Multidisciplinary Healthcare Providers Research Articles

Provider Perspectives on the Implementation of Psychosocial Risk Screening in Pediatric Cancer.

Psychosocial risk screening is an important initial step in delivering evidence-based care. This qualitative descriptive study identified how multidisciplinary pediatric oncology health-care providers perceive psychosocial risk screening to identify factors in uptake and implementation. A script guided digitally recorded (transcribed) interviews regarding psychosocial screening and challenges to facilitators of screening. Participants were 15 multidisciplinary staff (physicians, nurses, social workers, psychologists, physician assistant) at nine sites, three using the Psychosocial Assessment Tool© for research and six for clinical care. Constant comparative analysis was used to analyze the independently coded interviews. Thematic content analysis identified an overarching theme - Screening is important because it facilitates clinical care - and four subthemes: Optimizing Psychosocial Care, Implementing Screening, Engaging Families, and Utilizing Clinical Pathways. Findings support the importance of integrating psychosocial risk screening into clinical care and offer strategies for implementation of screening across a range of settings.

Development of a decision aid for young canadians diagnosed with breast cancer who are at risk of infertility following cancer treatment.

108 Background: Young breast cancer patients are at risk of temporary or permanent infertility following the administration of gonadotoxic cancer treatments. Currently patients do not feel they receive enough information to make informed fertility decisions before treatment. We aim to determine the fertility-related information health care providers and breast cancer survivors consider valuable to include in a Canadian decision aid (Can-DA) for young breast cancer patients by reviewing existing decision support resources. Methods: A qualitative descriptive approach was used to evaluate 6 decision support resources created in other jurisdictions. Using purposeful sampling, 8 multi-disciplinary health care providers and 8 breast cancer survivors from across Canada evaluated 1 to 2 decision support resources in structured interviews. Interviews were conducted in-person and by telephone from March to June 2016 and ranged in length from 30 to 90 minutes. Interviews were transcribed verbatim, organized in NVivo, and analyzed deductively using the pre-defined sections of the interview guide as a framework. Results: Each decision support resource had valuable components to adapt for the Can-DA. Participants valued the inclusion of Canadian-specific and accurate information on resources for additional support and the success rates and cost ranges of fertility preservation procedures. There were mixed views on the impact and value of including in-depth fertility information such as adoption and other fertility-related options after treatment. Discrepancies were also seen on the value of personal stories and an explicit values clarification exercise. There was consensus on the inclusion of only pertinent fertility-related information that does not replicate information in supplementary patient education material to avoid overwhelming patients. Conclusions: The evaluation provided valuable insight on the information and design features to consider for the Can-DA. Findings will be used in combination with the International Patient Decision Aid Standards criteria to ensure the Can-DA meets the fertility information needs of young breast cancer patients in Canada.

P2-196 - Innovation of multidisciplinary oncologic team through the workshops in rural area. -The challenge of MAHOLOBA-juku-

Background: Although the necessity of multidisciplinary oncologic medical care team has been emphasized in the field of medical oncology, it must be not so easy to perform actually high quality daily practice through the medical team in medical institutes of the rural area. Aims: Under the basic understanding for concept of effective multidisciplinary medical team building, the common problems in each medical institutes were extracted and discussed to solve these with sharing information each other. Objective and Methods: For health care providers who work around cancer chemotherapy at the hospital in Nara prefecture, “Medical And HOListic Oncology Brush-up Academy (MAHOLOBA-juku)” was established. The Academy held WS style conference to encourage active participation of attendee, who discussed through the group works and then the plenary discussion was done by all participants and facilitators. Results: At first the common oncologic problems were extracted, and the issues, which were considered highly important and urgent were chosen as WS themes. In the questionnaire, satisfaction degree of the attendee was high in each WS, and their comments were mainly positive and prospective ones such as obtaining a new awareness for the importance of medical team, hoping to make unique guideline or to share and communicate information by SNS or mailing list. Conclusions: WS by the multidisciplinary health care providers considered effective tool to extract problems and share information for improvement of medical oncology and care in entire area. The Academy must be keep innovating and advancing to empower the team ability more powerful by receiving more various discipline participants such as MSW and nutritionists, furthermore, survivors and peer supporters not only medical doctors, nurses and pharmacists.

