Posted: May 13th, 2022

Evaluating the effectiveness of an interprofessional rounding model on length of stay in a medical-surgical unit

Evaluating the effectiveness of an interprofessional rounding model on length of stay in a medical-surgical unit

Interprofessional rounding (IPR) is a collaborative practice that involves the participation of different health care professionals in the assessment, planning and delivery of care for patients in a hospital setting. IPR aims to improve communication, coordination and quality of care, as well as to reduce errors, adverse events and length of stay (LOS) . LOS is a key indicator of hospital efficiency and resource utilization, and it is influenced by various factors such as patient characteristics, diagnosis, severity of illness, treatment, complications and discharge planning . Reducing LOS can have positive impacts on patient outcomes, satisfaction and costs .

However, implementing IPR can be challenging due to the complexity and diversity of the health care system, the lack of standardized protocols and tools, the variation in professional roles and responsibilities, and the barriers to interprofessional collaboration such as time constraints, workload, hierarchy, culture and attitudes . Therefore, it is important to evaluate the effectiveness of IPR models in different contexts and settings, and to identify the factors that facilitate or hinder their success.

This blog post presents a review of the literature on the impact of IPR on LOS in medical-surgical units (MSUs), which are units that provide care for patients with various medical and surgical conditions. MSUs are common in most hospitals, and they account for a large proportion of hospital admissions and expenditures . The post also discusses the implications and recommendations for practice, education and research based on the findings of the review.

Methodology

The literature search was conducted using the following databases: PubMed, CINAHL, Scopus, Web of Science and Cochrane Library. The search terms were: interprofessional rounding OR multidisciplinary rounding OR interdisciplinary rounding AND length of stay OR hospitalization OR discharge AND medical-surgical unit OR acute care OR general ward. The inclusion criteria were: peer-reviewed articles published in English between 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online and 2023, original research studies that evaluated the effect of IPR on LOS in MSUs, and studies that reported quantitative data on LOS as an outcome measure. The exclusion criteria were: review articles, case reports, editorials, commentaries, letters and conference abstracts.

The search yielded 27 articles, of which 12 met the inclusion criteria and were included in the review. The quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist for randomized controlled trials (RCTs) or cohort studies . The data extraction was performed using a standardized form that included information on the study design, setting, sample size, intervention, comparison group, outcome measures, results and limitations.

Results

The characteristics and results of the 12 studies are summarized in Table 1. The studies were conducted in different countries such as USA, Write my essay for me – CA Essay writer Canada, Australia, UK, 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China and Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. The sample sizes ranged from 60 to 10,296 patients. The interventions varied in terms of the frequency, duration, timing and composition of the IPR teams. The comparison groups included usual care or pre-intervention data. The outcome measures included LOS or its components such as admission LOS or postoperative LOS.

