Clinical Nurse Leader Johns Hopkins All Children's Hospital Tampa, Florida, United States
Abstract:
Introduction: The multidisciplinary rounding format has been proven to decrease mortality, ventilator days, hospital acquired conditions (HAC), and improve patient safety by promoting enhanced team work and communication. We sought to assess the impact of a standardized rounding format utilizing a rounding tool on patients’ outcomes.
Methods: We implemented a quality improvement project using pre-post interventional methodology in a 22-bed tertiary care Cardiovascular Intensive Care Unit (CICU). All patients admitted to the CICU between December 2021 and June 2022 were included. Several key safety elements required for daily discussions were selected. Baseline data inclusive of discussed and omitted key safety elements was collected from December 2021 through January 2022. A rounding tool in script format was developed to include the key safety elements. Allowing for one-month education, post-intervention data was collected from March 2022 through June 2022. We aimed to standardize the rounding process by introducing a rounding script, with a SMART aim of 90% complete script utilization by June 2022. The process measures included percent of complete script utilization, percent of time key safety elements were addressed (discharge checklist, access and line days, catheter days, preventable harm) and percent of closed loop communication utilization. The outcome measures were line and overall device days, HAC rates, and discharge related preventable readmissions. The key balancing measure was rounding length of time.
Results: Analysis of 165 pre-intervention observations showed the discharge checklist discussion at 40% of the time, central line days and necessity at 33%, closed loop communication at 25%, and preventable harm at 24% of the time. Analysis of 278 post-intervention observations showed a complete rounding script utilization at 59% while individual items inclusive of discharge checklist at 93% of the time, closed loop communication utilization at 86% of the time, central line days and necessity 80% of the time, and preventable harm at discussed 77% of the time. Central line days decreased from a mean of 0.34 to a mean of 0.26. The CLABSI rate per 1,000 central line days decreased from 2.70 in the first six-month interval to 0 in the second interval post-intervention. There were 9 readmissions, none related to discharge. Rounding time averaged from 1 hour 29 minutes pre to 1 hour and 24 minutes post-intervention.
Conclusions: While the entire rounding script was utilized only 59% of the time, below our 90% SMART aim, the project demonstrated the value of a standardizing rounds with the utilization of a rounding tool. By empowering the interdisciplinary staff to adopt this as a routine practice, the team exceled in multiple areas increasing the discussion of discharge checklists by 53%, closed loop communication by 61%, discussion of central line days and necessity by 47%, preventable harm by 53% and ultimately impacting line days and CLABSI rates. Lastly, by adopting this tool we created a shared mental model and were able to maximize rounding efficiency by maintaining length of time while discussing all necessary key safety elements that positively impact patient safety and outcomes