Patient and health-care provider perspectives of pregnancy-related health-care provision in Guangdong, China: a qualitative interview-based study

BackgroundPregnancy-related care can reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes. But little is known about the special health-care needs related to pregnancy of these women, or about the gap between these needs and health-care provision in China. We aimed to identify the perceived needs in women with type 1 diabetes and health-care providers for pregnancy-related care. The goal is for the findings to assist in the establishment of optimised management of this population in China. MethodsWe did in-depth interviews, a method widely used in social science to investigate people's attitudes and behaviours. The intended interviewees included women with type 1 diabetes (aged ≥18 years) and health-care providers of both diabetes-related and pregnancy-related disciplines living in Guangdong, China. Written informed consent was obtained from all participants. Selective sampling was used to ensure that the recruited women with type 1 diabetes covering different areas of Guangdong, and were of diverse age, disease duration, marital and child-bearing status, income, and education level; and to ensure that the included health-care providers were from different types of health-care facilities. Transcripts of the interviews were coded into themes by three investigators (SX, SL, and CW) via a thematic framework method and NVIVO (version 10) qualitative software. The recruitment ended when no new themes emerged. Rendered themes of women with type 1 diabetes and health-care providers were compared by thorough discussion within the study team. FindingsThe recruitment started in April, 2015, and ended in June, 2016. 30 women with type 1 diabetes (mean age 26·9, SD 5·7 years) and 35 health-care providers (17 physicians and 18 nurses; 24 from general hospitals and 11 from community health facilities) were included in the study. Pregnant women and health-care providers agreed that pregnancy-related health-care resources were scarce and knowledge of pregnancy-related health care needs of both patients and health-care providers was limited. Both groups agreed that pregnancy-related health care in various forms should be started at the age of maturity (18 years old) and done by well-trained multidisciplinary health-care providers. Both groups acknowledged the importance of peer support in pregnancy-related health care. And both groups agreed on the need for guidelines for planned pregnancy and management of blood glucose and diabetic complications during pregnancy. However, health-care providers reported that bodyweight management, fetal development monitoring, type 1 diabetes-specific screening tests, and postnatal lifestyle should also be emphasised. Health-care providers had a generally positive attitude to outcomes of pregnancy if glycaemic control was satisfactory, whereas patients tended to have a pessimistic perspective. Finally, women with type 1 diabetes expressed great unmet needs: thorough and timely communication with health-care providers, psychological consultation, and type 1 diabetes knowledge in non-diabetician health-care providers. Most health-care providers did not show awareness of these needs, although they were aware of insufficient pregnancy-related knowledge and expressed their intent for further training. InterpretationWomen with type 1 diabetes had various unmet needs for pregnancy-related health care, but the health-care resources were scarce in Guangdong. Both patients and health-care providers had gaps in knowledge of the need for pregnancy-related health care, indicating that further education should be given to patients, and the role of professional and psychosocial support should be enhanced. These findings identify gaps between the needs of women with type 1 diabetes and current health care provision, and would be helpful to guide the establishment of a patient-centered pregnancy-related health care system in Guangdong. FundingNational Health and Family Planning Commission Foundation for public welfare industry research project (201502011), World Diabetes Foundation (WDF14-921), and Sun Yat-Sen University clinical research 5010 program (2007030).

What does 'palliative care' mean? Diverse definitions from cancer care providers.

40 Background: Existing literature on the epistemology of palliative care has mostly centered on patient/family perspectives. Understanding how multi-disciplinary healthcare providers themselves define palliative care is a critical step towards addressing barriers and harnessing facilitators that affect optimal delivery. Methods: Semi-structured key informant interviews (N = 19) were conducted with members of healthcare provider teams as part of a qualitative study on goals of care for cancer patients enrolled in clinical trials. Purposive sampling included diverse roles: attending physicians/principal investigators, oncology fellows, physician assistants, research and clinical nurses, patient care coordinators, palliative care physicians, social workers, chaplains, and pharmacists. One probe asked participants, “What does palliative care mean to you in your work?” Responses were transcribed and independently coded by two raters using interview-derived deductive and emergent inductive codes. Themes were then identified and analyzed using NVivo. Results: Informants included different elements in their definitions: attributes of palliative care (“Palliative care is helpful”); structure (“We have a pain and palliative team”); patient outcomes “(comfort”), and relation to other services (“adjunct to necessary medical care”). Additional themes also included (1) the charge of palliative care to alleviate suffering; (2) the recognition that palliative care should be holistic; (3) the centrality of symptom management, in particular pain; (4) the conflation of end-of-life, hospice, and palliative care; (5) tensions between palliative and curative care. Provider role and specific team membership appear to influence perspectives on definitions of palliative care. Conclusions: Providers share a wide range of perspectives on the operationalization of palliative care in their work. In addition to soliciting input from patients and family members, the viewpoints of a diverse set of providers should be ascertained often to inform models of care, alleviate tensions between palliative and curative care provider teams, and increase optimal usage of palliative care.

