On weekdays at LVMC, a small cluster of key staff responsible for patient care walk into every patient’s room in the Medical Surgical, Critical Care and at times the Alternative Birthing units.
Led by each patient’s primary nurse, the group circles the patient’s bed with a specific purpose. This effort is known as Structured Interdisciplinary Bedside Rounding, or SIBR, and has been a practice since last October.
Created by Dr. Jason Stein of Emory University, SIBR is designed with the goal of improving quality and patient outcomes. “They’re part of their care, instead of us always dictating what they should do,” explains Assistant Nurse Executive Yvette Cope. “This is their input for their own care.”
The members of the team, in addition to the registered nurse, include the Case Manager, Pharmacist, Administrator, Dietitian and if necessary a physical therapist and/or respiratory therapist. If the attending Physician is unable to attend rounds, the Primary nurse shares all pertinent information with the doctor.
At first, some patients look a bit terrified when the group approaches. Each visitor says their names and turns the discussion to the patient’s hospital stay — asking about daily goals, any issues and discussing paths to discharge. Family members are highly encouraged to be in the room for the visit.
We’re just checking to see if there’s anything we can do. A common question we ask is “Are there any questions or concerns we can address for you today?”
SIBR takes place early in the day — starting at 10:15 a.m — and the team spends about five minutes or less in each room, or longer if necessary. It’s a “moment in time” glimpse into immediate patient needs and goals.
MaryAnne Pioli Hooper, whose adult son Matthew was recently a patient, said she and her sister, Beth Pioli, made sure to be in the room when SIBR took place.
“This is nice to have this kind of contact,” Beth Pioli said. “It’s really, really comforting to us. I love it.” Without such contact with physicians and the care team, Hooper said it’s stressful, not knowing if they missed something. “Even if we didn’t use that opportunity to talk to them, we knew who they were so we could ask questions later,” Pioli said. Usually, the SIBR team visits about 20 patients each day.
A variation of the rounding took place years ago, but occurred three days a week in a conference room, without patients. In monitoring patient satisfaction scores — a critical mark to show how the hospital is performing — staff identified that patients wanted more input in their care. Then came SIBR.
“This is a chance for service recovery,” Cope says. “With any complaints, the patient might have, we can fix it.”
Using SIBR, she says, “shows that we’ve listened to the community that comes to our hospital. Any of the phone calls or any of the feedback we’ve received from them was that they wanted staff to listen to them. This just pulls in everything we hear from those feedback forms.” Pharmacy Director Dr. Chad Signorelli said SIBR has allowed all members of the health care team to interact in a direct, united effort for each patient.
People have said they felt like they were part of the team. It’s so well coordinated. The patients want to talk and share everything.
“As a pharmacist, I can better understand what the patient’s goals are and how I can improve the medication regimen to achieve those goals,” Dr. Signorelli said. “I am also more available to answer patient and family member questions about their medications, discharge medication options, and any issues that I can immediately address. It very effectively engages the entire team along with the patient and family in making that patient better.”
The team goes through its worksheet with the patient, making sure the patient understands what’s taking place in his or her care. “With this team, things don’t get lost,” Cope says. “We look at prevention of blood clots — are they up and ambulating? What is their risk factor for developing a Deep Vein Thrombosis? We talk about fall risks, and why they might be high risk.”
A few initiatives that have come into being as a result of SIBR includes “Fall Risk” signs in patient rooms and the distribution of earplugs to any patients complaining about noise.
“We’ve gotten so many compliments,” Cope notes. “People have said they felt like they were part of the team. It’s so well coordinated. The patients want to talk and share everything. We keep hearing from them that they feel important, which is awesome.” When the team first started going into rooms, they’d get “big eyes” from people wondering what was happening, Cope said.
“But if you explain it really well, and the primary nurses are doing well, they tell the patient what to expect,” she says. “There’s always a goal for the day on the whiteboard in the room.” A goal may be as simple as working on breathing exercises to a bigger improvement such as walking unassisted to the bathroom. “If a patient doesn’t have a goal for the day, that’s what we catch in these rounds,” Cope said.
In just a few months that it’s been in place, SIBR has led to increased patient satisfaction scores. The team has now added discharging patients to the rounds. “We make sure all the medical reconciliations are completed,” Cope says. “We want to make sure their final goodbye was good and they got all their questions answered.”