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Improving Patient Rounds (IPR):
 Patient- and Family-Centered Care
“Takes On” Academic Bedside Rounds
  at the Medical College of Georgia

   4th International Conference PFCC
   Philadelphia, PA ~ August 18, 2009

              MCG ~ MCGHealth
   Center for Patient- and Family-Centered Care
             Walter Moore, MD, Nettie Engels,
     Christine O’Meara, MA, MPH, Sol Guerrero, MD
Specific Aims: Quality Improvement

  Implement Bedside PFCC Rounds
    Adult care hospital - General Internal Medicine (5-W)
    Interdisciplinary Team - Red Team (attending, residents,
    interns, students), nurses, pharmacy, allied health staff
    Patient Advisor Observers

  Engage patients & families as partners
    In care, decision-making, discharge planning

  Disseminate PFCC Rounds
  Transform how we teach PFCC
    Impact graduate medical education
     • Professionalism, communication, interpersonal skills
Improving Patient Rounds
Outcomes
  16 Patients
  67 PFCC Rounds encounters
  Timing and duration 2–30 minutes
     Upfront time investment
     More efficiency over time with same patient
  Benefits Patient/family
     Engaged; > Communication; > Satisfaction
    “Having PFCC Rounds is like taking a wall between the doctors
     and patient’s family away.”
  Benefits Nursing
     > Communication; > Exchange of information
    “Rounds with nurse helps with continuity of care.”
    “Keeps people informed, keeps nurse informed, make sure that
    we’re all on the same page as far as patient care.”
Improving Patient Rounds
Strategic Elements & Infrastructure

  Contiguous Geographical Location

  Scheduled times (9:30 am – 11:30 am)

  Physicians onboard

  Nursing staff involved

  Leadership support
    Nursing Supervisor, Department Chair, Hospital
    Leadership

  Education & Training
    PFCC principles and practices
Improving Patient Rounds
Challenges

  Patient Advisor Training
     Human Assurance Committee CITI; HIPAA

  Consent patients

  Coordinate nurses, doctors, allied health

  Dynamic group
    Make-up of team changes at Academic
    Medical Center (Attending, Residents, Interns,
    Students, Patient Advisors)
Improving Patient Rounds
Overcoming Challenges


  Observer – Need more consistency with same
  patients

  PFCC Rounds standard of care – No consent

  Coordination – Set PFCC Rounds schedule to
  allow more interdisciplinary care team members
  to participate

  Dynamic group – Team building and development
Improving Patient Rounds
Observation Checklist
 Patient Advisor Observer join care team
 Assess communications
 Debrief
    Care team self-assess
    Observer gives feedback to team
    Nurses
    Patient / Family

 Components:
    Demographics
    Domains – PFCC core concepts
    Behaviors – engage pt/family, listen actively, model
Improving Patient Rounds
Checklist
OBSERVATION ACTIVITY:

     Use Checklist while observing video

     Discussion

     View themed video segment

     Questions & Answers

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Improving Patient Rounds (IPR): Medical College of Georgia/Georgia Health

  • 1. Improving Patient Rounds (IPR): Patient- and Family-Centered Care “Takes On” Academic Bedside Rounds at the Medical College of Georgia 4th International Conference PFCC Philadelphia, PA ~ August 18, 2009 MCG ~ MCGHealth Center for Patient- and Family-Centered Care Walter Moore, MD, Nettie Engels, Christine O’Meara, MA, MPH, Sol Guerrero, MD
  • 2. Specific Aims: Quality Improvement Implement Bedside PFCC Rounds Adult care hospital - General Internal Medicine (5-W) Interdisciplinary Team - Red Team (attending, residents, interns, students), nurses, pharmacy, allied health staff Patient Advisor Observers Engage patients & families as partners In care, decision-making, discharge planning Disseminate PFCC Rounds Transform how we teach PFCC Impact graduate medical education • Professionalism, communication, interpersonal skills
  • 3. Improving Patient Rounds Outcomes 16 Patients 67 PFCC Rounds encounters Timing and duration 2–30 minutes Upfront time investment More efficiency over time with same patient Benefits Patient/family Engaged; > Communication; > Satisfaction “Having PFCC Rounds is like taking a wall between the doctors and patient’s family away.” Benefits Nursing > Communication; > Exchange of information “Rounds with nurse helps with continuity of care.” “Keeps people informed, keeps nurse informed, make sure that we’re all on the same page as far as patient care.”
  • 4. Improving Patient Rounds Strategic Elements & Infrastructure Contiguous Geographical Location Scheduled times (9:30 am – 11:30 am) Physicians onboard Nursing staff involved Leadership support Nursing Supervisor, Department Chair, Hospital Leadership Education & Training PFCC principles and practices
  • 5. Improving Patient Rounds Challenges Patient Advisor Training Human Assurance Committee CITI; HIPAA Consent patients Coordinate nurses, doctors, allied health Dynamic group Make-up of team changes at Academic Medical Center (Attending, Residents, Interns, Students, Patient Advisors)
  • 6. Improving Patient Rounds Overcoming Challenges Observer – Need more consistency with same patients PFCC Rounds standard of care – No consent Coordination – Set PFCC Rounds schedule to allow more interdisciplinary care team members to participate Dynamic group – Team building and development
  • 7. Improving Patient Rounds Observation Checklist Patient Advisor Observer join care team Assess communications Debrief Care team self-assess Observer gives feedback to team Nurses Patient / Family Components: Demographics Domains – PFCC core concepts Behaviors – engage pt/family, listen actively, model
  • 8. Improving Patient Rounds Checklist OBSERVATION ACTIVITY: Use Checklist while observing video Discussion View themed video segment Questions & Answers