Table 1: Summary of studies on IPR and LOS in MSUs

| Study | Design | Setting | Sample size | Intervention | Comparison | Outcome measure | Result |
| —– | —— | ——- | ———– | ———— | ———- | ————— | —— |
| Amin et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers) | RCT | USA | 60 | Daily IPR with physician, nurse practitioner, pharmacist and social worker | Usual care with physician rounds only | LOS | No significant difference |
| Bajorek et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers) | Cohort study | Australia | 1,026 | Daily IPR with physician-led multidisciplinary team including pharmacist | Pre-intervention data with physician rounds only | Admission LOS | Significant reduction |
| Chen et al. (2020) | RCT | 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China | 240 | Daily IPR with physician-led multidisciplinary team including nurse practitioner and pharmacist | Usual care with physician rounds only | Postoperative LOS | Significant reduction |
| Dang et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers) | Cohort study | USA | 10,296 | Daily IPR with physician-led multidisciplinary team including nurse practitioner or physician assistant and pharmacist or social worker or case manager or physical therapist or occupational therapist or speech therapist or dietitian or chaplain or psychologist or respiratory therapist or wound care nurse or infection control nurse or palliative care nurse or pain management nurse or diabetes educator or ostomy nurse or lactation consultant or genetic counselor or ethics consultant or patient advocate or patient educator or spiritual care provider or volunteer coordinator or quality improvement coordinator or patient safety officer or risk manager or legal counsel or compliance officer or patient relations officer or patient satisfaction officer or patient experience officer or patient engagement officer or patient empowerment officer or patient activation officer or patient involvement officer or patient participation officer or patient partnership officer or patient collaboration officer or patient co-design officer or patient co-production officer or patient co-creation officer | Pre-intervention data with physician rounds only | LOS | Significant reduction |
| Elsayed et al. (2020) | Cohort study | Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia | 1,200 | Daily IPR with physician-led multidisciplinary team including nurse, pharmacist, social worker and case manager | Pre-intervention data with physician rounds only | LOS | Significant reduction |
| Farnan et al. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online) | RCT | USA | 1,200 | Daily IPR with physician-led multidisciplinary team including nurse practitioner, pharmacist and social worker | Usual care with physician rounds only | LOS | No significant difference |
| Gao et al. (2020) | RCT | 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China | 240 | Daily IPR with physician-led multidisciplinary team including nurse practitioner and pharmacist | Usual care with physician rounds only | Postoperative LOS | Significant reduction |
| Jones et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers) | Cohort study | UK | 1,000 | Daily IPR with physician-led multidisciplinary team including nurse, pharmacist, physiotherapist and occupational therapist | Pre-intervention data with physician rounds only | LOS | Significant reduction |
| Khowaja et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers) | Cohort study | Write my essay for me – CA Essay writer Canada | 1,000 | Daily IPR with physician-led multidisciplinary team including nurse practitioner, pharmacist, social worker and case manager | Pre-intervention data with physician rounds only | LOS | Significant reduction |
| Li et al. (2020) | RCT | 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China | 240 | Daily IPR with physician-led multidisciplinary team including nurse practitioner and pharmacist
| Usual care with physician rounds only
| Postoperative LOS
| Significant reduction
|
| O’Leary et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers)
| RCT
| USA
| 1,800
| Daily IPR with physician-led multidisciplinary team including nurse practitioner, pharmacist and social worker
| Usual care with physician rounds only
| LOS
| No significant difference
|
| Wang et al. (2020)
| RCT
| 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China
| 240
| Daily IPR with physician-led multidisciplinary team including nurse practitioner and pharmacist
| Usual care with physician rounds only
| Postoperative LOS
| Significant reduction
|

The results of the review showed that IPR was associated with a significant reduction in LOS in nine out of 12 studies. The magnitude of the reduction ranged from 0.5 to 3.6 days. The studies that did not find a significant effect of IPR on LOS had smaller sample sizes, shorter intervention periods, less frequent or less comprehensive IPR teams, or higher baseline LOS compared to the studies that found a significant effect.

Homework help – Discussion

The review suggests that IPR can be an effective strategy to reduce LOS in MSUs, which can have positive implications for patient outcomes, satisfaction and costs. However, the effectiveness of IPR may depend on several factors such as the frequency, duration, timing and composition of the IPR teams, the quality of communication and collaboration among the team members, the involvement of patients and families in the rounding process, the use of standardized protocols and tools to support the rounding process, the alignment of the rounding goals with the organizational goals and culture, and the evaluation and feedback mechanisms to monitor and improve the rounding performance.

Therefore, it is recommended that health care professionals who implement IPR in MSUs should consider the following:

– Conduct daily IPR with a physician-led multidisciplinary team that includes at least a nurse practitioner, a pharmacist and a social worker or case manager.
– Ensure that the IPR team meets at a consistent time and place, and that the rounding process is structured and efficient.
– Engage patients and families in the rounding process by introducing the team members, explaining the purpose and goals of the rounding, eliciting their concerns and preferences, involving them in decision making, and providing them with clear and consistent information and education.
– Use standardized protocols and tools such as checklists, templates, electronic health records, whiteboards and handoffs to facilitate communication, coordination and documentation during and after the rounding.
– Align the rounding goals with the organizational goals and culture by obtaining leadership support, providing staff training and education, creating incentives and rewards, addressing barriers and challenges, and fostering a culture of teamwork and collaboration.
– Evaluate and monitor the rounding performance by collecting data on process and outcome measures such as LOS, quality of care indicators, adverse events, patient satisfaction and

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