weekdays, with hospitalists, nurses, and case managers always involved and other providers when they are available. His team discusses all patients on a 40-bed unit in a little more than half an hour by sticking to a clearly defined script with a checklist he developed. Bedside nurses attend only for the time it takes to discuss their patients. Each floor schedules rounds at different times in the morning so physicians can attend multiple rounds if they have patients on different floors. Dr. Li says the rounds are “a work in progress” because they are continually refined.
At the University of Colorado Hospital in Denver, multidisciplinary rounds are done within the acute care for the elderly service. They are conducted weekdays by all providers caring for patients on the service. This includes four physicians, four nurses plus a charge nurse, case manager, pharmacist, and physical or occupational therapist, with the addition of a pet therapist once a week. A typical meeting covers five to six patients and lasts about 15 minutes, according to Ethan Cumbler, MD, director of the service.
Dr. Cumbler calls the current incarnation of multidisciplinary rounds “2.0.” The previous version didn’t work because elderly patients were spread throughout the hospital. “We scrapped that version and worked on getting most of our patients assigned to the same floor and began again with more success.”