An International Perspective onInterprofessional Rounds

Andre Amaral, MDAssociate ProfessorInterdepartmental Division of Critical Care MedicineUniversity of TorontoSunnybrook Health Sciences Centre

• To review the current data on rounds

• To broaden our perspectives on rounds with data from aninternational survey

OBJECTIVES

HOW THIS ALL STARTED…

Amaral et al. Unpublished data

WHAT DO WE WANT FROM ROUNDS?

10-15 interruptions/h

• Louise Rose

• Steve Webb

• Jean-Louis Vincent

• Mark Mikkelsen

• Ruxandra Pinto

• Jorge Salluh

• And many, many, many others!

INTERNATIONAL SURVEY OF ROUNDING PRACTICES

• 2405 respondents

• 62% staff intensivists

• 15% RNs

• 84% academic centers

• 48% ICUs > 20 beds

• 92% ”closed” units

RESPONDENTS

EVIDENCE 1. ROUNDS IMPROVE QUALITY OF CARE

HOW MANY RESPONDENTS HAVE ROUNDS?

73%

97%92%

82%

75%

66%61%

53%

0%

20%

40%

60%

80%

100%

DAILY ROUNDS 2 H ROUNDS BEDSIDE

North America

South Asia

Latin America

South Asia

East Asia / Pacific

South Asia

0%

20%

40%

60%

80%

100%

BED FLOW QUALITY DECISION TEACHING

North America

Middle East

Europe

Middle East

Latin America

South Asia

EVIDENCE 2. ROUNDS IS TEAMWORK

0%

20%

40%

60%

80%

100%

RN PHARM RT DIETICIAN PHYSIO

North America

South Asia

North America

Europe

North America

Europe

0%

20%

40%

60%

80%

100%

SATISFACTION HEARD

North America

Asia Pacific

EVIDENCE 3. INCLUDE FAMILIES ON ROUNDS

Kalocsai et al. BMC HSR 2018

“So I think rounds again build trust and the community. I think the trust – the trust level for us has been very high, because we felt that we had been treated honestly and with great compassion.”

0%

20%

40%

60%

80%

100%

FAMILIES UPDATES PARTICIPATE

North America

Latin America

North America

Latin America

North America

Latin America

EVIDENCE 4. ROUNDING TOOLS IMPROVE ROUNDS

• CHECKLISTS• PROMPTS• DAILY GOALS• DEFINE ROLES• DESIGNATE A WRITER• CREATE SCRIPTS• …

ARE THERE INCIDENTS RELATED TO ROUNDS?

FAMILY: 20%

DELAYS IN DECISIONS: 22%

44%

61%53% 50%

46%42% 41% 40%

DO ROUNDS IMPROVE CARE?

DEFINE PLAN: 73%

DEFINE GOALS: 68%

CLARIFY DIAGNOSIS: 56%

92%97%

91% 90% 90% 89% 88%82%

0%

20%

40%

60%

80%

100%

DAILY GOAL PROBLEM WRITER SCRIPT CHECKLIST ASSISTANCE

7%* 7%* 10%* 4%* 3% 9%*

Latin America

Asia / Pacific

Latin America

North America

Latin America

North America

Asia / Pacific

North America

Asia

North America

Europe

North America

• Phil Taylor• Suzanne Witts• Ligia Rabello• William Vianna• Andrew Chapman• Tatiana Salgueiro• Phil Shin• Matt Cavanagh• Cameron Guest• Nicole Marinoff• Wade Stedman• Neill Adhikari• Brian Cuthbertson• Pamela Meyer• Grace Walter• Alberto Goffi• Stephan Hain• Dominique Piquette• Wasim Yunus• Igor Shvartsman• Matteo Parotto• Helen Su• Hiroko Aoyama• Laura Dragoi• Ming Lam• Jennifer Tsang• Grazielle Ramos• Du Bin

• Carmen Soto• Kozue Schmidt• Martin Urner• Andrea Falvo• Aline Reis• Janice Zimmerman• Diana Hughes• Vishakha Kumar• Harald Grossmann• Claire Pillar• Jagtar Pooni• M Piedad Guzman• Alison Fox-Robichaud• Donna Goldsmith• Emiliano Tizi• Stephen Lapinsky• Alawai Alsaeedi• Peter Cox• Andrew Argent• Stephen Brett• Mervyn Mer• Yaseen Arabi• Khalid Maghrabi• Ganesh Suntaralingam• Federico Carini• Gary Masterson• Sandy Mather• Rob Fowler• Konrad Reinhardt

0%

20%

40%

60%

80%

100%

RN SATISFACTION RN HEARD

0%

20%

40%

60%

80%

100%

Trainee SATISFACTION Trainee HEARD

North America

Latin America