Curtis Sudbury, MD
Pediatric Resident
Penn State College of Medicine, United States
Disclosure information not submitted.
Jessica Boegner, DO
Pediatric Resident
Penn State College of Medicine, United States
Disclosure information not submitted.
O'Neil Riley, MD
Pediatric Resident
Penn State College of Medicine, United States
Disclosure information not submitted.
Adrian Zurca, MD,
Associate Professor of Pediatrics
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania
Disclosure information not submitted.
Title: Shared Mental Model: Team Member Presence and Review of Goals on Interdisciplinary PICU Rounds
Introduction: Interdisciplinary rounds are key to providing effective care in the pediatric intensive care unit (PICU), allowing for establishment of care plans and review of safety elements. Multidisciplinary participation is crucial in establishing a shared mental model and achieving patient care goals. The objective of this study is to evaluate the presence of interdisciplinary team members on PICU rounds, the frequency with which goal and safety checks are performed and the perceived understanding of the daily care plan.
Methods: IRB approval was obtained. Rounds in an 18-bed PICU were observed for the presence of interdisciplinary team members including attending physicians, fellows and advanced practice practitioners (APPs), residents, and nurses. The review of patient care goals (blood pressure, sedation, pH, oxygenation, fluid balance, electrolytes) and safety checks (presence and duration of indwelling catheters, endotracheal tube depth) was documented. PICU providers were surveyed on their perceptions of rounds.
Results: Rounds were observed on 49 patients with an average of 9.1±4.3 minutes spent per patient. Nurses were present 88% of the time, but were present for the entirety of rounds 47% of the time. Patient care goals were reviewed on 27% of patients and safety checks on 8% of patients. 45 providers responded to the survey, including 26 bedside nurses, 11 attendings, and 8 APPs. Overall, 40% of providers feel that goals are routinely reviewed and 14% that goal sheets are routinely completed during rounds. 80% of attending physicians, 85% of fellows and APPs and 77% of nurses feel that the plan of care of the day is clear to them at the end of rounds. 87% of nurses feel that they usually attend rounds for their patients.
Conclusions: Most of the surveyed team members feel that they understand the plan of the patient for the day after rounds; however, nurses do not routinely attend the entirety of PICU rounds, which may impact the development of a shared mental model. Perceived frequency of goal sheet review and completion is less than the actual rate. Barriers to nurse participation on rounds are being identified. A standardized rounds structure and new goal sheets will be implemented and their impact on the frequency of safety checks and development of a shared mental model will be measured.