Improving Length of Stay and Patient Satisfaction by Implementing Multidisciplinary Rounds

Jessica Malloy, MS, RN-BC, ONC, Iris Gonzalo-Sowle, BS, RN-BC, ONC, Donna Trerise, BSN, RN, CCMSaratoga Hospital

Introduction Methods

Conclusion

Purpose ResultsTo determine if implementing multidisciplinary rounds decreased length of stay and improved patient satisfaction.

Developed a team to implement multidisciplinary patient rounds.

Established the format and guidelines for conducting multidisciplinary rounds.

Press Ganey scores were utilized to compare patient satisfaction data pre and post rounding.

Hospital Length of Stay data was collected and compared pre and post rounding .

Graph 2: Average Length of Stay by Year Healthcare Cost and Utilization Project (HCUP).

(2009). HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009. Retrieved March 3, 2011, from http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Healthcare Cost and Utilization Project (HCUP). (n.d.). National and regional estimates on hospital use for all patients from the HCUP Nationwide Inpatient Sample. 2009 National and state statistics. Retrieved March 3, 2011, from http://hcupnet.ahrq.gov/HCUPnet.jsp

Kurtz, S.M.., Ong, K.L.., Schmier, J., Mowat, F., Saleh, K., Dybvik, E., et. al. (2007). Future clinical and economic impact of revision toatal hip and knee arthroplasty. The Journal of Bone and Joint Surgery. 89(3), 144-151.

Background Organizations such as the Institute of Medicine,

the Institute for Healthcare Improvement and The Joint Commission support the need for interdisciplinary collaboration and patient involvement in care as strategies to improve healthcare.

The ANCC Magnet Recognition Program emphasizes the importance of nursing's role with patients, families and the interdisciplinary team. Objectives

Explain how multidisciplinary rounds affect patient satisfaction scores and length of stay for total joint replacement patients.

Discuss barriers to implementing multidisciplinary orthopedic rounds and measures to overcome them.

Process Multidisciplinary rounds are conducted daily.

Rounds are done at the bedside with participation of the patient and their coach (family, friend, etc…) Monday thru Friday.

Team members include the orthopedic unit care manager, Nurse Practitioner, charge nurse, Physical Therapist and Occupational Therapist.

Rounds include the review of the patient’s lab work, any ordered procedures, therapy schedule with objectives, and discharge plan including anticipated discharge date.

Changes in the patient’s plan of care is disseminated to the nursing and therapy staff involved in the patient’s treatment.

BarriersRecent statistics of Total Joint Replacements (Healthcare Cost and Utilization Project, 2009 & 2010):

The rate of knee arthroplasty increased 84% and the rate of hip arthroplasty increased 33% from 1997-2009.

Knee arthroplasty was the fourteenth most common procedure in 2009.

Females needing knee arthroplasty was 57% greater than males and female hip arthroplasty was 38% higher than for males.

Nationally the length of stay in 2009 for hip arthroplasty was 4.3 days and for knee arthroplasty it was 3.4 days.

The average length of stay for knee arthroplasty in New York State in 2010 was 3.8 days.

The average length of stay for hip arthroplasty in New York State in 2010 was 4.8 days.

Costs for osteoarthritis grew at twice the rate as other hospital cost between 1997 and 2009.

The cost of total joint arthroplasty is estimated to exceed 65 billion by the year 2015 (Kurtz, S., Ong, K.L., Schmier, J. et al., 2007).

• The implementation of multidisciplinary rounds increased the Press Ganey patient satisfaction scores on the orthopedic unit to the 99th percentile rank in the sections with questions regarding physician, discharge, and nursing care.

• The length of stay decreased significantly placing our mean length of stay days below that of New York State.

• The length of stay is also below the national length of stay data for hips and comparative for knees.

2008 2009 2010 20110

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Elective Hips

Elec-tive Knees

Graph 1: Patient Satisfaction Scores from Press Ganey

o Some of the barriers identified during the development and execution of starting a multidisciplinary rounding team were: staff buy-in, participation from the needed disciplines, and scheduling conflicts.

o Methods to enhance staff buy-in included discussing the patient centered environment we strive to create, asking for volunteers from those departments that had more than one staff member available in the same role, starting with a small and specific orthopedic population (total hips and knees) and identifying champions for the process.

o To ensure participation from the needed disciplines the group agreed upon a time of day that would provide the least disruption of the daily routine. Issues such as attendance and punctuality are dealt with on an as needed basis with understanding that occasionally an issue may supersede a staff member from rounding.

o From 2008-2010 orthopedic surgical care was delivered on a traditional medical/surgical unit (C3) with semi-private rooms which did not always facilitate the exchange of information at the bedside. In 2010 a new orthopedic unit (D3) was opened as part of Saratoga Hospital’s center for excellence . D3 has all private rooms which helped increase the flow of information at the bedside.

2008 C3

2009 C3

2010 C3

2010 D3

2011 D3

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94 Nurses kept you informed

Physicians kept you informed

Physician concern questions/worries

As shown in Graph 1, patient satisfaction improved for questions such as “nurses kept you informed”, “physicians kept you informed” and “physicians concern question/worries”.

The question “staff worked together to care for you” also increased from the 80th percentile rank to the 99th percentile.

Discharge questions such as “extent felt ready for discharge” and “help arranging home care services” also increased to the 99th percentile.

Length of stay for 2008-2011 is depicted in Graph 2. The length of stay for knees decreased from 3.89 to 3.42 and for hips decreased from 4.31 to 3.32.

Results

References