In Safe Hands: Structured Interdisciplinary Bedside Rounds

Orange Health Service, Western NSW Local Health District

Summary

The structured interdisciplinary bedside rounds (SIBR) project involved a restructuring of the Medical Unit at Orange to allow care to be delivered via daily interdisciplinary patient and family-centred rounds delivered in plain English with collaborative care and goal planning involving patient, family and the multidisciplinary healthcare team.

Aim

To improve patient and family engagement in healthcare decision-making and to offer seamless communication between the healthcare team, the patient and the family. An indirect aim is to reduce hospital stay, reduce bed-block, improve patient safety and facilitate a smoother patient journey.

Benefits

• Improved patient safety
• Reduced length of stay
• Shared and joint accountability across the multidisciplinary team 
• Increased consumer focus and engagement in care
• Introduction of an integrated care model
• Improved communication

Project status

Project started:  September 2012

Project status: Sustained. The project has been implemented and is sustained in standard business.

Background

The program was designed to address:

1. Monday morning bed block leading to 6-8 patients having to spend much of their hospital stay in the emergency department
2. General medical patients having to be cared for on surgical wards causing elective surgery cancellations due to lack of surgical bed availability
3. A poor nursing skill mix and fractured, episodic medical input leading to disjointed care on the medical ward
4. A need to improve communication and planning with families
5. The significant problem of high rates of falls and incident delirium among patients, which were frequently requiring nursing ‘specials’
6. Significant quality and safety challenges with pressure areas, deep vein thrombosis prevention (DVT prophylaxis), hand hygiene and hospital acquired infections
7. Quantitative and qualitative measures of patient experience and staff satisfaction were available from the statewide surveys. Complaints and patient stories provided a rich case for change. 

Solutions implemented

The following components of the SIBR program were implemented:

• A daily structured interdisciplinary bedside round involving the patient, family and multidisciplinary team
• The introduction of the patient ‘journey board’ which is used as the primary communication tool on the SIBR. It includes the estimated date of discharge, daily care plan and documentation of family questions and answers.
• At the beginning of each day nursing staff ask the patient’s goals for the day and these are documented on the bedside patient ‘journey board’.

The Medical Unit identified care focus areas for a shared safety and quality checklist and these included:

• falls risk
• deep venous thrombosis prophylaxis 
• advanced care directives
• indwelling catheter
• intravenous cannula
• observations.

Results

Nine months after implementation began in September 2012 data collected compared outcomes for a similar cohort of patients.

Patient and Family experiences prior to the intervention was estimated from previous statewide patient surveys and some early post-implementation patient experience feedback. 

Impacts on the ‘Whole of Hospital’ strategies that can be indirectly attributed to the success of the In Safe Hands ward include:

• reduction in emergency department bed block
• reduction of elective surgery cancellations
• reduction in medical patient outlier treated in surgical wards.

Table 1: NEAT Admitted target for Medical patients to the In Safe Hands ward.

Lessons Learnt

In Safe Hands demonstrates the benefit and acceptability of an integrated care model not seen before in the health setting. The core value of this model of care is patient engagement.

The addition of the patient journey board enabled seamless communication between the broader health team and the patient and their family. 

Having the nursing, medical and allied health team all co-located provided a supportive, seamless environment where each health professional is not only being held accountable for their contribution in a patient's care but also a learning environment where each discipline learns and respects each other’s contribution to patient care. 

Partnerships

This project is part of the In Safe Hands Program by the Clinical Excellence Commission.

Contact

Acting Medical Director
In Safe Hands Ward, Orange Health Service
Western NSW Local Health District
Phone: 02 6361 1501