Scheduling staff seems to be the biggest stumbling block for hospitalists who would like to do multidisciplinary rounds but have given up. “Although our intensive care unit does multidisciplinary rounds, we can’t find a way to make it work on our medical floors,” says Matthew Szvetecz, MD, CPE, division of internal medicine director, Kadlec Medical Associates, Richland, Wash. “When you have five geographic units, four rounding physicians, and many nurses and ancillary service providers, you’ve added more levels of scheduling complexity. Try as we might, even in our relatively small hospital, we can’t figure out how to make it work.”
Committing so much of a providers’ time to meetings makes Dr. Nelson skeptical of whether multidisciplinary rounds are worth the effort. “If you have 20 people sitting around in a room for an hour, you’re losing 20 hours of healthcare time. You could take those people and redirect their efforts and get a better result, I suspect,” he says.
Yet, Dr. Nelson agrees multidisciplinary rounds are a good idea and says they have tried to do them at Overlake Hospital. “We’ve done it in fits and starts, but we really don’t have a meaningful model.”
Dr. Li notes that multidisciplinary rounds can be a time-saver, not a time waster. “I view rounds as an investment, and as with any wise investment, it pays off in time savings,” he says. If rounds are effective, hospitalists don’t get as many pages, nor are nurses interrupted by physicians afterward. “Everyone leaves knowing the care plan and is ready to carry it out,” he concludes.
Dr. Nelson believes adapting rounds for patients with common issues may be more effective—for example, rounds on patients age 70 and older with the goal of reducing falls. “Set up multidisciplinary rounds to address the things you know improve care that may be missed during regular caregiver rounds,” he suggests.
Although Dr. Szvetecz believes “nothing is a substitute for face-to-face communication,” he is working on a technological “rounding” system he hopes will come close. He envisions an interactive digital document containing a communication checklist that could be accessed by all caregivers. Information that would have been discussed at multidisciplinary rounds would be entered into the database and each morning caregivers would take action on the items.
“You might still be losing 25% to 50% of the information transfer in face-to-face communication, but if it’s not feasible to do multidisciplinary rounds, this might be the next best thing,” he suggests.
Advocates note that studies have credited multidisciplinary rounds with improving patient care, reducing length of stay, minimizing unneeded services, reducing bounce-back rates, and preventing gaps and delays in care. Some hospitals report that multidisciplinary rounds are a key to developing a culture of collaboration and improvement.
For those considering implementing them, Dr. Cumbler says it’s important to have champions who embrace cultural change and value communication. “People in hospitals aren’t rewarded for communication, so sometimes it’s hard getting everyone to agree to give it a try.”