Discussion post: what the evidence says about interprofessional collaboration and bedside rounds

Initial post

This week's question asks whether interprofessional collaboration (IPC) interventions improve patient outcomes. My honest answer is that the strongest evidence is less clear than many of us assume, but that doesn't mean the interventions aren't worth doing.

The Cochrane review on IPC included nine randomized studies with 6,540 participants, comparing practice-based interventions such as externally facilitated team activities, interprofessional rounds, meetings and checklists with usual care. Because the certainty of evidence was low to very low, the authors concluded there was not enough evidence to draw clear conclusions about the effects of IPC interventions. Low-certainty evidence suggested that some interventions may slightly improve professionals' adherence to recommended practices and the use of health care resources, and none of the studies reported mortality or complication rates (Reeves et al., 2017).

Smaller studies help explain how collaboration may work. Gausvik et al. (2015) studied structured interdisciplinary bedside rounds on an acute care for the elderly unit in a community hospital. Compared with staff on units using traditional physician-centered rounds, nurses, therapists, patient care assistants and social workers on the unit reported significantly better teamwork, communication, understanding of the plan for the day, safety, efficiency and job satisfaction. The study was a survey of 24 staff on the intervention unit and 38 on control units, so it measured perceptions rather than patient outcomes, and staff weren't randomly assigned.

My conclusion is that IPC interventions have strong face validity and positive effects on how staff experience their work, which matters for retention, but their effect on patient outcomes is not yet proven. For a DNP project, that means choosing a specific, well-described intervention such as structured bedside rounds, measuring patient outcomes as well as staff perceptions, and allowing a long enough period for the team to adapt before evaluating, as the Cochrane authors recommend.

Question for the group: Has anyone measured patient outcomes, not just staff satisfaction, after starting interprofessional rounds?

Reply to a peer

Thanks, Priya, for describing your unit's move to bedside rounds. I agree that nurses' presence on rounds changes the conversation. You mentioned that physicians sometimes start rounds before the nurse arrives, which is a common problem. One fix in the structured bedside rounding model is a fixed schedule posted for each room so nurses can plan their time. I'd also suggest tracking how often the nurse is present for rounds as a process measure, since an intervention can only work if it actually happens.

References

Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of Multidisciplinary Healthcare, 8, 33–37. https://doi.org/10.2147/JMDH.S72623

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6), Article CD000072. https://doi.org/10.1002/14651858.CD000072.pub3