Abstract
ObjectiveTo describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement.DesignMixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7).Measurements and Main ResultsMedical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient’s bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥1 interruption for ≥50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning.ConclusionsThere is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.
Highlights
Effective communication among healthcare providers is essential for high quality patient care
Opportunities exist to improve Intensive Care Unit (ICU) rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality
Funding sources had no role in the design, conduct, or reporting of this study and the authors are unaware of any conflicts of interest
Summary
Effective communication among healthcare providers (subsequently referred to as providers) is essential for high quality patient care. A systematic review performed by Lane et al (2013)[4], which was recently updated[5], identified 13 best practices for ICU patient care rounds These included implementing interprofessional rounds (physician, nurse, and pharmacist at minimum)[6,7,8,9,10,11,12,13,14,15]; standardizing practices[16,17,18,19]; defining roles for all participants[20,21,22,23]; using a structured tool[24,25,26,27,28,29,30,31,32,33,34,35]; reducing time spent on non-essential activities[17,18]; minimizing interruptions[36,37,38]; developing and documenting daily goals[22,31,39,40]; considering the best location of rounds (bedside vs conference room) to optimize patient-centeredness and efficiency[36,41,42,43]; and establishing both an open and collaborative discussion environment[16,42,43,44]. The role of families in rounds in adult ICUs is less well defined and two recent studies have reported both positive and negative provider perceptions[56,57]
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