STRONGER TOGETHER for Better Care
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memories of medical school and residency where the team of medical students, residents and the attending physician go to see the patient then discuss the patient at length, sometimes with a discharge planner and pharmacist. The Institute for Healthcare Improvement( IHI) defines MDRs as a patient-centered model of care in which multiple members of the care team representing different disciplines come together to discuss the care of the patient in real time, while emphasizing patient safety and quality( How-to Guide: Multidisciplinary Rounds, 2015).
Various forms of MDRs have been studied to determine the impact on hospital length of stay( LOS), readmissions, mortality, hospital acquired infections( HAIs) and patient satisfaction among many other patient safety and quality indicators. Though this article is not meant to be an in-depth review of the research done on MDRs, one systematic review published in the Journal of Hospital Medicine reviewed 22 studies analyzing effects of MDRs on various outcomes such as LOS, cost, harm reduction and staff satisfaction( Bhamidipati et al., 2016). Another systematic review published in the Journal of Patient Safety reviewed 33 studies analyzing the effect of MDRs on patient-centeredness, which was defined as a patient being well-informed and able to participate in shared decision-making, as well as the effect on LOS, readmission rates and team collaboration( Heip et al., 2022). Both systematic reviews showed potential in improving patient safety and quality metrics, though both systematic reviews noted limitations due to small sample sizes in the studies as well as variability in the structure of MDRs and outcome reporting.
In my years of hospital medicine, I have participated in several variations of MDRs as well as implemented MDRs at multiple facilities. Based on my experience, I have found that a patient-centered common purpose is essential. Not only must MDRs be patient-centered, but the MDR team must also agree about the purpose of rounds. As a hospitalist, my purpose for MDRs is usually to discuss a patient’ s discharge planning, or what I call“ the plan for the day, plan for the stay.” However, MDRs can have many other purposes as well. I have been part of MDRs focusing only on patient safety and quality indicators, where we discuss each patient on the unit and each patient’ s risk for acquiring an infection due to a foley or central line( hospital-acquired infection, or HAI). I have also been a part of MDRs where we round at each patient’ s bedside, assessing how a patient’ s stay has gone and what can be improved. Regardless of the MDR structure, keeping the patient at the forefront of the discussion so that each discipline can advocate for the patient is essential. Also, if the purpose of MDRs is not explicitly stated beforehand to the group, then the discussion can be quickly derailed when others start wanting to discuss items not related to the agreed purpose.
In implementing MDRs, I recommend the following:
• MDR checklist: to keep MDRs on track, having a checklist that outlines the purpose of rounds is very helpful. Whether the purpose is for discharge planning or reducing the risk of HAIs, having a list that the team addresses each time and for each patient keeps the discussion moving forward and focused. Having a list can then also define the essential members of the MDR team that need to be present to make MDRs meaningful. For example, having MDRs for discharge planning would be ineffective without the discharge planner or the social worker to provide input.
• Physician as an active team member: ideally, MDRs should be physician-led, particularly if the MDR purpose is for discharge planning. As a hospitalist, I am the captain of the patient’ s ship when coordinating his or her care in the hospital, therefore it is imperative that I am aware of what each team member is doing in moving the patient along. Even when MDRs are for other purposes, the physician should be an active member of the team, providing input, sharing her expertise and advocating for the patient. Having physicians work collaboratively alongside other disciplines in advocating for the patient builds collegiality in the care team, which not only improves communication, but can improve patient and team member satisfaction.
• Efficient, consistent, but flexible: For any MDRs to be sustainable, the team must be efficient and consistent, but flexible. Unlike our medical school experiences of teaching rounds that last hours, MDRs must be efficient and focused, respecting the time and competing priorities of all the members of the care team. MDRs must also be consistent. Setting expectations for which care team members need to attend, what will be discussed and the schedule of rounds such that they happen at the same time each day are all important in keeping MDRs moving forward and becoming part of the care team’ s workflow. Most importantly, MDRs need to be flexible to allow for changes to be made to make the time more efficient, to improve patient care or just recognize that something is not working among the team.
I have found MDRs to be a great tool in improving communication among my fellow care team members. Much like the systematic reviews on MDRs, the objective data for the MDRs at my facilities have been inconclusive, and any improvements in length of stay, HAIs and patient satisfaction scores cannot be solely based on MDRs alone. MDRs,
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