This article was originally published on HBR.
Every day, physicians and staff on the Verdi 5 North General Medicine unit participate with their patients in Structured Interdisciplinary Bedside Rounds. Recent rounds included (l-r): Veronica Wilkins, RN; Bennie Taylor, MD, resident; Jeremy Schwartz, MD, medical director; Kimvi Diep, PharmD, pharmacy resident; Kristen Hysell, MD, resident; Deanna Morabito, LCSW, social worker; and Atsuko Yamahiro, MD, fellow. The rounds are part of an Accountable Care Unit pilot project that organizers hope to eventually launch hospital-wide.
Staff and physicians on Verdi 5 North at the Saint Raphael Campus are putting a new spin on rounding.
All Yale New Haven Hospital units hold daily transitional care rounds Monday – Friday. These involve physicians, Care Management and the charge nurse, who usually meet in a conference room to discuss patients’ progress, treatments and care planning.
The Verdi 5 North General Medicine unit has traded transitional care rounds for Structured Interdisciplinary Bedside Rounds (SIBR). Held seven days a week, the rounds involve the transitional care rounds participants, along with the patient, family members, the patient’s bedside nurse and pharmacist. Rounds may also involve staff from Physical Therapy, Social Work and other departments involved in the patient’s care.
“Inter-professional engagement is a key aspect of this,” said Jeremy Schwartz, MD, Verdi 5 North medical director.
SIBR are part of an Accountable Care Unit model Verdi 5 North is piloting. Dr. Schwartz was awarded a Clinical Innovation and Incentive grant from Yale School of Medicine’s Department of Medicine to study the model, which started at Emory University Hospital in Atlanta about 10 years ago. The model includes other elements already in place in many YNHH teaching units. These include “localizing” physicians to one clinical unit, a physician-nurse dyad leadership team for each unit and the use of unit-based metrics to guide improvements.
It’s the implementation of SIBR that is turning Verdi 5 North into an Accountable Care Unit, Dr. Schwartz said. SIBR are held in addition to regular physician team rounds and nurse handoff rounds, but serve a distinct purpose. SIBR consist of three to four minutes of highly structured discussion to update every participant on the patient’s daily care plan and next steps, including post-hospital care.
“The rounds involve coordination of care and collaboration on care – all at one time,” said Patricia Ann Vakos, RN, patient service manager, Verdi 5 North.
Participants said the rounds give them a more global view of patients’ conditions and care. For example, said Amy Ashman, RN, assistant patient service manager, “doctors are hearing more about skin care, which wasn’t part of their daily conversation before. They’re hearing the nurses’ safety checklist, which covers pressure ulcers and other issues. SIBR has opened up a lot more channels for communication and awareness.”
Also during SIBR, pharmacists review patients’ medications, and patients and family members can raise potential post-hospital care issues, said Catherine Dawson, MD, third-year resident, Primary Care Program. “When you’re rounding with the physician team, you get one side of the picture, looking at things like lab results and imaging,” she said. “SIBR brings everyone together. Patients can see that we’re all working together, as a team.”