A U.S. children’s hospital halved the time taken for rounds in its paediatric intensive care unit (PICU) following interventions also aimed at increasing team engagement and patient and family satisfaction. The study is published in BMJ Quality Improvement Reports.
Kirsten Beck, Seattle Children’s Hospital, and colleagues set out to improve the quality of rounds in the PICU. Rounds took around 4 hours per day, and involved at least ten different roles, with unclear expectations for each role. In particular, rounds did not reliably advance the daily care plan, they write. Previous attempts to improve rounds had failed, they note:
“The inability to sustain improvements was attributed to the lack of formal quality improvement training for members of the care team, lack of agreement about the purpose of rounds, missing focus on patient and family needs, limited leadership support, and the absence of data to assess the impact of changes.”
The project’s background goals:
- the purpose of rounds is to advance the care of the patient
- to efficiently use the time of all the people on the care team
- reduce rounding time from four hours to two hours
See Also: 5 Ways to Improve ICU Rounds
The measures implemented included a written care plan for each patient, a documented review of patient care quality and safety indicators, such as catheter removal, which is included in a standard Plan of the Day template and a read back of patient orders to the whole team. In addition, a formal rounding schedule meant that families knew when the team would be at their child’s room. Plans of the days were posted in the patients’ rooms and scripts were provided for what information each team member was to present. Most teaching and complex family conversations were taken off rounds. Since the intervention was implemented, much of the information is available electronically. The authors note that this intervention is applicable elsewhere, and is being implemented in their cardiac ICU.