Multidisciplinary rounds

[CNL2B]

We do daily multidisciplinary rounds in my SICU (the MICU also does them.) Everybody comes -- nursing (obviously), PT, RT, speech therapy, the dietician, chaplaincy, the ID nurse tries to make it once/week, and usually one of the residents/interns covering the unit at the time (teaching hospital.) These are scheduled at the same time every day and the time was arranged so that we could have maximum representation from all involved departments. I believe we started doing these 3-4 years ago when research came out on the benefits of multidisciplinary rounds. This is still a big initiative going on hospital wide and we have someone that collects our rounding data, etc. 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.

Problem I am having is the staff doctors (not the residents/interns) HATE rounding with us. They absolutely know what time they are and very often, have their residents tied up doing rounds on their own and will NOT participate with the rest of the team. Today, I tried to pull one of the residents/interns away from their little huddle so we could get the physician input on the plan of care for the multidisciplinary rounds (there are 3 of them right now -- 2 interns and 1 resident) and he wouldn't release even one of them. The entire team had assembled and we were already 5 minutes behind because we were waiting for them when I asked if one of them could come present (I was charge for the day.) The staff doctor told me he was in the middle of his own rounds with the residents and he needed "15 or 20 minutes" (which I observed took more like 45 minutes, for two whole patients). I told him that I could not tie up 6 other departments for 15 or 20 minutes waiting. He replied, and I quote, "Well, obviously you are doing something much more important (heavy on the sarcasm)" .....such a jerk. I walked away from him and started rounds per our usual routine without MD input, which we have to do on average a couple of times a month. Super lame.

MICU docs have totally bought into this and their STAFF presents on MD rounds. Their process is so much smoother and it actually works.

Anybody out there with experiences participating in these and how it goes for them to share?

[getoverit, BSN, RN, EMT-P]

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?

[HamsterRN, ADN, RN]

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.

[PCCNnurse]

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.

[platon20]

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.

[platon20]

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.

[CNL2B]

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.

[Otessa, BSN, RN]

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

[Otessa, BSN, RN]

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