Throughout my career in hospitals and healthcare, I have always been drawn to the ritual of daily patient rounds. I have had the privilege of working in hospitals as large as a 430-bed urban teaching hospital and as small as 25-bed rural community hospitals. Every hospital experience has been unique and highly rewarding in its own way, but one common denominator for me is that the best hospitals that I have worked in have often made good use of daily interdisciplinary rounds.
For example, the teaching hospitals are renowned for the phenomena of daily teaching rounds in which the teaching staff lead a troop of young interns and residents. But I have been equally impressed when I worked in a small hospital in rural Montana and our four-member medical staff made a practice of conducting morning rounds together, along with the nursing staff to get the maximum medical care for each of our hospital’s inpatients. How great it was for each of our patients to receive decades of medical and nursing experience.
I am proud to say that my current hospital, a community hospital in Northern California, has found a valuable role for daily interdisciplinary rounds. Our rounds are attended by hospitalists, social workers, rehabilitation professionals, nurses, pharmacists, infection prevention specialists, dietary experts, case managers and discharge planners. Sometimes even an occasional hospital CEO will stop by to observe the process. All are welcome and encouraged to contribute.
Recently, one of our new nurses said, “This is so great! I have only read about interdisciplinary rounds, but never experienced them before.”
Rounds usually begin, promptly at 11 a.m. with an overhead page to alert our team that it is “time for rounds.” Our team assembles in a conference room, located close to the patient rooms for convenience of our staff. Each patient is presented by their nurse, with any updates and valuable insights into the care plan for the day. This is a wonderful opportunity for clinical staff to interact, communicate and plan for the best outcomes.
Interdisciplinary rounds are a significant time commitment and financial investment by our facility. However, they are well worth the cost. Can you imagine the combined salaries for everyone in the room? The advantage is that we are able to use our work time to address the most important aspects of care and to identify priorities. We have also found that by doing rounds, we are providing individualized care to meet our patients’ immediate needs.
Some positive benefits include opportunities to clarify drug orders, and sometimes to change the orders based upon input from the pharmacists. Most importantly, we have found that our patients become more personal to our staff. Dietary concerns are addressed from intake to NPO for procedures, as are the need for patient and family education or food preferences. Social services and counseling needs are addressed, which is especially important for difficult cases. And there is no doubt that patient safety is enhanced through the experience and medical errors are reduced.
We highly recommend interdisciplinary rounds to all other hospitals. The quality of our communications have been greatly enhanced with our patients and their care teams, including family, primary care providers and caregivers. It is clearly a win-win situation.
Raymond Hino, MPA, FACHE, is the president and CEO of the Sonoma West Medical Center in California.