"Interdisciplinary bedside rounds are the right thing to do for our patients and their families," says Dalene Newton, Director of Neurosciences, Rehabilitation Services and Interprofessional Practice. "I am really proud of how our teams have taken on this new initiative and made it a priority for their units."
During interdisciplinary bedside rounds (IDR), members of a patient's health care team come together at the same time with the patient, and their family if possible, to discuss their care. The healthcare team includes the physician, nursing, and the interprofessional practice team which may include physiotherapy, occupational therapy, social work, pharmacy, registered dieticians, speech language pathology, and Client Patient Access Services (CPAS) – everyone helping to address that particular patient's needs.
Versions of these types of rounds have been around for many years. The difference with IDR is it takes the discussion of the patient's care to the beside to include the patient. Recently, the Health Quality Council created a toolkit to bring greater standardization to these rounds as part of the plan to reduce emergency wait times. Evidence has shown that participation in regular IDR improves patient flow and the patient experience. They are also a core feature of an accountable care system, which is being implemented throughout the province as part of the Ministry of Health's commitment to improve emergency department wait times.
Daily IDR can vary from just a few minutes to almost 30 minutes per patient, depending on the complexity of patient needs. They are done regularly to ensure everyone, including the patient's family, is on the same page to reduce any gaps in communication.
Two units - one in Saskatoon City Hospital and one at Royal University Hospital - are at different stages of implementation of IDR and each unit is making the rounds work for their patients and the team. For both units, consistent communication among all the team members is the key to IDR success.
Surgery 3100/3200/3300 – Saskatoon City Hospital
This surgical unit is on the third floor of Saskatoon City Hospital. It has a diverse surgical short-stay and long-stay patient population that includes those admitted for orthopedic surgery, as well as gynecological surgery, and surgery on jaws, breasts and eyes.
Staff on this unit began their IDR journey using the provincial model in November 2016.
On this unit, over 35 different physicians may visit and review (also known as rounding) patients throughout the day.
"Right from the planning stages we knew that we would need to adjust our IDR to work with the number of physicians involved," says Linda Gartner, Co-Manager for the units. "We created a two-step process to our IDR. The first step involves the bedside round and includes the physician, the nurse and the patient. The second step happens separately and includes the nurse and all the other health care team members like physiotherapy, occupational therapy, social work, client patient access services, and sometimes the dietician."
"It would be impossible to have everyone attend one set of IDR rounds," says Dolores Kraft, Co-Manager for the units. "So instead, the nurse has become the vital link between the two stages. And it is working very well for us. Consistent team communication has improved greatly already, and we know we will continue to evolve this process."
Acute Stroke Unit 6300 – Royal University Hospital
The Acute Stroke Unit on the sixth floor of Royal University Hospital has been working to evolve their IDR since the beginning of February. The number of stroke patients on the unit fluctuates, but on average there are about 20 stroke patients on the unit every day
"We are very much making the interdisciplinary rounds our own," says Jodi Copeland, Clinical Coordinator for the Stroke Unit. "It's a learning process, but we noticed that communication improved right away. Everyone on the team feels like they are now on the same page with the patient and their family."
The goal is to eventually expand IDR to more areas of the Neuroscience Unit.
"Everyone who participates in the IDR agrees that it is time well spent despite the challenges of getting everyone there at the same time," continues Copeland. "The feedback we have received from our patients and their families has been overwhelmingly positive."