Challenged to decrease length of stay, increase patient and staff satisfaction, and improve clinical outcomes, an interdisciplinary team in a 615-bed, tertiary care hospital developed an integrative model for walking rounds from the perspective of the patient. Engaging key stakeholders, including patients and families, has fostered collaborative care planning, greater awareness of hospital and community care resources, improved efficiency in care delivery, and smooth transition from the acute care setting.

Method

A team, sponsored by the chief nursing officer and care management director, was formed and given an aggressive timeline of three months to implement interdisciplinary rounds with the goal of decreasing length of stay. Disciplines included were care management, nursing, rehabilitation therapy, dietary, chaplaincy, pharmacy, respiratory, homecare, and information management. A formal charter clearly defined goals, timeline, and action plan. Brainstorming provided opportunity for care providers and patient representatives to identify needs to improve efficiency and the patient experience. A review of literature for evidenced-best practices and the hospital’s current models, led to the development of an integrative model for patient rounding. 

Scripting and role playing, including the patient role, provided team insight into the patient’s experience. This critical turning point refocused members to approach the project from the patient perspective, not the caregiver. Care team rounding was moved to the bedside to better engage patients and to keep the patient at the center of care discussions. Rounding schedules were determined by unit managers and staff, based on their patients’ needs. Patient satisfaction survey questions were tracked monthly, and LOS indicators were measured and analyzed.

Results

Rounds were implemented on 12 units in 12 weeks. Patients are extremely satisfied with the integrative approach of their care team and the opportunity to participate in care decisions. Each discipline reports improved efficiency from the dialogue with colleagues and clients. Length of stay for 4 of 5 targeted DRGs has decreased.

Conclusions and Recommendations

This patient-focused, integrative model for rounding can be adapted to any acute care setting and can be used to improve communication, collaboration and efficiency in any care management environment.