Angela Lambert

The Use of Structured Interdisciplinary Bedside Rounds to Improve Interprofessional Collaboration

BACKGROUND: Management of critically ill patients requires interprofessional collaboration (IPC) of healthcare teams to deliver on their promise of patient care excellence. Current practice in the Heart and Vascular Institute Critical Care Unit at Penn State Health, a quaternary care academic medical center in rural central Pennsylvania, lacks consistent use of structured interdisciplinary bedside rounds (IBR) to collaborate on key nursing quality indicators. This quality improvement project aimed to improve IPC using IBR to collaborate on hospital-acquired pressure injury (HAPI) and patient fall prevention plans for at-risk patients. 

METHODS: Structured IBR using the Braden and Morse Fall Scales were established to identify at-risk patients for HAPI and patient falls. A collaborative prevention plan was developed and documented in the medical record. Eligible participants included nurses, intensivists, and APPs. Pre- and post-intervention surveys were conducted to assess change in IPC using the Collegial Nurse-Physician Relations subscale from the National Database of Nursing Quality Indicators Practice Environment Scale of Nursing Work Index survey. RESULTS: 73 pre-intervention and 72 post-intervention surveys were sent with a response rate of 75% and 47.2%, respectively. Analysis of the pre-intervention and post-intervention surveys demonstrated an increase in the overall unit’s perception of collaboration over time (p = 0.014) but found no improvement in the overall unit’s perception of relationships (p = 0.315) or teamwork (p = 0.78). Additionally, there was a decrease in HAPI, stage 2 or higher, and injury falls per 1,000 patient days during the third quarter of 2022 when compared with the pre-intervention 12 quarter average which was also below the benchmarked national average when compared with like academic intensive care units with an adult cardiac specialty (Penn State Health, 2023b). 

CONCLUSION: The use of structured IBR, by targeting HAPI and patient fall prevention plans for at-risk patients, improved the overall unit’s perception of collaboration over time, but did not demonstrate a perceived improvement in relationships or teamwork which may have resulted from inconsistent intervention use. Additionally, the incidence of HAPI and patient falls with injury were fewer. Routine use of structured IBR to improve IPC between healthcare teams can lead to improved outcomes of nursing quality indicators and supports the expansion of IPC on all aspects of patient management during IBR rounds. 

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