Structured interdisciplinary bedside rounds do not reduce length of hospital stay and 28-day re-admission rate among older people hospitalised with acute illness: An Australian study

Abstract

Objective: Structured interdisciplinary bedside rounds (SIBR) are being implemented across many hospitals in Australia despite limited evidence of their effectiveness. This study evaluated the effect of SIBR on two interconnected outcomes, namely length of stay (LOS) and 28-day re-admission. Methods: In the present before-after study of 3644 patients, twice-weekly SIBR were implemented on two aged care wards. Although weekly case conferences were shortened during SIBR, all other practices remained unchanged. Demographic, medical and frailty measures were considered in appropriate analyses. Results: There was no significant difference in median (interquartile range) LOS before and during SIBR (8 (5-15) vs 8 (4-15) days respectively; P = 0.51). In an adjusted analysis, SIBR had no effect on LOS (hazard ratio 0.97; 95% confidence interval 0.90-1.05). The presence of dementia or delirium, or the ability to speak English, did not modify the effect of SIBR (P>0.05 for all). Similarly, SIBR had no effect on 28-day re-admission rates (20.3% vs 19.0% before and during SIBR respectively; P=0.36). Conclusions: Although ineffective interdisciplinary communication is associated with negative outcomes for patients and healthcare services, models of care that aim to improve communication are not necessarily effective in reducing LOS or early re-admission. Clinical services implementing SIBR are encouraged to independently evaluate their effects.