Implementation of a Multidisciplinary Rounding Tool in a Medical Intensive Care Unit and Its Association with Rounding Efficiency and Multidisciplinary Collaboration.

Background

Multidisciplinary rounds are essential for high-quality intensive care but are frequently hindered by inconsistent team participation and logistical inefficiencies. We evaluated the associated impact of implementing a standardized multidisciplinary rounding checklist and real-time paging system on multidisciplinary team attendance, rounding efficiency, and selected clinical outcomes in the ICU.

Methods

A retrospective, observational pre- and post-intervention cohort study featuring a concurrent control group was conducted at a tertiary care hospital. The study included 331 adults admitted to the medical ICU (MICU) and neurovascular critical care unit (NCCU; control). The intervention combined a standardized rounding checklist incorporating the ICU Liberation (ABCDEF) bundle and FAST HUGS BID mnemonic with a real-time paging notification system to alert team members of round start times and locations. The primary outcome was change in multidisciplinary team participation at the start and end of rounds; secondary outcomes included rounding time per patient and exploratory care-process outcomes.

Results

Multidisciplinary participation at the start and conclusion of rounds significantly improved for both the MICU advanced practice provider (APP) team (p = 0.003 and p = 0.002, respectively) and the resident team (p = 0.006 and p < 0.001, respectively), while attendance in the NCCU group remained unchanged. Median rounding time per patient decreased by 20.8% (13.0 to 10.3 min, p < 0.001). In a survivor-only sensitivity analysis, the streamlined workflow decreased the median time to physical and occupational therapy consultations from 4 to 2 days (p ≤ 0.002). Invasive device stewardship significantly improved; central venous catheter utilization decreased from 58.0% to 25.0% (p < 0.001), and arterial line utilization fell from 55.0% to 26.5% (p < 0.001), with median arterial catheter duration decreasing from 5 to 3 days (p = 0.001).

Conclusions

Implementing low-cost, reliable workflow standardization tools was associated with significantly improved multidisciplinary participation and shorter rounding time per patient. Favorable changes in selected care-process measures were also observed, although patient-level clinical outcomes should be interpreted as exploratory and future studies are warranted.