Nurse-Led Interprofessional Bedside Rounds: Impact on Patient Experience

Monday, 30 October 2017: 1:55 PM

Denise K. Gormley, PhD, MSN1
Amy J. Costanzo, MSN2
Jessica N. Hill, MA1
Jahmeel Israel, MS1
Jane Goetz, MSN3
Katherine Staubach, MSN, MEd4
Myrna Little, MEd5
(1)College of Nursing, University of Cincinnati, Cincinnati, OH, USA
(2)Center for Professional Growth and Innovative Practice, University of Cincinnati Medical Center, Cincinnati, OH, USA
(3)Inpatient Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
(4)University of Cincinnati Medical Center, Cincinnati, OH, USA
(5)College of Nursing, University of Cincinnati, College of Nursing, Cincinnati, OH, USA

In 1991, the Institute for Healthcare Improvement (IHI) proposed the triple aim: 1) improve healthcare through patient satisfaction and quality; 2) improve population health; and 3) reduce the cost of healthcare per person as a solution to the issues of fragmented and frequently poor quality healthcare. The impact of IPCP achieved by all healthcare providers influences the quality of care for patients and health care delivery systems (Walsh, Reeves, & Maloney, 2014). The Institute of Medicine (IOM, 2010) issued a report with recommendations for nursing to lead in changing and improving healthcare. Two key recommendations were to develop opportunities for nurses to contribute and lead in innovative models of patient-centered care, and participate in interprofessional collaborative practice. RWJF (2011) & WHO (2010) also recommend interprofessional collaborative practice as a means to improve siloed and fragmented care. This project implemented nurse-led interprofessional bedside rounds on a surgical oncology service at a large urban academic medical center to improve communication and collaboration between care providers for this complex patient population. Team members included: nursing, medicine, pharmacy, social work, dietary, and rehab services. Nurses participated in a leadership development program prior to implementation of bedside rounds. Nurse-led Interprofessional Collaborative Practice (IPCP) Rounds focus on the previous 24-hours and goal setting for the next 24-hours. Patient and family actively participate in rounds. IPCP Rounds are at a specific time each day and are structured with the use of a standardized communication tool. Outcomes examined the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores, particularly the questions related to ‘Rate Hospital Overall’; ‘Communication with Nurses’; ‘Communication with Doctors’; and ‘Discharge Information’. Findings demonstrated significant improvement in patient experience over one year compared to previous year after implementation of nurse-led interprofessional bedside rounds. The HCAHPS ‘Rate Hospital Overall’ score for 2016 improved 10.6 percentage points over 2015. Similarly, ‘Communication with Nurses’ score increased 7.8 percentage points. ‘Communication with Doctors’ actually decreased 2.6 points, potentially due to changes in physician coverage during the project. ‘Discharge Information’ improved by 3 points from 2015 to 2016. One of the challenges in the implementation of this project was a cultural shift of moving from a teaching focused rounding process to an interprofessional patient-centered care planning process. Additional challenges were the development of the nurse leader role for the IPCP rounds and identifying a time convenient for all care providers. Plans for the future include rollout of nurse-led interprofessional rounds to additional service teams at our academic medical center. This project can also be customized to meet the needs of a variety of patient populations in different healthcare settings.