Management of Tooth Wear: A Holistic, Dental, Medical, and Mental Healthcare Approach

Tooth wear is a condition that affects a substantial cohort of dental patients. It has a measurable impact on patients' satisfaction, and overall quality of life. Recently, with growing evidence, our understanding of the aetiology, progression, and management of tooth wear has evolved. The paper argues that pathological tooth wear should not be solely considered as a dental condition, but rather a dental manifestation of other mental and medical disorders. As such, successful management of tooth wear, and its underlying aetiology, requires a holistic, multidisciplinary management approach, involving dental, medical, and mental healthcare providers.

The Youth Throwing Score

Objectives:Epidemic levels of shoulder and elbow injuries have been reported in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. The purpose of this study was to validate an upper extremity assessment tool specifically designed for youth baseball players. We hypothesize this tool will be reliable, responsive and valid.Methods:The Youth Throwing Score (YTS) was constructed by a multidisciplinary healthcare provider team in addition to baseball coaches as a tool to assess upper extremity injury in 10 to 18 year old baseball players. The instrument was comprised of a demographics section and a 14 item assessment of pain, fatigue and psychosocial health. The 14 items were scored from 1 to 5 and weighted equally, with higher scores reflecting fewer symptoms and less functional disability. The psychometric properties, including the test-retest reliability, internal consistency, and responsiveness were calculated. Additionally, the Pearson correlation coefficient to 4 validated outcomes was determined.Results:A pilot form of the instrument was administered to 25 players to assess comprehension and mean item importance. Pilot analysis resulted in none of the 14 items receiving less than a 3 out of 5 mean athlete importance rating and the final instrument read at a Flesch-Kincaid level of 4.1, appropriate for patients age 9 and older. A total of 223 players completed the Youth Throwing Score, with an average player age of 14.3 ± 2.7 years old. The players self-assigned injury status, resulting in an average survey score of 59.7 ± 8.4 for the 148 players ‘playing without pain,’ 42.0 ± 11.5 for the 60 players ‘playing with pain,’ and 40.4 ± 10.5 for the 15 players ‘not playing due to pain.’ Players playing without pain scored significantly higher than those playing with pain (p < .001). The scoring tiers of the Youth Throwing Score are displayed in Figure 1. Additionally, players who had suffered throwing arm injuries (P < .001) and players who has undergone throwing arm surgeries (P = .039) scored significantly lower on the YTS. Finally, players who participated in both their school and club teams scored lower than those who only played for either their school or club teams (P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument Sports/Physical Functioning Scale (PODCI), Kerlan Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), and the Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH). Injured players scored an average of 9.4 points higher following treatment (P < .001) and players who improved in their self-assigned pain categorization scored 16.5 points higher (P < .001). The statistical properties of the Youth Throwing Score are summarized in Table 1.Conclusion:The Youth Throwing Score is the first valid, reliable and responsive instrument designed for assessing young baseball players’ upper extremity health. Its robust psychometric properties indicate its potential in assisting physicians care for injured throwers.

Human Factors Approach to Comparative Usability of Hospital Manual Defibrillators

IntroductionEquipment-related issues have recently been cited as a significant contributor to the suboptimal outcomes of resuscitation management. A systematic evaluation of the human-device interface was undertaken to evaluate the intuitive nature of three different defibrillators. Devices tested were the Physio-Control LifePak 15, the Zoll R Series Plus, and the Philips MRx. MethodsA convenience sample of 73 multidisciplinary health care providers from 5 different hospitals participated in this study. All subjects’ performances were evaluated without any training on the devices being studied to assess the intuitiveness of the user interface to perform the functions of delivering an Automated External Defibrillator (AED) shock, a manual defibrillation, pacing to achieve 100% capture, and synchronized cardioversion on a rhythm simulator. ResultsTimes to deliver an AED shock were fastest with the Zoll, whereas the Philips had the fastest times to deliver a manual defibrillation. Subjects took the least time to attain 100% capture for pacing with the Physio-Control device. No differences in performance times were seen with synchronized cardioversion among the devices. Human factors issues uncovered during this study included a preference for knobs over soft keys and a desire for clarity in control panel design. This study demonstrated no clearly superior defibrillator, as each of the models exhibited strengths in different areas. When asked their defibrillator preference, 67% of subjects chose the Philips. ConclusionsThis comparison of user interfaces of defibrillators in simulated situations allows the assessment of usability that can provide manufacturers and educators with feedback about defibrillator implementation for these critical care devices.

