In an effort to improve the quality of care across all of our ICU pods, we have been performing a trial of multi-disciplinary “Quality Rounds” across all of our ICUs over the last two months. The feedback has been uniformly positive. Among other things, foleys are being removed, central lines are being addressed, and a spotlight is being put on mobility goals.
The goal of Quality Rounds is to ensure that we are addressing key domains in the care of ALL of our ICU patients in a standardized fashion that involves all of the disciplines in the ICU. At the same time, the rounds are meant to be efficient, 10 minutes per pod, 15 minutes tops.
At our ICU collaborative, we reviewed pros/cons of the different versions and decided on the following scheme for Quality Rounds.
– Multidisciplinary team, one rep from each discipline is present. At a minimum, fellow and nurse is present to proceed.
-Walk rounds. Team walks from bed to bed, visually ensuring items on the list are addressed.
– Quality Rounds List. This will be kept in a binder in each pod in the MDs office. Items are quickly assessed with help of team members and/or visually confirmed directly (eg lines). Remember, these are all yes/no questions so there is no need to go into extensive detail on any item. It’s ok to collegially redirect a team member so that quality rounds move along quickly.
– Follow through. Fellow will refer to Rounding List on rounds so that deficiencies noted on Quality Rounds can be addressed in real time. Lead nurse will also re-inforce appropriate action items with bed-side nurse.
-Rounding times. Schedule per pod:
MORNING: Make sure previous day’s list is available for reference.
– Pods 1-3: Starts in Pod 2 at 8am, proceed to pod 3, 815 in Pod 3 (pod 1 fellow takes over), finish in Pod 1.
– Pod 4: Start at 8am.
– Pod 5: Start at 830 AM
AFTERNOON
-All pods start at 3pm. Fellow, nurse, and mobility. Goal is to ensure that follow through has occurred on all items on the rounding tool.
As usual, this process is not set in stone. We hope to continually reassess and improve. Your feedback is important. Please let me know what works and what isn’t working so that we can refine. I truly appreciate your collaboration and hope that you agree that this process will benefit all of our patients.