Interdisciplinary Bedside Rounding on Medical

by Stephanie Chapman, MSN, RN-BC, NE-A

In the Spring of 2011, Dr. Timothy Blanchat attended the annual meeting in Dallas Texas for the Society of Hospital Medicine. Dr. Jason Stein a physician from Emory University Hospital presented a process he developed for Structured Interdisciplinary Bedside Rounds (SIBR). This process is a patient centered approach in which the care team collaborates at the bedside with the patient and family to address any concerns and discuss the plan of care. This process has been proven to improve patient satisfaction with nursing and physician care, decrease length of stay, decrease patient safety issues, and increase nurse satisfaction with nurse/physician communication.

As vital part of CVMC innovative hospitalists, Dr. Blanchat was intrigued and requested we trial this process on the Medical Unit. As the director of the Medical Unit and realizing the potential impact such practice change could elicit, I contacted Dr. Stein at Emory University Hospital to get more information about SIBR. He suggested that we visit Emory and see the rounds. He stated “You will learn more by actually seeing the process than you would by reading the information”. A team was formed which consisted of physicians, nurses, and a pharmacist to visit Emory in June 2011.

Starting in July 2011, the Medical Unit implemented Structured Interdisciplinary Bedside Rounds. The nurses and physicians use a template that was developed by Dr. Stein that focuses on patient/family concerns, nurse concerns, and quality and patient safety.

After implementing the new process in July 2011, our nurse and physician patient satisfaction scores outperformed our comparison groups for August and September of 2011. What a great success; but then, in October 2011, the Medical Unit patient satisfaction scores for both physicians and nurses began to decline. Curious about the possible causes for the lower scores, we completed an assessment and determined there were inconsistencies with how the rounds were being completed. Dr. Blanchat lead a review the process with other physicians and worked through some of their concerns.

Patients and nurses were surveyed to see if they were satisfied with the rounding process. Patient comments were positive:
1. “I didn’t realize there were so many people involved in my care”.
2. “I have an opportunity to ask questions”.
3. “I actually got to talked to my doctor”.
Nurses commented with some mixed reviews:
1. Nurses are better informed about the daily plan of care from all disciplines.
2. The nurse hears what the physician tells the patient.
3. Calls from nurses to physicians have decreased.
4. The rounds were time-consuming for the nurse.

Multidisciplinary/interdisciplinary Team Bedside Rounds continue daily on the medical unit. In true keeping with CVMC’s mission of providing quality care to the community, the medical unit healthcare professionals encourage a partnership with patients’ and families. It is through this partnership that patients, families, and nursing staff are provided with better communication regarding the plan of care and goals for each patient.