Improving team work during bedside rounds: using daily goals and best practices

Introduction

Communication between healthcare professionals is a key step for patient safety, its failure accounting for over 60% of root causes in sentinel events [1]. Bedside rounds are important for teamwork communication and can be improved by an explicit approach [2] and by process-oriented information tools to organize and direct interprofessional rounds [3].

Methods

As part of a quality improvement project, we conducted an observation of the documentation of daily goals (DG) and best practices (BP) in a step-down unit (both tools have been previously added to patient flowsheets), before and after the introduction of a structured rounds process and team education. Our hypothesis was that these important tools were used before rounds, without input from all team members. Rounds were observed on two separate periods and the observer would take notes of whether DG and BP were documented or not and whether discussion took place before documentation. Differences in proportions between the two periods were analyzed with Fisher's exact test. P < 0.05 was considered significant.

Results

We observed 100 bedside interactions on each period. Documentation remained unchanged for DG (pre 55% vs post 53%, P > 0.05) and BP (pre 57% vs post 48%); however, the second period had an improved documentation after team discussion (DG: pre 2% vs post 31%, P < 0.001; BP pre 0% vs post 33%, P < 0.001).

Conclusions

The intervention aided in increasing documentation after discussion, implying an increased communication among the interprofessional team. About 50% of patients still will not have documentation after bedside rounds. Patient information was not collected, therefore our study is limited in providing information on clinical outcomes. Further research should focus on how to best implement these tools, how to qualitatively assess the content of daily goals and to demonstrate effects on patient-centered outcomes.