Innovative Approach to Rounding at Patient's Bedside Leads to Reduced Readmissions, Better Communication

LEXINGTON, Ky. (May 16, 2018) —  Being admitted to the hospital can be a stressful experience. Having to return to the hospital and be readmitted shortly after discharge due to complications or other issues, can significantly add to an already distressing situation.

While some readmissions are unavoidable, hospitals around the country are continuing to look for ways to reduce 30-day readmission rates and help patients have an improved transition from the hospital to home -- or other care facility.

At UK HealthCare, a new and unique interprofessional team approach has not only reduced readmissions but also enhanced communication among patient care providers and the patient, said Dr. Mark V. Williams, chief transformation & learning officer for the UK HealthCare and director of the UK Center for Health Services Research.

With support from the Office for Value & Innovation in Healthcare Deliver (OVIHD) in the Center for Health Services Research, Williams served as senior investigator for the study, "Interprofessional Teamwork Innovation Model (ITIM) to Promote Communication and Patient-Centered, Coordinated Care," recently published in the British Medical Journal for Quality and Patient Safety.

Dr.  Jing Li, lead author, and Williams worked with registered nurse Sheri Dotson, Dr. Preetham Talari, and pharmacist Kim Manning to develop the model, which promotes a collaborative environment where patients and their family caregivers, physicians, nurses, pharmacists, case managers and others work and share in the process of care.

"UK HealthCare’s teamwork approach to rounding on hospitalized patients generated novel results," Li said. "Prior research using bedside rounds did not show improvement in outcomes, but we documented reduction in 30-day readmissions with our approach." The results were also presented by Williams and UK HealthCare Chief Nurse Executive Colleen Swartz and featured at the annual meeting of the American Association of Colleges of Nursing.

The ITIM approach includes having a hospitalist, pharmacist and nurse case manager, along with the patient's bedside nurse, "round" or visit the patient as a team each day. The concept was first implemented on the 7th floor of UK HealthCare's Good Samaritan Hospital where registered nurse Sherri Dotson is the floor's unit manager.

"Change can be difficult and we have spent a lot of time communicating as a team to adapt to this rounding model but it has been worth the effort," Dotson said. "Now, Interprofessional Teamwork Innovation Model (ITIM) is the standard on our unit and most of those who work in this fashion would prefer to continue."

Traditionally, patient care providers from different departments have acted independently without consistent efforts to communicate to other members of the team  ̶  often leaving messages or notes that can be incomplete, misunderstood or misinterpreted.

One of the primary benefits of the interdisciplinary team model is that this team approach supports team members working together to all see and interact with the patient at the same time and work through any issues the patient may have had overnight, any medication problems, or discuss and resolve any other concerns all while at the patient's bedside.

"The team and the patient are on the same page regarding the daily goals and any issues that have been brought up during the rounds," Dotson said. "We have been able to troubleshoot barriers to discharge in advance due to improved communication among the team at the bedside and as a result our length of stay (LOS) for patients has decreased."

Coordinated care is especially important prior to discharge.

"Our patients at UK HealthCare often have multiple health issues and they often don't live locally," said Williams. "They come here from as far as several hours away and it's important we prepare them for that return home with the knowledge they need at discharge."

Despite initial concerns that the team rounding approach would significantly increase the time needed to see patients, it was later reported that the model saved substantial time by reducing the need and occurrence of subsequent pages and calls among the patient, nurses and other providers. 

Analysis also showed no overall increase in costs  ̶  despite the added expenses of a pharmacist and a case manager beyond existing staff. A major component of offsetting cost savings was a reduction in pharmacy costs driven by the addition of a pharmacist to the team.

Swartz, who also serves as chief administrative officer for UK HealthCare and was a member of the research team, says the success of the ITIM has led to the spread of the model to other floors at Good Samaritan and now to two 36-bed units at UK Chandler Hospital.

"The ITIM model provides a reliable and replicable structure for our complex interdisciplinary work," Swartz said. "The structure is particularly compelling because of the assurance that the patient remains at the center of goal setting, goal acquisition and a very deliberate plan for transition of care post hospitalization."

Despite the accelerated complexity and intensity of care at UK HealthCare during the last decade, the ITIM model provides structure in what is often a very chaotic environment, especially when viewed through the lens of patients and families, she added. 

"Now and in the future, health care systems will increasingly be more dependent than ever on effective and efficient teamwork to coordinate care," Williams said. "The ITIM approach provides a collaborative environment in which patients along with their family caregivers, physicians, nurses, pharmacists, case managers and others, coordinate more efficiently for ultimately improved patient care."