Stigma About Mental Illness Among Multidisciplinary Health Care Providers in the Dominican Republic

Few studies have examined the attitudes of multidisciplinary health care providers toward mental illness, particularly in Latin America. The present study explored the attitudes of health care providers in the Dominican Republic (DR) toward persons with mental illness. Five Spanish-language focus groups were conducted in different regions of the DR with a purposive sample of 37 multidisciplinary health care providers and administrators. We found that among Dominican health care professionals mental illness was primarily defined as schizophrenia. Stigma was pervasive, but differed based on level of experience with persons with mental illness. People with mental illness were perceived as out of control and unable to conform to societal norms, resulting in fear and a lack of empathy among care providers. General practitioners felt unprepared to manage mental illness and unsupported by families and communities that also held stigmatizing attitudes. Providers considered government investment in mental health services imperative to improve access to treatment. Currently there are few options for intervention or rehabilitation for persons with severe mental illness. Strategies to reduce stigma among nonmental health care providers include governmental prioritization of mental health care, as well as formal training and clinical exposure to persons with mental illness in recovery.

Supplemental Material for Stigma About Mental Illness Among Multidisciplinary Health Care Providers in the Dominican Republic

Supplemental Material for Stigma About Mental Illness Among Multidisciplinary Health Care Providers in the Dominican Republic

Mental Health Care Providers' Views of Their Work with Consumers and Their Reports of Recovery-Orientation, Job Satisfaction, and Personal Growth.

The research examined the role of mental health care providers' perceptions of their professional relationships with consumers in understanding their reports of agency recovery-oriented services and their own sense of job satisfaction and personal growth. Multidisciplinary community mental health care providers (N=105) responded to an online self-report questionnaire. Providers' reports of higher levels of working alliance and greater provider directiveness in working with consumers was significantly related to providers' reports of higher levels of agency recovery-orientation and higher levels of personal growth. Providers' reports of working alliance accounted for the largest proportion of variance in providers' reports of job satisfaction. Mental health providers' perceptions of relationships with consumers are central to understanding providers' views of agency recovery-orientation and sense of professional and personal well-being.

Understanding recall rates in screening mammography: A conceptual framework review of the literature

Recall rates are one of the performance measures used to evaluate the effectiveness of mammography screening programs. There is conflicting evidence regarding the link between recall rates and cancer detection rates and a variety of differing recall rates exist between countries and readers. This variability in recall rates may have important clinical and economic implications such as unnecessary follow-up procedures, additional costs to the health care system and psychological effects for the women themselves associated with false-positive mammograms results. In order to reduce the impact of false positive recall rates in screening mammography, it is essential for all multidisciplinary health care providers, especially those in medical imaging, to fully understand the factors that may contribute and affect recall rates. The multifactorial nature of recall rates is explored in this paper through the construction of a conceptual map based on a review of the current literature.

Work-related stress and reward: an Australian study of multidisciplinary pediatric oncology healthcare providers.

Managing staff stress and preventing long-term burnout in oncology staff are highly important for both staff and patient well-being. Research addressing work-related stress in adult oncology is well documented; however, less is known about this topic in the pediatric context. This study examined sources of work-related stress and reward specific to multidisciplinary staff working in pediatric oncology in Australia. Participants were 107 pediatric oncology clinicians, including medical, nursing, and allied health staff from two Australian pediatric oncology centers. Participants completed an online survey using two newly developed measures: the work stressors scale-pediatric oncology and the work rewards scale-pediatric oncology. The most commonly reported sources of both stress and reward are related to patient care and interactions with children. Results indicated that levels of work-related stress and reward were similar between the professional disciplines and between the two hospitals. Regression analyses revealed no demographic or organizational factors that were associated with either stress or reward. Work-related stress and reward are not mutually exclusive; particular situations and events can be simultaneously stressful and rewarding for healthcare providers. Although patient care and interactions with children was found to be the most stressful aspect of working in this speciality, it was also the greatest source of reward. Results are discussed in relation to workplace approaches to staff well-being and stress reduction.

