Development and Implementation of a Care Coordination Rounds in a Medical-Surgical Unit

Purpose: The Institute of Medicine has called on different institutions to create and implement effective processes to impact the delivery of care possible due to complex natures of acute health care environment. Studies have shown that care coordination rounds is a model adapted by institutions to improve communication, promote continuity of care and improve patient outcomes. Care Coordination Rounds (CCR’s) was developed and implemented in a community acute care facility in one of the medical-surgical units.

Methods: Utilizing a hybrid of the Six Sigma Methodology Design Measure Analyze Improve and Control (DMAIC) for process improvement to determine how the existing process could be better structured and process design Define Measure Analyze and Verify (DMADV) to transition the existing process to a more efficient, reliable, and replicable design. The care coordination rounds model involved partnering with a hospitalist group to conduct the daily CCRs. A dedicated Hospitalist is assigned to unit weekly. The rounds is co-led by the Advance Practice Nurse (APN), attended by Nurses, Case Manager, Social worker, Dietician, and Physical Therapist. The team meets to discuss patient’s plan of care, to determine a discharge disposition, and to identify and address possible discharge problems in order to achieve outstanding patient care experience and improved patient outcome.

Results: The team utilized feedback from Press Ganey questions to compare the first and third quarters as a measurement of patient satisfaction. Multiple metrics improved tremendously, some examples are: “time physician spent with me” improved from 5% to 40%, “nurses kept me informed” improved from 5% to 60%, “likelihood to recommend” improved from 10% to 85%. The length of stay (LOS) was calculated by payer source. Medicare patients, LOS improved from 6.11 to 5.94 days; Self-Pay and Charity Care improved from 6.70 to 5.82 days. Overall average LOS improved from 5.7 to 5.4 days.

Conclusion: The success of the program prompted the team to replicate it on two other medicalsurgical units. Although there have been some challenges related to physical layout and patient population, overall the program appears to have shown some early success.