Team-based rounds boost the quality of care

REGINA – A collaborative model of bedside care, one of the first of its kind in Canada, is being tested at the Pasqua Hospital, part of the Regina Qu’Appelle Health Region. The Accountable Care Unit pilot seeks to improve safety and reduce hospital stays.

Every morning at the same time, a doctor, nurse, pharmacist, social worker and therapists make bedside rounds and talk with the patient.

The goal is to build teams on the unit that care for patients, John Ash (pictured), executive director of patient flow with the Regina Qu’Appelle Health Region (RQHR), told the Regina Leader Post newspaper.

The six-month pilot project began in late February. The region is implementing the program with existing resources and $305,000 in funding from the Ministry of Health’s Emergency Waits and Patient Flow initiative.

Two hospitalists – doctors who primarily have hospital-based experience with backgrounds in family and emergency medicine – are key to the project.

Prior to rounds, the hospitalists check reports that have come in overnight and each team member familiarizes themselves with each patient’s condition before discussing the next steps.

“At the end of the day, the doctors will have reviewed any of the investigations that have come back for that day, but they also review the patient’s response to treatment,” said Dr. David McCutcheon, the region’s vice-president of physician and integrated health services.

The hospitalist reviews each of the pilot project’s 35 patients three times throughout the day.

“In the traditional model, the doctor makes rounds once a day in the morning and we rely upon communication through the chart as to what goes on,” McCutcheon said. “This is live communication, so the doctor, the nurse, the pharmacist and whomever else are all together in one place at one time with the patient and the patient’s family member.”

Because rounds occur at a set time, physical therapists, occupational therapists and speech-language pathologists who work throughout the hospital know when to be on the ward to discuss their patients’ treatment.

There is pushback from some family doctors not involved in the pilot, McCutcheon said.

“There is a concern among some physicians that the hospitalists will be the focus of inpatient care over time and that they will be pushed out of inpatient care,” he said.

McCutcheon added some general internal medicine physicians believe patients in the test project are getting privileged care while they lack the same support.

“If this leads to better patient care, leads to better flow of patients through the hospital and if it’s more sustainable from a cost point of view … then people are going to have to move in the direction that the organization wants to take them,” McCutcheon said.

On the flip side, Ash noted patient and staff satisfaction has significantly increased.

“Physicians and staff are making comments like, ‘This is what medicine is supposed to be’ or ‘This is the work environment I always envisioned working in,’” he said.

Because most of the care team is on the unit, if a patient’s condition deteriorates they can change treatment right away or move him to an intensive care unit.

In a traditional environment, when a nurse notices complications, she calls the doctor and waits for a call back. If the call is returned after the nurse is gone for the day, “you end up with some inherent delays built into the system,” Ash said.

When patients receive more efficient care, they’re released from hospital sooner, which frees up beds for patients waiting in the ER for a bed on the unit.

Not only are there time efficiencies, but during daily rounds the team checks for infections or other complications and immediately deal with them, McCutcheon said.