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Sharon Mathai, BSN, RN, CRN
Clinical Resource Nurse, Medical Oncology
Improving Communication through Collaboration: Nurse-Physician Rounding
MD Anderson 2
Contents
IDENTIFYING A
PROBLEM
Background
Gaps in
Interdisciplinary
Communication
A CULTURE OF
PATIENT
CENTERED
CARE
HCAHPS Scores
Value Based
Purchasing
A
COLLABORATIVE
APPROACH
SWOT Analysis
Rounding Outline
& Process
RESULTS
Performance
Enhancing
Communication
Staff Satisfaction
POST EPIC
ROLLOUT
Technology as a
Barrier
Future
Sustainment Plans
01 02 03 04 05
MD Anderson
Identifying a Problem
3Improving Communication through Collaboration: Nurse-Physician Rounding
MD Anderson
• The diversity of the patient population and demands of the unit lead to
multiple physician teams rounding throughout the day.
• Physician rounding often occurs without the nurse or without discussion of a
plan of care with the nurse which leads to confusion and delays in patient
care.
• Inadequate communication is identified as a crucial factor for delays in care,
increased medical errors, decreased patient satisfaction, and poor patient
outcomes (Rimmerman, 2013).
Background
4Improving Communication through Collaboration: Nurse-Physician Rounding
5
Providers, nurses, and
patients aren’t on the
same page.
Time spent in
clarifying plan of
care
Loss of trust in
the
interdisciplinary
team
Gaps in Interdisciplinary Care
Delay in provider notes and orders
MD Anderson
Culture of Patient Centered Care
6Improving Communication through Collaboration: Nurse-Physician Rounding
MD Anderson
Bedside Shift Report
Implemented in 2012
Institutional Practice
7Improving Communication through Collaboration: Nurse-Physician Rounding
Occasional Rounds with Physicians Unstructured
Inconsistent
MD Anderson
Communication with Nurses HCAHPS Scores
8Improving Communication through Collaboration: Nurse-Physician Rounding
81.9 80.882.7
8591.2
82.7
73.1 73.2
69
60
75
88
99
79
1311
0
10
20
30
40
50
60
70
80
90
100
Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 April 2015 May 2015
Communication with Nurses
Top Box Score Top Box Rank
MD Anderson
Communication with Physician HCAHPS scores
9Improving Communication through Collaboration: Nurse-Physician Rounding
80.1
70.2
81.1 79.883.2 82.2
78.2
66.7
41
2
48
39
68
62
30
1
0
10
20
30
40
50
60
70
80
90
100
Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 April 2015 May 2015
Communication with Physicians
Top Box Score Top Box Rank
MD Anderson
VBP Incentive Payments: An Area for Revenue Growth
10Improving Communication through Collaboration: Nurse-Physician Rounding
10%
25%
40%
25%
Clinical Process
Patient Experience
Outcomes
Efficiency
MD Anderson
A Collaborative Approach
11Improving Communication through Collaboration: Nurse-Physician Rounding
12
Improve communication
between healthcare
providers and patients to
improve:
• quality of care
delivered
• sustain safety
• increase efficiency.
Project Aim
Increase patient satisfaction
by 10% within 3 months of
implementation in the
domains:
Communication with Nurses
Communications with
Physicians
Create a structured Nurse-Physician rounding system
01 02
03
13
Strength• Enhance communication
• Expedite care
• Clear plan of care
• Reduces delays
• Enhances physician/RN relationship
• Reduces confusion
• Less “leg work” (texting, paging,
callings, etc)
• On-the-spot clarifications
• RN input
• Patient advocacy
• “Bridges the gap” (communication)
SWOT Analysis
14
Weakness• Inconsistent rounding times
• RN busy with other tasks
• RN may think of it has time consuming
• Disruptions during crucial conversations.
