Approach to Align the Educational and Clinical Mission in Health Care Systems Mukta Panda, MD, FACP¹; William C Crowe, Jr, DNP, APN²; Michael Bettinger, MBA, BSISE²; Kathy Thurman²; Maryellen Howley, MBA, RN² ¹University of Tennessee College of Medicine Chattanooga ²Erlanger Health System, Chattanooga, TN BACKGROUND •Interprofessional multidisciplinary rounds (MDR) have been proposed to improve communication, decrease total hospital charges, and reduce length of hospital stay (LOS). •The ACGME core competencies, mandate from the Institute of Medicine, JCAHO and CMS, also outline the need for residency programs to make use of interdisciplinary teams for education. •Health professionals lack preparation and support to work in interprofessional teams especially with increased aging population, chronic and complex diseases. •Despite educational benefits, paucity exists in studies describing and evaluating models examining the MDR impact. • Academic programs struggle to demonstrate value added to affiliated hospitals •Although there are clear educational benefits, studies which examine impact of multidisciplinary rounds on LOS have had mixed results [1,2]. Thematic qualitative reports: increased communication, fosters collaboration, better “insight” into patients, better follow up , easier navigation of social, ethical and end of life issues due to involvement of spiritual care and legal help, increased education on documentation. Specifically third and PROJECT DESIGN • The medicine department instituted MDRTeams on academic inpatient service of medical residents, students, physicians, mid-levels, nurses; care management (case managers, documentation resource utilization specialist); therapists; nutritionist; pharmacist; legal aid and chaplain. • Team meets weekly, care management team and physicians also “huddle” daily. • Each member contributes to care plan. • A structured care documentation template and scorecard was developed and shared quarterly with all stakeholders. • Initial improvements led to expansion and adding palliative care, geographic units and structured outpatient continuity. MAJOR OUTCOMES • Improvements noted between beginning MDR process and 3 rd year: •Case Mix Adjusted Length of Stay – 11.4% reduction from 3.41 to 3.02 days •Overall Readmit Rate – 7.3% reduction • “Quality of Doctor’s Care” – 6.6% improvement • “Teamwork between Doctors, Nurses, and Staff” – 10.3% improvement •Documentation (Query Response) – maintained the rate at 98% (significant improvement versus 2009 rate of 91%) •CAUTI – decrease 0.69% to 0.41% •VTE Prophylaxis (new) 91.3% year to date PROJECT •Ongoing efficient sustainable process implemented and progressively enhanced over 3 years •Goals: -educate in a health system that utilized systems-based, safe, accountable cost conscious patient- centered, evidence-based care, practice based learning and improvement with reflection -address challenges of comprehensive competency CONCLUSIONS, LESSONS LEARNED, AND IMPLICATIONS • Organizations re- creating MDRTeams should involve all stakeholders, maintain goal as central focus and implement and review process slowly in phases. • Barriers included discussion on the huddle best time, especially in keeping with duty hour requirements for trainees. • Utilizing multidisciplinary team rounds is a sustainable method that fulfills residency program mandates for systems- based education and may be associated with cost savings and decreased hospital stay. SCORECARD BIBLIOGRAPHY •Wild, D., et al., Effects of interdisciplinary rounds on length of stay in a telemetry unit. J Public Health Manag Pract, 2004. 10(1): p. 63-9. •Curley, C., J.E. McEachern, and T. Speroff, A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous
Interprofessional Team Rounding: A Value Added Innovative Approach to Align the Educational and Clinical Mission in Health Care Systems Mukta Panda, MD,
Jan 11, 2016
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Interprofessional Team Rounding: A Value Added Innovative Approach to Align the Educational and Clinical Mission in Health Care Systems
Mukta Panda, MD, FACP¹; William C Crowe, Jr, DNP, APN²; Michael Bettinger, MBA, BSISE²; Kathy Thurman²; Maryellen Howley, MBA, RN²¹University of Tennessee College of Medicine Chattanooga
²Erlanger Health System, Chattanooga, TN
BACKGROUND•Interprofessional multidisciplinary rounds (MDR) have been proposed to improve communication, decrease total hospital charges, and reduce length of hospital stay (LOS). •The ACGME core competencies, mandate from the Institute of Medicine, JCAHO and CMS, also outline the need for residency programs to make use of interdisciplinary teams for education. •Health professionals lack preparation and support to work in interprofessional teams especially with increased aging population, chronic and complex diseases.•Despite educational benefits, paucity exists in studies describing and evaluating models examining the MDR impact.• Academic programs struggle to demonstrate value added to affiliated hospitals•Although there are clear educational benefits, studies which examine impact of multidisciplinary rounds on LOS have had mixed results [1,2].
Thematic qualitative reports: increased communication, fosters collaboration, better “insight” into patients, better follow up , easier navigation of social, ethical and end of life issues due to involvement of spiritual care and legal help, increased education on documentation. Specifically third and fourth year medical students identified MDR as a valuable educational addition.
PROJECT DESIGN• The medicine department instituted
MDRTeams on academic inpatient service of medical residents, students, physicians, mid-levels, nurses; care management (case managers, documentation resource utilization specialist); therapists; nutritionist; pharmacist; legal aid and chaplain.
• Team meets weekly, care management team and physicians also “huddle” daily.
• Each member contributes to care plan.
• A structured care documentation template and scorecard was developed and shared quarterly with all stakeholders.
• Initial improvements led to expansion and adding palliative care, geographic units and structured outpatient continuity.
MAJOR OUTCOMES• Improvements noted between beginning MDR process and 3rd year:•Case Mix Adjusted Length of Stay – 11.4% reduction from 3.41 to 3.02 days•Overall Readmit Rate – 7.3% reduction• “Quality of Doctor’s Care” – 6.6% improvement• “Teamwork between Doctors, Nurses, and Staff” – 10.3% improvement•Documentation (Query Response) – maintained the rate at 98% (significant improvement versus 2009 rate of 91%)•CAUTI – decrease 0.69% to 0.41%•VTE Prophylaxis (new) 91.3% year to date
PROJECT•Ongoing efficient sustainable process implemented and progressively enhanced over 3 years •Goals: -educate in a health system that utilized systems-based, safe, accountable cost conscious patient-centered, evidence-based care, practice based learning and improvement with reflection -address challenges of comprehensive competency based education improved care quality -environment fostering innovative learning
CONCLUSIONS, LESSONS LEARNED, AND IMPLICATIONS•Organizations re-creating MDRTeams should involve all stakeholders, maintain goal as central focus and implement and review process slowly in phases.•Barriers included discussion on the huddle best time, especially in keeping with duty hour requirements for trainees.•Utilizing multidisciplinary team rounds is a sustainable method that fulfills residency program mandates for systems-based education and may be associated with cost savings and decreased hospital stay.
SCORECARD
BIBLIOGRAPHY•Wild, D., et al., Effects of interdisciplinary rounds on length of stay in a telemetry unit. J Public Health Manag Pract, 2004. 10(1): p. 63-9.•Curley, C., J.E. McEachern, and T. Speroff, A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care, 1998. 36(8 Suppl): p. AS4-12.
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