Palliative Care Nursing in Jordan

Palliative care is progressively more existing and the importance of its role is increasingly acknowledged by many countries. This paper identifies and examines main stepladders taken by Jordan for the development of palliative care. In palliative care, the primary goal is alleviating symptom distress resulting from multiple symptoms and enhancing quality of life for patients and their families. To meet patients’ multiple needs, it is generally believed that the care should be holistic, multidisciplinary, and patient as well as family centred. Countries should develop and implement educational programs for multidisciplinary healthcare providers so as to be able to enhance the quality of care provided to patients and families at all levels of care. Unfortunately, in Jordan, skill development among health care providers; few educational and training opportunities exist to this point; and specialty acknowledgement also has not yet occurred. Research capacity is also inadequate. Policy to develop, improve, and sustain palliative care is also lacking in Jordan. Palliative care in Jordan is evolving but has far to go. Adequate resources provision, educational programs, credentialed healthcare providers are crucial elements that palliative care in Jordan needs.

Multi-disciplinary Care for the Elderly in Disasters: An Integrative Review.

Older adults are disproportionately affected by disaster. Frail elders, individuals with chronic diseases, conditions, or disabilities, and those who live in long-term care facilities are especially vulnerable. Purpose The purpose of this integrative review of the literature was to describe the system-wide knowledge and skills that multi-disciplinary health care providers need to provide appropriate care for the elderly during domestic-humanitarian and disaster-relief efforts. Data sources A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed, CINAHL, and PsycINFO were conducted using terms such as Disaster, Geological Processes, Aged, Disaster Planning, and Vulnerable Populations. Forty-six articles met criteria for inclusion in the review. Policies and guidance regarding evacuating versus sheltering in place are lacking. Tenets of elderly-focused disaster planning/preparation and clarification of legal and ethical standards of care and liability issues are needed. Functional capacity, capabilities, or impairments, rather than age, should be considered in disaster preparation. Older adults should be included in disaster planning as population-specific experts. Implications for Practice A multifaceted approach to population-specific disaster planning and curriculum development should include consideration of the biophysical and psychosocial aspects of care, ethical and legal issues, logistics, and resources.

Perinatal Psychiatry

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.As our field has seen a growing amount of evidence-based publications on topics within perinatal psychiatry, it is both easier to offer treatment to women who are pregnant, planning pregnancy, or postpartum and at the same time more difficult to keep up with the amassing literature. Within perinatal psychiatry, there is the dilemma of the need for an adequate number of multidisciplinary health care providers to deliver treatment, while the individual risk/benefit analyses and treatments are complex and, it could be argued, require the expertise and time of a clinician well versed in perinatal psychiatry. Has the time come for a recognized specialty in Perinatal Psychiatry?

Collaborative care for the treatment of comorbid depression and coronary heart disease: a systematic review and meta-analysis protocol.

BackgroundDepression and coronary heart disease (CHD) are frequently comorbid and portend higher morbidity, mortality and poorer quality of life. Prior systematic reviews of depression treatment randomized controlled trials (RCTs) in the population with CHD have not assessed the efficacy of collaborative care. This systematic review aims to bring together the contemporary research on the effectiveness of collaborative care interventions for depression in comorbid CHD populations.Methods/DesignElectronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) will be searched using a sensitive search strategy exploding the topics CHD, depression and RCT. Full text inspection and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Eligibility criteria are: population, depression comorbid with CHD; intervention, RCT of collaborative care defined as a coordinated model of care involving multidisciplinary health care providers, including: (a) primary physician and at least one other health professional (e.g. nurse, psychiatrist, psychologist), (b) a structured patient management plan that delivers either pharmacological or non-pharmacological intervention, (c) scheduled patient follow-up and (d) enhanced inter-professional communication between the multiprofessional team; comparison, either usual care, enhanced usual care, wait-list control group or no further treatment; and outcome, major adverse cardiac events (MACE), standardized measure of depression, anxiety, quality of life, cost-effectiveness. Screening, data extraction and risk of bias assessment will be undertaken by two reviewers with disagreements resolved through discussion. Meta-analytic methods will be used to synthesize the data collected relating to the outcomes.DiscussionThis review will evaluate the effectiveness and cost-effectiveness of collaborative care for depression in populations primarily with CHD. The results will facilitate integration of evidence-based practice for this precarious population.Systematic review registrationPROSPERO CRD42014013653.

