Why Multidisciplinary Rounds are not Multidisciplinary: Examination of a Neonatal ICU Rounding Process

摘要

Multidisciplinary rounds in the critical care environment have demonstrated improved communication,enhanced efficiency and better patient outcome. However, the mechanisms by which they work are not fullyunderstood. Particularly, few studies have investigated the degree to which multidisciplinary rounds areindeed multi-disciplinary, and which factors contributed to their multidisciplinary nature. Very few toolshave been developed to facilitate collaborative work for the rounding team. We attempt to fill some of thesegaps by observing and evaluating multidisciplinary rounds in a Neonatal Intensive Care Unit. We observedmorning rounds on 44 patients and analyzed auditing records of rounds on 62 patients. Analysis focused onparticipation and contribution of different disciplines, interactions between rounding members, anddimensions of the multidisciplinary nature of rounds. The analysis showed wide variation in the level ofparticipation and contribution across disciplines. The main factors that contributed to rounds’multidisciplinary nature fell into five categories, including number of participants, specific disciplinesparticipating, and their interactions. A paper-based tool that was used to facilitate the rounds incorporated asignificant amount of input from the nurses, but not other specialists. These findings suggest importantimplications in the implementation of multidisciplinary rounds and the development of information systemsto facilitate collaboration.