Pooja Nawathe, MD, CHSE-A,FCCM
Associate Director Congenital Cardiac ICU
Cedars-Sinai Medical Center
Los Angeles, California
Disclosure information not submitted.
Amy Rice, RN
Assistant Nurse Manager
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Maureen Chin, MSN, RN, CNML, CPN
Associate Director, Pediatrics
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Amy Parker, MSN, RN, CPNP-PC, ACCNS-P, CCRN-K
Clinical Nurse Specialist, Pediatric and Congenital Cardiac Intensive Care Unit
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Stephen Robert, MD
Director, PICU
Cedars Sinai Medical Center, United States
Disclosure information not submitted.
Title: Standardized interdisciplinary bedside rounding improve patient and family satisfaction
Introduction/ Hypothesis: Daily rounds in many Pediatric Intensive Care Units (PICUs) lack a set format and vary in quality, duration, and participation. We hypothesized that implementing structured interdisciplinary bedside rounds (SIBR) would improve our rounding process and patient satisfaction for the patient-family-centered initiative.
Methods: This was a quality improvement initiative in a 12-bed multidisciplinary PICU/congenital cardiac ICU (CCICU) in a tertiary care institution. Baseline data included rounding duration, participation of nurses (RN), respiratory care therapists, pharmacists, parents, and RN plan of care (POC) read-back practices. All patients admitted to the PICU/CCICU, including adult CCICU patients ( >21yo), were included. Interventions were establishing a standard rounding time and instituting a SIBR model. All staff, consecutive patients, and parents participated over 12 months. SIBR comprised of a report out of the patient background/pertinent events by the RN, a POC update from the MD, and a readback of the POC by the RN. Weekday rounds were audited consecutively from August 2020 to February 2021. Timestamps: rounds initiation time, duration of systems presentation a 24-hour events report out time, POC, POC recap. If delays ( >15 min/patient) occurred, the delays were classified based on care coordination, patient acuity, parent/ nursing/ physician-related.
Results: From August 2020- February 2021, 118 rounding interactions were audited. Average report time was 5.3 minutes, POC time 4.3 minutes, a recap time of 1.6 minutes, with the average total rounding time being 11.2 minutes. Rounding started within 15 minutes of the designated 0830 start time >95% of the encounters. In September 2020, the current patient experience data was rated overall 66.7% from 33% prior to that period. From October 2020, families reported this same indicator as 100%. Family perception and staff engagement remain the two most significant gains in these efforts.
Conclusions: Implementing a structured bedside process improves the quality of rounds in a PICU as evidenced by expanded interdisciplinary participation, more consistent read-back of POC, and improved family satisfaction. As a result of all interventions, efficiency increased with shorter rounding times per patient and enhanced patient satisfaction.