This document discusses interprofessional rounding teams and strategies to improve teamwork and communication. It provides background on how interprofessional healthcare teams can improve patient outcomes. Checklists, care pathways, and interprofessional education are presented as potential solutions. Checklists have been shown to reduce medical errors and mortality. Care pathways, while challenging to implement, can standardize care and reduce prescribing errors. Brief interprofessional education sessions have been found to improve collaboration attitudes and skills among professionals. Overall, the document advocates for interprofessional rounding teams and strategies to enhance communication and teamwork across disciplines.

1. INTERPROFESSIONAL
ROUNDING TEAMS
Group 6
November 28th, 2012

2. BACKGROUND
• Interdisciplinary healthcare teams are defined as
involving two or more health professions with
complementary skills assessing, planning, or
evaluating patient care.
Xyrichis, A. and Ream, E. Teamwork: a concept analysis. Journal of Advanced
Nursing (2008); 61, 232-241.

3. BACKGROUND
• Teamwork in healthcare can save lives, improve the
quality of patient care, reduce errors, enhance
patient flow, improve communication, and increase
satisfaction.
• THIS IS WHY WE NEED TEAMWORK!!!
Bharwani, Aleem M., MD, MPP, Harris, G. Chad, and Southwick, Frederick S., MD. Perspective: A
Business School View of Medical Interprofessional Rounds: Transforming Rounding Groups Into
Rounding Teams. Acad Med. 2012; 87:00-00.

4. WHAT DISCIPLINES ARE INVOLVED?
• Medicine • Respiratory
• Nursing • Physician Assistants
• Pharmacy • Nurse Practitioners
• Physical Therapy • Social Work
• Occupational • Etc.
Therapy
• Nutrition
• Case Management

5. DISCIPLINES FOR THIS PROJECT
• Medicine
• Nursing
• Pharmacy
• PT/OT
• Nutrition

6. MEDICINE
• Attending Physician
• Medical Resident
• Medical Intern
• Medical Student

7. PHARMACY
• Clinical Pharmacist
• Specialized
• Pharmacy Resident
• Pharmacy Student

8. NURSING
• Nurse Practitioner
• Floor Manager
• Nurse
• Nursing Tech/Student

9. OCCUPATIONAL THERAPY,
PHYSICAL THERAPY, AND NUTRITION
• Floor/Department

10. WHY IS THIS IMPORTANT?
• In 2006, the Joint Commission reported that
70% of medical errors were caused by lack
of communication between team
members.
Joint Commission on Accreditation of Health Care Organizations. Root causes for sentinel
events. http://www.jointcommission.org/Sentinel_Event_Statistics
/.

11. COMMUNICATION
(INTERDISCIPLINARY AND INTRADISCIPLINARY)
ISSUE

12. MEDICINE
BERNIE BOULANGER, MD, FACS

13. PHARMACY
DAVID FEOLA, PHARMD, PHD, BCPS

14. NURSING
NORA WARSHAWSKY, PHD, RN

15. COMMUNICATION BREAKDOWN
• Interdisciplinary • Intradisciplinary
• Attitudes towards • Continuity of care
other disciplines • Shift changes
• Both
• Paper charts
• Handwriting

16. CHECKLISTS
SOLUTION #1

17. SIX FUNCTIONS
• Provision of detailed case-related information
• Confirmation of case-specific details
• Articulation of concern or ambiguity
• Decision making
• Team building and camaraderie
• Education

18. Surgical Safety Checklist to Reduce Morbitiy and Mortality in a Global Population. Haynes AB, Weiser TG, Berry WR, Lipsitz
SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B,
Gawande AA; Safe Surgery Saves Lives Study Group. N Engl J Med 2009; 360:491-9.

19. L Lingard, S Espin, B Rubin, et al. Getting teams to talk: development and pilot implementation of a checklist to
promote interprofessional communication in the OR. Qual Saf Health Care 2005 14: 340-346

20. EXAMPLE - FASTHUG
• Used in ICU (intensive care unit)
• F-feeding
• A- analgesia
• S- sedation
• T- thromboembolic prophylaxis
• H- head of bed elevation
• U- stress ulcer prophylaxis
• G- glycemic control

21. EXAMPLE - SBAR
• Nurse Handoff & Nurse/Physician Communication
• S- Situation
• B- Background
• A- Assessment
• R- Recommendation

23. OUTCOMES
• The rate of death was 1.5% before the checklist was
introduced and declined to 0.8% afterward
(P=0.003). Inpatient complications occurred in 11.0%
of patients at baseline and in 7.0% after introduction
of the checklist (P<0.001).
Surgical Safety Checklist to Reduce Morbitiy and Mortality in a Global Population. Haynes AB, Weiser TG, Berry WR, Lipsitz
SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor
B, Gawande AA; Safe Surgery Saves Lives Study Group. N Engl J Med 2009; 360:491-9.