An Evolving Identity: How Chronic Care Is Transforming What it Means to Be a Physician.

Physician identity and the professional role physicians play in health care is rapidly evolving. Over 130 million adults and children in the USA have complex and chronic diseases, each of which is shaped by aspects of the patient's social, psychological, and economic status. These patients have lifelong health care needs that require the ongoing care of multiple health care providers, access to community services, and the involvement of patients' family support networks. To date, physician professional identity formation has centered on autonomy, authority, and the ability to "heal." These notions of identity may be counterproductive in chronic disease care, which demands interdependency between physicians, their patients, and teams of multidisciplinary health care providers. Medical educators can prepare trainees for practice in the current health care environment by providing training that legitimizes and reinforces a professional identity that emphasizes this interdependency. This commentary outlines the important challenges related to this change and suggests potential strategies to reframe professional identity to better match the evolving role of physicians today.

Unraveling exercise addiction: the role of narcissism and self-esteem.

The aim of this study was to assess the risk of exercise addiction (EA) in fitness clubs and to identify possible factors in the development of the disorder. The Exercise Addiction Inventory (EAI), the Narcissistic Personality Inventory (NPI), and the Coopersmith Self-Esteem Inventory (SEI) were administered to a sample of 150 consecutive gym attenders recruited in fitness centers. Based on EAI total score, high EA risk group (HEA n = 51) and a low EA risk group (LEA n = 69) were identified. HEA reported significantly higher total score (mean = 20.2 versus 14.6) on the NPI scale and lower total score (mean = 32.2 versus 36.4) on the SEI scale than LEA. A stepwise regression analysis indicated that only narcissism and self-esteem total scores (F = 5.66; df = 2; P = 0.006) were good predictors of days per week exercise. The present study confirms the direct and combined role of both labile self-esteem and high narcissism in the development of exercise addiction as predictive factors towards the risk of addiction. Multidisciplinary trained health care providers (physiatrists, psychologists, and psychiatrists) should carefully identify potential overexercise conditions in order to prevent the potential risk of exercise addiction.

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Introduction: Effective and efficient formal daily rounds are essential for patient care in any hospital setting. They allow for a clear exchange of information and formulation of a daily care plan. Family centeredness is a significant component in this commitment. Communication between families and multidisciplinary health care providers can be improved efficiently and adherence to best practice recommendations promoted by utilizing structured family centeredness. Methods: A structured standardized rounds policy was developed with well defined roles for each provider and provision of family participation. A quality improvement project utilizing a series of PDSA cycles was utilized to assess its effectiveness and monitor progress. To ensure that the process unfolds reliably and consistently, compliance was audited by daily review of the nursing presentation script. Deficiencies/obstacles were discussed/rectified in monthly team meetings. Results: Four Plan (P), Do (D), Study (S) and Act (A) cycles were conducted as following: Cycle 1: (P) Identify barriers. (D) Stakeholder survey (n=135). (S) Total response rate 53% with 70% preferring bedside rounding. Concerns included coordinating rounds with consulting services (22%) and distraction factors (19%). (A) A structured rounding policy was developed with resident and nursing presentation template. Cycle 2: (P) Observe compliance. (D) Script analyzed (n=322). (S) Completion rate 81%, family presence 37%, RT presence 22%. (A) Blueprint modification for easier data entry and extraction. Participation barriers identified and removed. Cycle 3: (P) Monitor patient care bundles. (D) Template incorporation (n=156). (A) Need for central line completed 85%, extubation readiness 78%, urinary catheter need 94%. (A) Integrate bundle elements. Cycle 4: (P) Add daily goal checklist. (D) Describe goal section. (S) Compliance of daily goals being monitored. Conclusions: These results demonstrate that a continuous PDSA cycle is an efficient technique adaptable to complex systems with multiple stake holders. Continuous quantitative and qualitative assessments of family and healthcare provider satisfaction along with patient care guidelines compliance (CLABSI, VAP and CAUTI bundles) can be effectively monitored utilizing such techniques.