From the 2018 HVPAA National Conference
Joshua Herb (UNC School of Medicine), Emily Hoke (UNC Hospitals), Pamela Choquette (UNC Hospitals), Katie Moser (UNC School of Medicine), Sara Higginson (UNC School of Medicine), Maureen Heck (UNC Hospitals), Michelle Brownstein (UNC School of Medicine)
Quality improvement studies illustrate that utilization of a daily goals sheet during ICU rounds improves communication, provider satisfaction, and adherence to quality measures. A 16-bed surgical ICU at an academic Level I Trauma Center identified areas of their rounding process that lacked standardization and did not include the interprofessional team.
With an estimated 28,800 possible team combinations in the ICU each month, a coordinated approach to rounding was needed. The objective was to use an interprofessional, quality improvement driven approach to implement a daily goals sheet in an academic Level I Trauma Center. The intended outcomes were improved team communication, rounding efficiency, and adherence to quality measures.
A formal interprofessional (physicians, nurses, dieticians, pharmacists, respiratory therapists) survey was conducted to evaluate current perceptions and practices related to the ICU rounding process. Observations were conducted to capture rounding time and the frequency with which key quality indicators (e.g. DVT prophylaxis, GI prophylaxis, central line and Foley catheter necessity) were addressed on rounds. Through a partnership between providers, nursing staff, ancillary disciplines, and the Performance Improvement and Patient Safety department, a daily goals tool was developed and implemented from the survey results and observations. Additionally, a standardized interprofessional rounds presentation format was developed. Multiple PDSA and feedback cycles were conducted to optimize the content of the tool and the reporting process. Post-implementation observations were conducted to identify changes in rounding time and discussion rates of quality measures. Directional two-proportion tests were conducted to identify significant differences pre- and post-intervention.
Pre-intervention survey response rate was 82%. The frequency of discussion regarding key quality indicators significantly increased in four of five categories (p=<.05) after implementation of a tool and interprofessional reporting process (Table 1). Compliance with completion of the daily goals tool is currently 79%. Preliminary results show a decrease in time spent rounding per patient.
The unit effectively adopted the daily goals tool and adapted the rounding process to ensure inclusion of all members of the interprofessional team. Consistent with previous studies, this intervention improved discussion of quality indicators. Utilization of an interprofessional quality improvement framework to foster change in a critical care setting is essential to success. Leveraging the full strength of the interprofessional team is as important in improving operational performance as it is in direct patient care.
Implications for the Patient
Well-functioning interprofessional rounding practices are a vital component of providing complex critical care. Improving consistency and standardization of the rounding process, with an emphasis on critical quality measures, can create a safer environment for patients and reduce the risk of preventable patient harm.