Interprofessional collaborative care characteristics and the occurrence of bedside interprofessional rounds: A cross-sectional analysis

Abstract

Background: Interprofessional collaboration improves the quality of medical care, but integration into inpatient workflow has been limited. Identification of systems-based factors promoting or diminishing bedside interprofessional rounds (BIR), one method of interprofessional collaboration, is critical for potential improvements in collaboration in hospital settings. The objective of this study was to determine whether the percentage of bedside interprofessional rounds in 18 hospital-based clinical units is attributable to spatial, staffing, patient, or nursing perception characteristics. Methods: A prospective, cross-sectional assessment of data obtained from nursing audits in one large academic medical center on a sampling of hospitalized pediatric and adult patients in 18 units from November 2012 to October 2013 was performed. The primary outcome was the percentage of bedside interprofessional rounds, defined as encounters including one attending-level physician and a nurse discussing the case at the patient's bedside. Logistic regression models were constructed with four covariate domains: (1) spatial characteristics (unit type, bed number, square feet per bed), (2) staffing characteristics (nurse-to-patient ratios, admitting services to unit), (3) patient-level characteristics (length of stay, severity of illness), and (4) nursing perceptions of collegiality, staffing, and use of rounding scripts. Results: Of 29,173 patients assessed during 1241 audited unit-days, 21,493 patients received BIR (74 %, range 35-97 %). Factors independently associated with increased occurrence of bedside interprofessional rounds were: intensive care unit (odds ratio 9.63, [CI 5.30-17.42]), intermediate care unit (odds ratio 2.84, [CI 1.37-5.87]), hospital length of stay 5-7 days (odds ratio 1.89, [CI, 1.05-3.38]) and >7 days (odds ratio 2.27, [CI, 1.28-4.02]), use of rounding script (odds ratio 2.20, [CI 1.15-4.23]), and perceived provider/leadership support (odds ratio 3.25, [CI 1.83-5.77]). Conclusions: Variation of bedside interprofessional rounds was more attributable to unit type and perceived support rather than spatial or relationship characteristics amongst providers. Strategies for transforming the value of hospital care may require a reconfiguration of care delivery toward more integrated practice units.