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Interdisciplinary Rounds

The information needed to care for the patient is distributed across the care team. The fastest way to get that information is to bring the care team together — with the patient and the family — at the bedside.

The starting point for great interdisciplinary teams is structure: who says what, when, and in what sequence. Standardization creates the predictability everyone needs.

But to get results, team members need skills: the individual and collective competence to drive real progress and the best possible experience for patients.

Structured Interdisciplinary Bedside Rounds

With Structured Interdisciplinary Bedside Rounds (SIBR® rounds), hospital care teams have the Shared Mental Model they need to be great.

During SIBR, the the doctor and nurse come together at the bedside. With specific SIBR training and performance feedback they learn advanced skills and become self-aware: how to invite Collaborative Cross Checks and overcome Clinical Inertia; how to maximize team Situational Awareness and create the Common Ground that lets everyone complete interdependent tasks efficiently.

Great teams improve Reliability by an order of magnitude through call-and-response reviews of a quality-safety checklist. Great teams use Cognitive Empathy to improve patient satisfaction. And great teams deliberately create Resilience because they understand the difference between foresight, coping, and recovery. 

Through thousands of observations, we’ve identified the specific individual and team skills physicians and nurses need to get results from great interdisciplinary rounds.

Originally we created SIBR for ourselves. When we realized other hospitals had the same needs, we created a solution for them, too. We’re happy to offer hospitals a pathway to great teams that’s better, faster, and less expensive than doing it yourself or hiring a traditional consulting firm.

Many hospital units have discovered that SIBR is merely the engine in a much more advanced care model known as the Accountable Care Unit (ACU).

Accountable Care Unit

SIBR team lead physician asking the nurse for their inputs

Accountable Care Units (ACUs) are geographic care areas consistently responsible for the clinical, cost, and satisfaction outcomes they produce. ACUs have four complementary design features:

  1. Unit-based physician teams
  2. SIBR
  3. Unit-level performance reporting
  4. Unit-level physician and nurse co-leadership

Organizing care teams by units improves predictability and cohesiveness. At its core, the ACU is about bringing people together to work together and care together.

The ACU care model has been implemented in a wide range of inpatient units, from medical, pediatric, geriatric, and cardiology units to intensive care, progressive care, long-term acute care, and general surgery, neurosurgery and orthopedic units. The core principles remain, but customizations are typically needed for these different patient populations and environments.

If you’re interested in one or more ACUs, let us help.

Length of Stay reductions per unit

ACUs show 9-17% reduction in length of stay
*10% length of stay reduction on a 25 bed unit equates to approximately 120 additional patients per year cared for on the unit.

Cost reductions per unit in 1 year

ACUs save $1 million on average in 1 year
*ACUs can see savings of approximately $1 million (USD) in 1 year

ACU Briefing Video

What can the ACU Care Model do for your discipline?

Patients

Patient benefits reported:

  • Loving SIBR rounds
  • Happier patients
  • Better engaged patients
  • Opportunities to participate in decision making
  • Getting questions answered
  • Goal for the day discussed everyday
  • Better informed, less uncertainty
  • Increased family attendance at team rounds through set start time
  • Plan for discharge from first team meeting

Doctors

Doctor benefits reported:

  • Better communication with nurses and allied health
  • Quicker resolution of issues
  • Fewer pages
  • Less hectic shifts
  • Greater sense of control
  • SIBR saves time

Nurses

Nurse benefits reported:

  • Knowing when the doctor will come to see the patients – no more guessing, no more uncertainty
  • Better integration of nursing shifts
  • Structured information passed between shifts – keep your ‘brain’ sheet but get the key information your colleagues might ask you about – learn more
  • Plan of care shared between all team members for each patient during SIBR rounds
  • Better access to doctors

Allied Health

Allied Health benefits reported:

  • Better integration into planning
  • Better communication with physician and nurse colleagues
  • Quicker identification of barriers to discharge
  • Better able to support continuing care needs
  • Higher work satisfaction

Unit Leaders

Unit Leader benefits reported:

  • More control on day-to-day processes & operations
  • Happier unit staff
  • Happier patients and families: less complaints
  • Improved clinical, cost, and patient outcomes
  • Decreased turnover
  • More time for interpersonal relationships rather than administrative duties, e.g. recruiting and orienting new staff
  • Quieter units

Hospital Executives

Hospital executive benefits reported:

  • Happier staff
  • Happier patients
  • Better insight into unit processes
  • Improved insight into staff competencies
  • Better integration of stakeholder groups through SIBR
  • Improved sense of ‘team’ and ‘teamwork’ on units
  • Clinical cost savings
  • Reduced turnover

Outcomes of the ACU Care Model

  • Clinical Outcomes

    25% reductions in-hospital mortality (ARR 1.8% relative to controls)

    25% reductions in complications of care

  • $100-$1,500 reduction in direct variable costs per hospitalization

    $240K-$2.4MM reduction in direct variable costs per unit in 1st two years

    10-25% reduction in nursing turnover

  • Throughput

    9-15% reduction in length of stay (0.4 days relative to controls)

    5-50% reductions in 30-day readmissions (relative to controls)

  • Satisfaction

    2-3x higher patient satisfaction scores

    2-3x higher employee engagement scores and teamwork scores

1 = The Impact of Accountable Care Units on Patient Outcomes. manuscript in preparation.
2 = Portability and Success of a Clinical Microsystem Model in Improving Safety, Quality, and Cost at a Community Teaching Hospital. Oral presentation, Society of Hospital Medicine Annual Meeting, 2015, Washington DC
3 = Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of Multidisciplinary Healthcare 2017:8 33–37.

How would you like to learn more?

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