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No other interdisciplinary care model has been as thoroughly studied and validated.
Frequently Asked Questions
What is SIBR?
Structured Interdisciplinary Bedside Rounds (or SIBR, pronounced “cyber”) is a team-based, patient-centered teamwork model. SIBR brings the bedside nurse, physician, and any available allied health & therapy professionals to the bedside. It creates the time, space, and scaffolding for team members to:
- Exchange updates and collaboratively cross check information with the patient, family, and one another
- Re-examine assumptions and identify closely held misinformation
- Hold each other accountable to a quality-safety checklist
- Synthesize a mutually supported plan of care; and
- Create the common ground needed to complete interdependent tasks efficiently the rest of the day
SIBR uses a 6-step communication protocol which outlines who says what, when, and in what sequence. It is designed this way for efficiency, but also for “sense-making.” Sense-making, of course, refers to how much easier it is to make sense of a myriad of data points when listeners know and can trust they will hear the same thing in the same order every time.
For SIBR to be operationally effective, staff must learn to arrive to SIBR prepared, respect punctual start times, and adhere to the 6-step communication protocol. Because they make sense but are also not obvious, these operational norms are taught and emphasized initially through online and onsite training, then reinforced through practice until they become routine.
What is clinically effective SIBR?
Clinically effective SIBR must be high-performance SIBR. The path to high-performance SIBR starts with online and onsite training to learn individual SIBR skills and team SIBR skills. Individual SIBR skills are verified through real-time, electronic assessment and feedback of individual performance. Verification is data-driven: when an individual demonstrates 9 of 10 discrete SIBR high-performance behaviors for 3 different SIBRs, “SIBR Certification” is earned and tracked through a data and analytics software platform.
Team SIBR skills are learned through practicing “orchestration,” a unique concept taught and emphasized initially through online and onsite training, then reinforced through deliberate SIBR practice. The hallmark sign of a SIBR team practicing great orchestration is when participants routinely notice the effectiveness of each step of SIBR and interact dynamically as self-aware team members to optimize it.
High-performance SIBR requires training and self-awareness, but it drives all the gains, from throughput and cost outcomes to clinical outcomes and, patient and staff satisfaction. Just showing up to go through the motions of interdisciplinary rounds is not enough. As with any other clinical competence, expertise matters – each SIBR participant should have individual skills and teams skills.
High-performance SIBR can be tracked across key criteria and reported to unit leaders, service line directors and hospital executives using the 1Unit Software Platform.
How is Nurses First™ connected to Structured Interdisciplinary Bedside Rounds (SIBR)?
Units that have already implemented Nurses First will have their nurses optimally set up to participate in SIBR rounds. The Nurses First Bedside Handover includes the quality-safety checklist items that the nurses will be sharing during SIBR.
Nurses should leave nursing bedside handover with >90% of the information they need for each of their patients for SIBR. Our handover process thus enables bedside nurses to continue with their other key tasks during the busy morning period, yet are always ready to present or advocate for their patients during the shift.
By aligning nursing handover with the nurse’s portion of SIBR, we reduce communication errors and elevate the preparedness and presentation skills of all bedside nurses, so that nurses can be fully recognized as being the experts on their patient.
We have numerous reports of new grad nurses handing over to specialist consultants or Rapid-Response Teams/Medical Emergency Teams with confidence, composure, and clarity.
SIBR Training Process
Brief online videos and quizzes followed up by efficient classroom training for all SIBR participants.
Charge nurses and clinical educators use our web-app to conduct quick electronic skills assessments — providing private, objective feedback on actual bedside skills. When SIBR participants can demonstrate high-performance behaviors at the bedside, they earn their SIBR Certification.
Regular activity reports and performance analytics to track progress of each individual and unit, so leaders can quickly gauge progress and take action.
Accountable Care Units (ACUs)
Organizing care teams by unit creates predictability, cohesiveness, and better communication.
At its core, the ACU is about bringing people together to work together and care together.
An Accountable Care Unit (ACU) is a hospital unit specifically organized for operational and clinical effectiveness.
An ACU starts with Nurses First, but then goes beyond to add SIBR and a nurse-physician dyad as a co-leadership and co-management layer.
A fully developed ACU has four features:
- Unit-oriented physician teams: physicians able to dedicate themselves to the relationships and routines of a single unit throughout a day or week.
- Unit-based teamwork: nurses support each other through Nurses First and integrate with physicians through high-performance Structured Interdisciplinary Bedside Rounds (SIBR).
- Unit co-leaders: the nurse manager and a specified physician partner are paired in formal co-leadership roles to support staff, set high expectations, and to drive key performance indicators. This dyad receives special attention from hospital leadership, but also accepts responsibility for managing the unit’s outcomes to specific targets.
- Unit performance reports: the unit co-leaders have the training, performance and clinical outcomes data to share with staff and the autonomy and accountability to actively manage outcomes.
When these 4 elements are present, remarkable results are possible. See the Evidence Base section for a variety of results reported by ACUs.