Improving Teamwork and Patient Outcomes with Daily Structured Interdisciplinary Bedside Rounds: A Multimethod Evaluation
"Robyn Clay-Williams, PhD", Centre for Healthcare Resilience & Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney NSW 2109, Australia; Telephone: 02-9850-2438; Fax: 02-9850-2499; E-mail: email@example.com
BACKGROUND: Previous research has shown that interdisciplinary ward rounds have the potential to improve team functioning and patient outcomes.
DESIGN: A convergent parallel multimethod approach to evaluate a hospital interdisciplinary ward round intervention and ward restructure.
SETTING: An acute medical unit in a large tertiary care hospital in regional Australia.
PARTICIPANTS: Thirty-two clinicians and inpatients aged 15 years and above, with acute episode of care, discharged during the year prior and the year of the intervention.
INTERVENTION: A daily structured interdisciplinary bedside round combined with a ward restructure.
MEASUREMENTS: Qualitative measures included contextual factors and measures of change and experiences of clinicians. Quantitative measures included length of stay (LOS), monthly “calls for clinical review,’” and cost of care delivery.
RESULTS: Clinicians reported improved teamwork, communication, and understanding between and within the clinical professions, and between clinicians and patients, after the intervention implementation. There was no statistically significant difference between the intervention and control wards in the change in LOS over time (Wald χ2 = 1.05; degrees of freedom [df] = 1; P = .31), but a statistically significant interaction for cost of stay, with a drop in cost over time, was observed in the intervention group, and an increase was observed in the control wards (Wald χ2 = 6.34; df = 1; P = .012). The medical wards and control wards differed significantly in how the number of monthly “calls for clinical review” changed from prestructured interdisciplinary bedside round (SIBR) to during SIBR (F (1,44) = 12.18; P = .001).
CONCLUSIONS: Multimethod evaluations are necessary to provide insight into the contextual factors that contribute to a successful intervention and improved clinical outcomes.