Featured EBP Project-July 2012
Improving Length of Stay and Patient Satisfaction by Implementing Multidisciplinary Rounds
Authors: Jessica Malloy, MS, RN-BC, ONC; Iris Gonzalo-Sowle, BS, RN-BC, ONC; & Donna Trerise, BS, RN, CCM
Saratoga Hospital, Saratoga Springs, NY
In the fast pace of healthcare today, it is important to provide safe, effective, and quality care. Organizations such as the Institute of Medicine, the Institute for Healthcare Improvement, and the Joint Commission support the need for interdisciplinary collaboration and patient involvement in care as strategies to improve healthcare. The American Nurses Credentialing Center (ANCC) Magnet Recognition Program emphasizes the importance of nursing's role with patients, families, and the interdisciplinary team.
In 2010, Saratoga Hospital opened a new, state-of-the-art Orthopedic Unit- D-3. Although purposeful rounding was an established nursing practice on all units, the interdisciplinary care team of D-3 recognized an opportunity to enhance the process to increase communication and satisfaction among all providers, as well as improve patient and family satisfaction and impact patient outcomes. After review of the literature and discussions at multidisciplinary meetings, the D-3 team established a process for implementing multidisciplinary rounds. Two outcome measures were established to assess the effectiveness of this new process: Press Ganey patient satisfaction scores and length of stay data.
The new multidisciplinary rounds are conducted once a day at the patient’s bedside and are attended by the Orthopedic Unit Care Manager, Orthopedic Nurse Practitioner, Charge Nurse, and Physical and Occupational Therapists. To ensure participation from the needed disciplines, the group agreed upon a time of day that would provide the least disruption of the daily routine. Rounds include the review of the patient’s lab work, any ordered procedures, therapy schedule with objectives, and discharge plan including anticipated discharge date. The patient and family member are encouraged to participate and given an opportunity to clarify information and ask questions. Any changes in the patient’s plan of care are disseminated to the nursing and therapy staff involved.
Pre- and post rounding data demonstrated that length of stay decreased by 0.99 days for total hip replacements and 0.47 days for total knee replacements. Press Ganey survey mean score data increased for responses such as “nurses kept you informed,” “physician kept you informed,” and “staff worked together to care for you,” changing the percentile rank from 81 or below to 99.
Equally as important, the members of the Orthopedic Team have expressed satisfaction with the multidisciplinary rounding process. All are in agreement that improved communication and collaboration, and an increased sense of ‘team’ have resulted.
To view the poster for this project, please click here
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