View
2
Download
0
Category
Preview:
Citation preview
An International Perspective onInterprofessional Rounds
Andre Amaral, MDAssociate ProfessorInterdepartmental Division of Critical Care MedicineUniversity of TorontoSunnybrook Health Sciences Centre
• To review the current data on rounds
• To broaden our perspectives on rounds with data from aninternational survey
OBJECTIVES
HOW THIS ALL STARTED…
Amaral et al. Unpublished data
WHAT DO WE WANT FROM ROUNDS?
10-15 interruptions/h
• Louise Rose
• Steve Webb
• Jean-Louis Vincent
• Mark Mikkelsen
• Ruxandra Pinto
• Jorge Salluh
• And many, many, many others!
INTERNATIONAL SURVEY OF ROUNDING PRACTICES
• 2405 respondents
• 62% staff intensivists
• 15% RNs
• 84% academic centers
• 48% ICUs > 20 beds
• 92% ”closed” units
RESPONDENTS
EVIDENCE 1. ROUNDS IMPROVE QUALITY OF CARE
HOW MANY RESPONDENTS HAVE ROUNDS?
73%
97%92%
82%
75%
66%61%
53%
0%
20%
40%
60%
80%
100%
DAILY ROUNDS 2 H ROUNDS BEDSIDE
North America
South Asia
Latin America
South Asia
East Asia / Pacific
South Asia
0%
20%
40%
60%
80%
100%
BED FLOW QUALITY DECISION TEACHING
North America
Middle East
Europe
Middle East
Latin America
South Asia
EVIDENCE 2. ROUNDS IS TEAMWORK
0%
20%
40%
60%
80%
100%
RN PHARM RT DIETICIAN PHYSIO
North America
South Asia
North America
Europe
North America
Europe
0%
20%
40%
60%
80%
100%
SATISFACTION HEARD
North America
Asia Pacific
EVIDENCE 3. INCLUDE FAMILIES ON ROUNDS
Kalocsai et al. BMC HSR 2018
“So I think rounds again build trust and the community. I think the trust – the trust level for us has been very high, because we felt that we had been treated honestly and with great compassion.”
0%
20%
40%
60%
80%
100%
FAMILIES UPDATES PARTICIPATE
North America
Latin America
North America
Latin America
North America
Latin America
EVIDENCE 4. ROUNDING TOOLS IMPROVE ROUNDS
• CHECKLISTS• PROMPTS• DAILY GOALS• DEFINE ROLES• DESIGNATE A WRITER• CREATE SCRIPTS• …
ARE THERE INCIDENTS RELATED TO ROUNDS?
FAMILY: 20%
DELAYS IN DECISIONS: 22%
44%
61%53% 50%
46%42% 41% 40%
DO ROUNDS IMPROVE CARE?
DEFINE PLAN: 73%
DEFINE GOALS: 68%
CLARIFY DIAGNOSIS: 56%
92%97%
91% 90% 90% 89% 88%82%
0%
20%
40%
60%
80%
100%
DAILY GOAL PROBLEM WRITER SCRIPT CHECKLIST ASSISTANCE
7%* 7%* 10%* 4%* 3% 9%*
Latin America
Asia / Pacific
Latin America
North America
Latin America
North America
Asia / Pacific
North America
Asia
North America
Europe
North America
• Phil Taylor• Suzanne Witts• Ligia Rabello• William Vianna• Andrew Chapman• Tatiana Salgueiro• Phil Shin• Matt Cavanagh• Cameron Guest• Nicole Marinoff• Wade Stedman• Neill Adhikari• Brian Cuthbertson• Pamela Meyer• Grace Walter• Alberto Goffi• Stephan Hain• Dominique Piquette• Wasim Yunus• Igor Shvartsman• Matteo Parotto• Helen Su• Hiroko Aoyama• Laura Dragoi• Ming Lam• Jennifer Tsang• Grazielle Ramos• Du Bin
• Carmen Soto• Kozue Schmidt• Martin Urner• Andrea Falvo• Aline Reis• Janice Zimmerman• Diana Hughes• Vishakha Kumar• Harald Grossmann• Claire Pillar• Jagtar Pooni• M Piedad Guzman• Alison Fox-Robichaud• Donna Goldsmith• Emiliano Tizi• Stephen Lapinsky• Alawai Alsaeedi• Peter Cox• Andrew Argent• Stephen Brett• Mervyn Mer• Yaseen Arabi• Khalid Maghrabi• Ganesh Suntaralingam• Federico Carini• Gary Masterson• Sandy Mather• Rob Fowler• Konrad Reinhardt
0%
20%
40%
60%
80%
100%
RN SATISFACTION RN HEARD
0%
20%
40%
60%
80%
100%
Trainee SATISFACTION Trainee HEARD
North America
Latin America
Recommended