This is my first post on this blog and I’m very happy to be contributing to it with this illustrious group of docs. Thanks Leslie! At my hospital we have set up mandatory multidisciplinary rounds where we run through every single hospitalist and teaching patient on every floor every day. We have found that the time slot from 10-11am works well with the teams’ rounding and morning report. A seasoned doctor can present all the pertinent information within 30 to 60 seconds. In addition to getting appropriate feedback from case management, OT, PT, Social Work and Nursing; this allows me to keep daily contact with all the residents on service and all the day-time hospitalists. It allows the group to feel cohesive and part of the same team, get to know each other better, provides opportunities to address critical policy changes, new coding requirements, review admission vs obs criteria, learn occasional clinical tidbits, and have baby showers and goodbye parties (very important!).
Having many of the key players in inpatient patient care in the same room every day provides a way to address conflicts, losses and wins in our attempts to improve patient flow. Ethical and end of life issues are frequently addressed and plans are made for the next step. It’s not always fun but it’s always useful.
The providers file in and out at their prescribed time while other staff sit around a table with or without donuts. When we first implemented these mandatory daily rounds there was a good amount of complaining and concern that it would be a waste of time and interfere with the day. Now, because they know that if they are late they will have to wait, folks have become very punctual. Because they know they will irritate their colleagues if they take too much time they have become experts at presenting appropriate information. As the hospitalist director I value keeping touch with each doctor every day and having a cursory knowlege of all the patients on the service. Frequently when I’m wandering the halls after hours I’m asked by a nurse or a family member to explain something on a patient I heard about that morning and am able to be helpful. We are in the process of moving to a more unit based care system, and while I can see the benefit of unit based rounds I would miss this ability to keep a finger on the pulse of the medical service and to get to know the rotating housestaff and I am hesitant to change this system. I would be interested in others’ perspectives on this model verses unit based MDRs.