Redesigning Intensive Care Unit Rounds to Improve Collaboration at a Military Hospital.

BACKGROUND

Team communication is essential to delivering health care safely. Nurses in the adult intensive care unit at a large military treatment facility were not consistently present in daily patient rounds and stated that team communication could be improved. This clinical question was developed: among critical care staff members, how does a standardized daily rounding script, compared with current practice, impact interdisciplinary communication over a 36-week period?

REVIEW OF EVIDENCE: Current literature includes 3 themes: rounds should be interdisciplinary; include the ABCDEF bundle (pain assessment, spontaneous awakening and breathing trials, analgesia and sedation choice, delirium assessment, early mobility, and family engagement); and use a standardized script. These elements can improve perceptions of collaboration in rounds.

IMPLEMENTATION: An interdisciplinary rounding script was introduced across 2 adult intensive care units at a military hospital over 36 weeks. Before and after the intervention, the Collaboration and Satisfaction About Care Decisions survey was used to assess nurses' perceptions of collaboration; rounds were observed for key elements.

EVALUATION: After implementation, the mean survey score (both units combined) rose by 1.5 units, nurse presence at rounds increased by 21.6% (P = .01), nurse contributions to rounds increased by 31.1% (P = .001), all bundle elements were reviewed 18.9% more often (P = .07), a summary of care was given 53.6% more often (P < .001), and order read back was completed 69.8% more often (P < .001).

SUSTAINABILITY: Continued use of the script in the military treatment facility will require adapting it to practice changes and training new staff members on its use.