24. OUTCOMES
• One example aimed to provide timely pain medication by
having nurses observe every four hours for pain.
• Reduced the likelihood of a patient’s experiencing untreated pain
from 41% to 3%
• Another was a checklist for patients on mechanical ventilation
• Proportion of patients who didn’t receive the recommended care
dropped from 70% to 4%
• The occurrence of pneumonias fell by 25%;
• 21 fewer patients died than in the previous year
• “The research shows that simply having the doctors and nurses
in the I.C.U. make their own checklists for what they thought
should be done each day improved the consistency of care to
the point that, within a few weeks, the average length of patient
stay in intensive care dropped by half.”
Gawande, Atul. Annals of Medicine: The Checklist. The New Yorker. December 10, 2007.

25. CARE PATHWAYS
SOLUTION #2

26. WHAT IS A CARE PATHWAY?
• Also known as care map, critical pathways, or
integrated care pathways.
• Definition: Complex interventions to organize care
for patients.
• Although research shows that implementing care
pathways can be challenging for teams, the overall
consensus with proper management customized
care pathways can improve patient care.
Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Care
pathways lead to better teamwork: results of a systematic review. Soc Sci Med. 2012 Jul;75(2):264-8.

27. SYSTEMATIC REVIEW
• Level III evidence from a trial showed that pathways
significantly reduced prescribing error by 30%
(p=0.002)
• CONS- trouble implementing care pathway
Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Care
pathways lead to better teamwork: results of a systematic review. Soc Sci Med. 2012 Jul;75(2):264-8.

28. HMcD/Steering Group
Care Pathways for People with MND - In patient diagnosis Northern Ireland
July 2003
Referral
Screening if potential MND urgent appointment 3-4 weeks
Seen at Outpatients
Admission (tests etc)
Contact made with Care Centre Co-ordinator
DIAGNOSIS Care Centre Co-ordinator available/present at diagnosis:
or referral made to Co-ordinator to follow up immediately
after diagnosis.
Follow up appointment Onward
with neurologist (variable GP/Primary Care Referral to
Care Centre to meet needs 2-6 weeks Leaflet to GP Services as
Co-ordinator
appropriate
available at Info on MND support
Outpatients clinic Referral
Via Association To MDT
Refer to RCA
Re-offer services of
Care Centre Follow up contact within two weeks (telephone or visit)
Liaise with Care
Centre RCA makes initial visit, checking statutory services
Co-ordinator If no contact wanted
and Association services
GNDH/11.8.05 Maintain contact or contact with AV

29. http://www.mndassociation.org/for-professionals/sharing-good-practice/care-pathway-and-clinical-guideline-examples

30. EDUCATION
(PRE-PROFESSIONAL AND POST-PROFESSIONAL)
SOLUTION #3

31. IMPACT OF INTERPROFESSIONAL EDUCATION ON
COLLABORATION ATTITUDES, SKILLS, AND BEHAVIOR AMONG
PRIMARY CARE PROFESSIONALS
• Interprofessional education session consisted on 3
workshops which lasted 2 to 3 hours.
• Brief interprofessional education (IPE) sessions results
in significant improvement in the teams’ attitudes
other professions.
Sarah Robben MD, Marieke Perry MD, PhD, Leontien van Nieuwenhuijzen MSc, Theo van Achterberg RN, PhD,
Marcel Olde Rikkert MD, PhD, Henk Schers MD, PhD, Maud Heinen RN, PhD, René Melis MD, PhD. Impact of
interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. Journal
of Continuing Education in the Health Professions. 32(3): 186-204, 2012.

32. BUSINESS SCHOOL VIEW OF
ROUNDING TEAMS
• Scenario-based situations followed by video
critiques are also shown to an effective form of
interprofessional education for healthcare teams.
Bharwani, Aleem M., MD, MPP, Harris, G. Chad, and Southwick, Frederick S., MD. Perspective: A
Business School View of Medical Interprofessional Rounds: Transforming Rounding Groups Into
Rounding Teams. Acad Med. 2012; 87:00-00.

33. QUESTIONS?