Redesigned hospital rounds increased nurse-physician teamwork and patient safety in two medical units in a Northwestern Medicine study. Interestingly, the positive change was so successful that it spread to additional units before a recent follow-up study even began.
“Teamwork culture appeared to improve before we formally implemented our study on five additional units,” said Kevin O’Leary, MD, ’00 GME, ’09 MS, chief of Medicine-Hospital Medicine and first author of both studies.
In previous research, Dr. O’Leary and his colleagues found that nurses and physicians have different attitudes about their collaboration: While physicians rated the quality of their teamwork high, nurses believed it was poor.
This is important because effective communication and teamwork are tightly linked to patient safety. Miscommunication or lack of communication can cause adverse events, errors that injure a patient, such as drug-related mistakes, falls or hospital-acquired infections.
To improve collaboration and decrease adverse events, Dr. O’Leary’s group designed an intervention called Structured Interdisciplinary Rounds (SIDRs). It involved a leadership component—a partnership between a unit medical director and a nurse manager—and a structured format for communication.
“Before, all of the teams had some sort of discharge rounds, but they weren’t very effective. It wasn’t every day and the actual nurse wasn’t always there. It was usually the physician, maybe the social worker and maybe the charge nurse,” said Dr. O’Leary. “We wanted to redesign our interdisciplinary rounds to make sure that the actual team members who need to be there are there.”
A working group of nurses, physicians and other medical professionals decided how to organize the new rounds: when, where, how often and what content should be discussed regarding the daily plan of care for patients.
After implementing SIDR in two units for 16 to 20 weeks, nurses reported the safety environment and quality of communication with physicians significantly higher than those in a control unit. The rate of adverse events significantly reduced during the period.
The findings were published in the Journal of Hospital Medicine and Archives of Internal Medicine. Maureen Slade, associate chief nurse executive at Northwestern Memorial Hospital, co-led the efforts.
Later, when SIDR was carried out in five units in the follow-up study, teamwork improved only slightly and adverse events were not reduced at all. The results were published in the American Journal of Medical Quality.
“People were already redesigning their interdisciplinary rounds before we went live with that phase two. There was already a positive cultural and behavioral shift,” said Dr. O’Leary.
He points to several reasons that explain how word spread: The physicians rotate on different units. Nurse managers talk to each other. Pilot data was shared at division and department meetings. The positive change initiated by the first study permeated into the other units instinctively.
“We didn’t see a difference because the baseline for phase two was higher. The teamwork climate started out better and the adverse events lower,” said Dr. O’Leary.
Next, he wants to start formal interdisciplinary rounds in other units and hospitals.
“We’d like to disseminate this across hospitals beyond Northwestern. We think communication is a broad and generalizable issue,” he said. “Ultimately, we want this to be something that people don’t have to learn how to do. We want it be part of normal daily operations.”
In addition, O’Leary’s group is piloting patient-centered bedside rounds, to see if being involved improves a patient’s engagement and care.
The follow-up SIDR study was funded by the Agency for Healthcare Research and Quality grant R18 HS019630.