Changing the Focus of ICU Daily Rounds

Researchers have found that making the focus of the daily rounds by doctors and residents more patient-centered than provider-centered reduced the length of stay by half. Their study was published in the July 2003 issue of Critical Care Medicine.

The researchers had noticed that during rounds, doctors were more focused on physiology, pharmacology, and "available evidence” aspects of patients than on specific goals for their recovery. To remedy this, they developed a list of short-term goals for each patient, timed directly to a daily care plan. They then tested the plan in a study involving 112 patients in the surgical oncology intensive care unit (ICU) and a team of medical personnel that included staff doctors, post-doctoral fellows, anesthesia and surgery residents, nurse practitioners, nurses, and a pharmacist. During daily rounds, the team visited each patient for about 25 minutes and created a plan of care for the day.

At the end of rounds, the patient's primary nurse and resident on call were evaluated on their understanding of the daily recovery goals and the work needed to get the patient to the next level. To evaluate outcomes, the researchers assessed how long the patients were in the ICU. During the year-long study, length of stay decreased by half, while the number of residents and nurses who understood the daily goals increased by 80%.

"Improved communication enhances patient care, decreases length of stay, and most importantly reduces the risk of errors that can result from poor communications between healthcare provider and patient,” said co-author Peter Pronovost, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at Johns Hopkins (Baltimore, MD, USA).



Related Links:
Johns Hopkins