Implementation and function of interdisciplinary rounds: An observational multisite hospital study from project ACHIEVE.

Abstract

Interdisciplinary rounds (IDR) are increasingly employed by hospitals; however, there is no formal definition, structure, or framework. The purpose of this observational study was to document the heterogeneity of IDRs and assess the different characteristics associated with IDR functions. Observation of IDR occurred at 27 hospitals that were purposively selected to ensure a mix of the following criteria: geographic region, provider type, for-profit status, population (e.g., urban, rural), and teaching status. Hospitals identified general medical floors covered by hospitalists for IDR observations. The study team conducted hospital site visits to observe the implementation of IDR. A checklist was developed to record IDR structure and processes, content, and outcomes. Data from two content expert observers were reconciled, and a consensus was attained. The study measures include two IDR functions: topics discussed during IDR (changes in medical treatment, responsibilities and shared understanding of goals and expectations, anticipation of discharge date and needs, anticipating follow-up care and service needs), and effective communication. Hospitals varied significantly in IDR implementation. 51.9% included the "core" team (i.e., a physician, nurse, pharmacist, and case manager/social worker), though all included a case manager or social worker. Most (81.5%) occurred before noon. Content chiefly focused on medical care (74.1 to 92.6%) with patient responsibilities and preferences being less frequently discussed (25.9 to 40.7%). Bivariate analyses revealed that afternoon rounds were more likely to include dischargeȐrelated topics, such as patient/caregiver preferences (100% vs. 27.3%, p = .003) and follow-up needs (100% vs. 36.4%, p = .010).When IDR occurred at bedside, financial resources were more often assessed (100% vs. 34.8%, p = .015) and patient's ability to obtain medication was more often anticipated (75% vs. 21.7%, p = .031).