• Multiple services/consultations: Difficult to
decide which team to round with
• Communication when team does not contact
nurse. GIM resources (MD rounding without
MLP)
• Inconsistency with teams
• Explaining procedures to the patient (Nurse
left to complete process after provider has
spoken to the patient)
• Press Ganey question
• Closing the loop when providers have
spoken to the consulting service without
communicating to nurse
SWOT Analysis
15
Opportunity
• Comprehensive understanding
of plan of care
• Resource to the provider
• Reminders to write orders
• Provider communication to the nursing
staff (close the loop)
• Engaging the patient in the plan of care
when expecting a consulting team
• Using the white board
• Utilizing other members of the team
• Relationship building
• Can the team s make contact with the
nurse
• MD to ensure a nurse rounds when
consulting or when the MD is in the room
• Provider liaison
SWOT Analysis
16
Threat• Lack of participation
• Physician engagement or buy in
• Resistance to change (another
thing to do)
• Intimidation factors (bullies)
• Comfort level with interpersonal
communication and knowledge
level
SWOT Analysis
MD Anderson
Rounding Outline
Summarize
Plan of Care
Interdisciplinary Care
Review of issues and
test results
Update Current Status
Preparation: Nurse and Physician
MD Anderson
• Physician arrives on unit and alerts nurse for first patient to be rounded on
• Nurse communicates arrival using Vocera & notifies the PSC if they are
rounding in the room
• Nurse and physician discuss patient briefly before going into the room
• Nurse and physician follow outline while in the room to prioritize patient and
staff informational needs
• Nurse and physician leave the room (nurse may leave early only in case of an
emergency)
• Nurse notifies the next nurse via Vocera to begin process again for the next
patient
Rounding Process
18Improving Communication through Collaboration: Nurse-Physician Rounding
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Collaboration Results
19Improving Communication through Collaboration: Nurse-Physician Rounding
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Communication Scores
20Improving Communication through Collaboration: Nurse-Physician Rounding
79 78.1
93.9
85.9
80
76.2
91.9
79.5
0
10
20
30
40
50
60
70
80
90
100
June 2015 July 2015 Aug 2015 Sept 2015
Post Implementation HCAHPS Communication Scores
Communication with Nurses Communication with MDs
MD Anderson
Staff Satisfaction: NDNQI RN-MD Relationship Scores
21Improving Communication through Collaboration: Nurse-Physician Rounding
61.23
68.72
0 10 20 30 40 50 60 70
2013
RN-MD Relation Scores—Pre-Implementation
Unit Score Hospital Average
MD Anderson
Staff Satisfaction: NDNQI RN-MD Relationship Scores
22Improving Communication through Collaboration: Nurse-Physician Rounding
3.08
3.04
3.23
3.14
0 0.5 1 1.5 2 2.5 3 3.5
2015
2016
RN-MD Relation Scores—Post Implementation
Unit Score Hospital Average
MD Anderson
Post Epic Rollout
23Improving Communication through Collaboration: Nurse-Physician Rounding
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Technology as a Barrier
24Improving Communication through Collaboration: Nurse-Physician Rounding
81.2 80.6 80.6 78.3
86.4
72.2
78.8
73.980.7 83.3
79.7 77.5
71.2
76.5
88.9
76.4
83.976.4
60.3
82.9
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
March 2016 April 2016 May 2016 June 2016 July 2016 Aug 2016 Sept 2016 Oct 2016 Nov 2016 Dec 2016
Top Box Scores
Communication with Nurses Communication with MDs
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Future Plans
Reinforcing Communicating with
WoWs
Revamping Rounds
New EHR
Sustaining Effective Communication
MD Anderson
Chapman, K. (2009). Improving communication among nurses, patients, and
physicians. American Journal of Nursing, 109(11), 21-25.
Department of Health and Human Services (2015). Hospital value-based
purchasing. Retrieved from https://www.cms.gov/Outreach-and-
Education/Medicare-Learning-Network-
MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN90766
4.pdf
Duke, P., Frankel, R.M., & Reis, S. (2013). How to integrate the electronic health
record and patient-centered communication into the medical visit: A skills-based
approach. Teaching and Learning in Medicine: An International Journal, 25(4),
358-365. doi: 10.1080/10401334.2013.827981
Farber, N.J., Liu, L., & Chen, Y. (2015). EHR use and patient satisfaction: What
we learned. The Journal of Family Practice, 64(11), 687-689.
References
26Improving Communication through Collaboration: Nurse-Physician Rounding
MD Anderson
Ratanawongsa, N., Barton, J.L., & Lyles, C.R. (2016). Association between
clinician computer use and communication with patients in safety-net clinics.
JAMA Internal Medicine, 176(1), 125-128. doi:
10.1001/jamainternmed.2015.6186
Rimmerman, C. (2013). Establishing patient-centered physician and nurse
bedside rounding. Physician Executive, 39(3), 22-5. Retrieved from
http://search.proquest.com/docview/134 9951310?accountid=7135
Schiefelbein, B. (2011). RN-Physician rounding a hit with nurses, patient,
physicians. Nursing Matters, 22(10). Retrieved from
http://www.wha.org/TCABnursingMatters10-2011.pdf
References
27Improving Communication through Collaboration: Nurse-Physician Rounding
MD Anderson 29Improving Communication through Collaboration: Nurse-Physician Rounding
MD Anderson
Contact
30Improving Communication through Collaboration: Nurse-Physician Rounding
Sharon Mathai
Clinical Resource Nurse, Medical Oncology
