After his pilot program, nurses reported they were more satisfied with their jobs and saw patient care improve in a direct and immediate way. The hospital awarded a quality improvement grant to track their effect on outcomes such as reduced falls, restraint use, and length of stay. Dr. Cumbler hopes the results will encourage the hospital to implement multidisciplinary rounds hospitalwide.
Dr. Nelson says measurement is critical: “Start with a goal in mind, then go back and measure to make sure multidisciplinary rounds are moving the quality needle on those things.”
Dr. Li says people give up on multidisciplinary rounds when team members fail to show up on time, stray off the topic at hand, and are unprepared to speak. At first, rounds can be too physician-centered, discouraging others to participate.
Dr. Cumbler solves this problem by putting his hand on the shoulder of the presenting physician if he talks for more than 40 seconds. Dr. Li recommends doing rounds standing to encourage people to be quick and to the point.
Dr. Li says caregivers learn to be more effective if they are given a script and encouraged to role play. “We have a checklist of what we need to talk about for each patient,” he says. “It’s like a play. The best way to learn your part is to practice and have a script.” He points out that as staff members change, new ones have to be taught. “It’s always a work in progress,” he notes.
Dr. Li also has found bedside nurses are critical for effective multidisciplinary rounds. “There’s no way a charge nurse can bring the same information as a bedside nurse,” he asserts.
Advocates go on to say that multidisciplinary rounds are the future of hospital medical care because they reflect attitude changes toward more cooperation and teamwork. “Physicians writing orders in isolation breaks down in the light of how sick hospitalized patients are and how complex their treatment has become,” Dr. Cumbler points out.
Perhaps the best argument for multidisciplinary rounds comes with experience. “Once you pilot it, support builds and everyone sees patient care improving,” Dr. Cumbler says. “Then they become self-sustaining.” TH
Barbara Dillard is a medical journalist based in Chicago.