Impact of Multidisciplinary Rounds Using Daily Goals in a Cardiothoracic Intensive Care Unit

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Wirtz Murphy, Hannah
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The purpose of this project was to develop and implement a rounding and communication process using multidisciplinary rounds (MDR) for cardiothoracic patients admitted to the intensive care unit (ICU). MDR, as supported by the Institute for Healthcare Improvement and the Agency for Healthcare Quality and Research, are essential to provide safe and effective care for critically ill patients and to avoid fragmented communication, care delays, errors, and prolonged ICU stays. Errors in the ICU are attributed to lack of teamwork and miscommunication. The sample included all cardiothoracic patients (N=41) cared for by a single intensivist group from July 14th-November 13th, 2021 from a 24-bed cardiothoracic ICU in Southwestern United States. An evidenced-based literature review indicated MDR positively impact patient care through improved communication and length of stay (LOS) reduction. Best practice protocol was translated into standardized daily rounding sheet, a multidisciplinary team was formed and educated prior to implementation. The ICU Nurse-Physician Questionnaire (ICU-NPQ) was administered pre- and post-MDR initiation. Data from the electronic medical record was collected retrospectively. The results included the pre-implementation group (n=22) and the implementation group (n=19). There were no statically significant demographic differences however, the LOS, number of foley and central venous catheter (CVC) days all decreased but not significantly. The average LOS was 129.2 hours (SD=197.6), and 81.2 hours (SD=83.9) for the pre-implementation and implementation groups, respectively. Average foley and CVC days decreased non-significantly in the implementation group. No central line or foley-associated infections occurred. The ICU-NPQ depicted nurses’ reports of improved interprofessional communication. Improvements post-implementation in understanding communications and asking for advice were noted by both nurses and providers. In conclusion, this quality improvement project provided an opportunity to initiate MDR in a cardiothoracic ICU. While no significant reduction in the project’s quality metrics occurred, replication with a larger sample size and stronger stakeholder support is warranted as literature indicates that MDR provide organized communication thereby reducing errors and improving patient outcomes.
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