TY - JOUR
T1 - Improving teamwork and patient outcomes with daily structured interdisciplinary bedside rounds
T2 - A multimethod evaluation
AU - Clay-Williams, Robyn
AU - Plumb, Jennifer
AU - Luscombe, Georgina M.
AU - Hawke, Catherine
AU - Dalton, Hazel
AU - Shannon, Gabriel
AU - Johnson, Julie
N1 - Funding Information:
Disclosures: None of the authors had conflicts of interest in relation to the conduct or reporting of this study, with the exception that the lead author’s institution, the Australian Institute of Health Innovation, received a small grant from the New South Wales Clinical Excellence Commission to conduct the work. Ethics approval for the research was granted by the Greater Western Area Health Service Human Research Ethics Committee (HREC/13/GWAHS/22). All interviewees consented to participate in the study. For patient data, consent was not obtained, but presented data are anonymized. The full dataset is available from the corresponding author with restrictions. This research was funded by the NSW Clinical Excellence Commission, who also encouraged submission of the article for publication. The funding source did not have any role in conduct or reporting of the study. R.C.W., J.P., and J.J. conceptualized and conducted the qualitative component of the study, including method, data collection, data analysis, and writing of the manuscript. G.L., C.H., and H.D. conceptualized the quantitative component of the study, including method, data collection, data analysis, and writing of the manuscript. G.S. contributed to conceptualization of the study, and significantly contributed to the revision of the manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. As the lead author, R.C.W. affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned have been explained.
Publisher Copyright:
© 2018 Society of Hospital Medicine.
PY - 2018/5
Y1 - 2018/5
N2 - BACKGROUND: Previous research has shown that interdisciplinary ward rounds have the potential to improve team functioning and patient outcomes. DESIGN: A convergent parallel multimethod approach to evaluate a hospital interdisciplinary ward round intervention and ward restructure. SETTING: An acute medical unit in a large tertiary care hospital in regional Australia. PARTICIPANTS: Thirty-two clinicians and inpatients aged 15 years and above, with acute episode of care, discharged during the year prior and the year of the intervention. INTERVENTION: A daily structured interdisciplinary bedside round combined with a ward restructure. MEASUREMENTS: Qualitative measures included contextual factors and measures of change and experiences of clinicians. Quantitative measures included length of stay (LOS), monthly “calls for clinical review,’” and cost of care delivery. RESULTS: Clinicians reported improved teamwork, communication, and understanding between and within the clinical professions, and between clinicians and patients, after the intervention implementation. There was no statistically significant difference between the intervention and control wards in the change in LOS over time (Wald χ2 = 1.05; degrees of freedom [df] = 1; P =.31), but a statistically significant interaction for cost of stay, with a drop in cost over time, was observed in the intervention group, and an increase was observed in the control wards (Wald χ2 = 6.34; df = 1; P =.012). The medical wards and control wards differed significantly in how the number of monthly “calls for clinical review” changed from prestructured interdisciplinary bedside round (SIBR) to during SIBR (F (1,44) = 12.18; P =.001). CONCLUSIONS: Multimethod evaluations are necessary to provide insight into the contextual factors that contribute to a successful intervention and improved clinical outcomes.
AB - BACKGROUND: Previous research has shown that interdisciplinary ward rounds have the potential to improve team functioning and patient outcomes. DESIGN: A convergent parallel multimethod approach to evaluate a hospital interdisciplinary ward round intervention and ward restructure. SETTING: An acute medical unit in a large tertiary care hospital in regional Australia. PARTICIPANTS: Thirty-two clinicians and inpatients aged 15 years and above, with acute episode of care, discharged during the year prior and the year of the intervention. INTERVENTION: A daily structured interdisciplinary bedside round combined with a ward restructure. MEASUREMENTS: Qualitative measures included contextual factors and measures of change and experiences of clinicians. Quantitative measures included length of stay (LOS), monthly “calls for clinical review,’” and cost of care delivery. RESULTS: Clinicians reported improved teamwork, communication, and understanding between and within the clinical professions, and between clinicians and patients, after the intervention implementation. There was no statistically significant difference between the intervention and control wards in the change in LOS over time (Wald χ2 = 1.05; degrees of freedom [df] = 1; P =.31), but a statistically significant interaction for cost of stay, with a drop in cost over time, was observed in the intervention group, and an increase was observed in the control wards (Wald χ2 = 6.34; df = 1; P =.012). The medical wards and control wards differed significantly in how the number of monthly “calls for clinical review” changed from prestructured interdisciplinary bedside round (SIBR) to during SIBR (F (1,44) = 12.18; P =.001). CONCLUSIONS: Multimethod evaluations are necessary to provide insight into the contextual factors that contribute to a successful intervention and improved clinical outcomes.
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U2 - 10.12788/jhm.2850
DO - 10.12788/jhm.2850
M3 - Article
C2 - 29698537
AN - SCOPUS:85054574332
SN - 1553-5606
VL - 13
SP - 311
EP - 317
JO - Journal of hospital medicine (Online)
JF - Journal of hospital medicine (Online)
IS - 5
ER -
