(1353) Implementation of a Multidisciplinary Rounding Tool in a Medical Intensive Care Unit

Introduction: Literature on multidisciplinary rounds and rounding checklists improving intensive care unit (ICU) patient outcomes is limited to pre- and post-intervention studies lacking a control group. The objective of this study was to describe the impact of a standardized rounding process on multidisciplinary member attendance, rounding duration, and clinical outcomes.

Methods: This was an observational, retrospective, cohort study of patients admitted to the neurovascular critical care service (control group) or medical ICU advanced practice provider (APP) and resident services (intervention groups) pre- and post-implementation of a standardized rounding tool and paging system.

Results: A convenience sample of 33 days pre-intervention and 34 days post-intervention was analyzed. The control group had no difference pre- and post-intervention in the number (median[IQR]) of disciplines starting (7.0[6.5,8.0] vs 7.0[6.0,8.0], p=0.696) or ending (7.0[6.0,8.0] vs 6.0[6.0,7.0], p=0.183) rounds. The intervention groups showed statistically significant differences in the number of disciplines on rounds. The APP group started rounds with 5.0[4.5,5.0] versus 7.0[6.0,8.0] disciplines (p=0.03) and ended rounds with 5.0[4.0,6.0] versus 7.0[6.0,8.0] (p=0.002). The resident service started rounds with 6.0[5.0,7.0] vs 7.0[6.0,8.0] disciplines (p=0.006) and ended rounds with 4.0[4.0,6.0] vs 7.0[6.0,8.0] (p < 0.001). The duration of rounds per patient decreased in the intervention groups by 20.8% (13.0[12.0,14.8) vs 10.3[9.5,12.0] minutes (p < 0.001). Demographics of the pre- and post-intervention groups were similar in age and ICU length of stay, but were different in incidence of COVID (15.3% vs 5.0%, p=0.200), ICU mortality (35.9% vs 11.0%, p< 0.001), and in-hospital mortality (49.6% vs 15.5%, p< 0.001). When adjusted for mortality, there was decreased time to physical therapy consults, decreased incidence of central, arterial, and foley catheters, and decreased duration of arterial catheters post-intervention.

Conclusions: Implementation of a standardized rounding tool and paging system resulted in an increase in number of disciplines at multidisciplinary rounds compared to a control group. These interventions reduced rounding time per patient and improved clinical outcomes.