Multidisciplinary rounds

I work predominantly in MICU and, like you said, our MDs are present for rounds everyday. The difference is the rounding was initiated by the pulmonologists. The SICU rounds are essentially the same and I see all the surgeons with their "minions" (as we like to call them) rounding, starting around 0630.

Sorry your doctor was a sarcastic jerk. Maybe if you could start documenting who was present and identify their medical chief as a co-signer things could change?

Our Docs were the ones who actually initiated our multidisciplinary rounds by encouraging nursing and other disciplines to attend their rounds. It sounds like it is the surgeons you are having the most trouble with, which is not surprising since surgeons tend to be the most independent and headstrong (jerks). The most you can do is make the case for their involvement with any supporting evidence, and be flexible while still expecting that they respect your time as well.

I work on a PCU. we have interdisciplinary rounds m-f. Our MDs are required to come. They obviously play an important role in plan of care. Since you are at a teaching hospital there should be a director for the surgical residency program. Perhaps your NM could contact them.

Good luck getting any kind of surgical MDs to do multidisciplinary rounds. They are a lot diffferent than non-surgeons. Their "rounds" consist of a 3 minute peek at the patient and make sure they are still breathing. Then its off to the OR as quick as possible to get as many cases in the day as they can.

Non-surgeon MDs will be more receptive to the idea, and thats ONLY because they dont have any OR time they are trying to schedule around. They have a lot more time to hang out and do rounds with everybody.

Multidisciplinary rounds are a good idea, its helpful to get everybody on the same page. However coordinating all those people to come together at the same time is a logistical nightmare.

My assumption is that the decision to do multidisciplinary rounds was collaborative -- meaning my nurse manager probably initiated it, but I can't imagine that she could unilaterally decide to do this without physician input (since they are a key member of the team.) I would have to think that the SICU medical director and staff MDs bought into the plan to do this as well.

Oh I'm sure thats exactly how it happened. If you sent out a memo to all the surgeons about it, I'm sure they'd love the idea in theory as well..

Then, when the rubber hits the road and they realize that its going to delay them by even a little from getting to the OR in the AM ASAP, thats where it falls apart. Getting surgeons to agree in principle to group rounds and then actually getting them to utilize it in practice, when it makes them "late" in getting to the OR, are 2 entirely different animals.

You structure the rounds in such a way so that they can get to the OR at the same time, and I'm sure they would all be glad to do it. But time is money and as long as they perceive these group rounds to be holding them away from their cash machine (i.e. OR time) they are NOT going to participate.

Oh I'm sure thats exactly how it happened. If you sent out a memo to all the surgeons about it, I'm sure they'd love the idea in theory as well..

Then, when the rubber hits the road and they realize that its going to delay them by even a little from getting to the OR in the AM ASAP, thats where it falls apart. Getting surgeons to agree in principle to group rounds and then actually getting them to utilize it in practice, when it makes them "late" in getting to the OR, are 2 entirely different animals.

You structure the rounds in such a way so that they can get to the OR at the same time, and I'm sure they would all be glad to do it. But time is money and as long as they perceive these group rounds to be holding them away from their cash machine (i.e. OR time) they are NOT going to participate.

Actually rounds were structured to fit the interns/residents schedules. Once a week they are away from the facility (at their medical school) where they are required to sit in on grand rounds. We moved mulitdisciplinary rounds on that day because of that conflict. There is another day that rounds are an hour early because of a conflict. As well, the interns/residents rarely scrub in when they are covering the SICU. Mostly they get stuck with doing post-op management. I can't remember the last time one of them was actually in the OR when we were supposed to be doing rounds.

Our SICU surgeons have very few cases -- they take call for emergencies but it is rare that they have an actual scheduled case (maybe 1-2/week.) They aren't tied up in the OR all that much. Their job is to run the ICU and cover the interns/residents. Not that they don't have other duties, but yes, actually, they were consulted when we started doing these to find times that worked for everybody. They are just backing out on the deal now.

Multi-disciplinary rounds were a God-send as well as reporting at the bedside to oncoming nurse at the bedside.

Happier patients. less mis-communications regarding assessment and plan of care.

OP, sorry that your unit is having troubles with certain disciplines. Sounds like the MICU could be held up as an example of how it SHOULD be done (if there is any data related to lowering infection rates, pt. satisfaction, etc.-the execs will generally FORCE those non-compliant people into submission-numbers talk).

cheers,

otessa

I work predominantly in MICU and, like you said, our MDs are present for rounds everyday. The difference is the rounding was initiated by the pulmonologists. The SICU rounds are essentially the same and I see all the surgeons with their "minions" (as we like to call them) rounding, starting around 0630.

Sorry your doctor was a sarcastic jerk. Maybe if you could start documenting who was present and identify their medical chief as a co-signer things could change?

Actually-for each patient-we had a list(signed in, actually) of who DID attend the rounding that day. This way the NM and higher ups knew who was and wasn't participating-worked like a charm.

cheers,

otessa