ICU Rounds Redesign

Abstract

Purpose: Multidisciplinary daily rounds (MDR) are an essential part of the development of a culture of team cohesion and interdisciplinary communication in the intensive care unit (ICU). MDR are known to play an important role in patient safety and staff satisfaction, yet rounds vary widely. We aimed to understand the process of rounds in BIDMC’s ICUs and to optimize rounds through a frontline provider driven intervention. Methods: Baseline data was collected through the use of a fishbone diagram and an 18-question staff survey to understand opinions about rounds. Additionally, 120 observations of patient rounds in BIDMC’s 7 diverse ICUs were performed. A group of 30-40 multidisciplinary frontline providers then utilized Lean principles to design interventions that were implemented and modified using rapid experiments. A final three-part intervention was selected and dispersed to all ICUs. An 18-question survey was re-administered and 295 post intervention observations of patient rounds were performed. Results: Results revealed important changes in staff inclusion and communication. Observational data showed that after implementation of our three-part intervention the rate of nurses present for the entire rounds on their patient increased from 66% to 83% (p<0.0001). Frequency of communication about the order of rounds rose from 64% to 100% (p<0.0001). Nurse participation during patient presentation rose from 40% to 87% (p<0.0001), with 87% of those contributions containing new/different information. Nurse participation during the formation of the plan of care rose from 33% to 88% (p<0.0001). Survey data showed the proportion of providers who felt a plan was always clearly communicated rose from 18% to 29% (p<0.01) with 88% of providers feeling that a clear plan was always or frequently communicated to the entire team. Conclusions: A simple intervention can lead to cultural change spurring more inclusion of all providers, leading to improved interdisciplinary communication across diverse ICU environments.