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Use of Multidisciplinary Rounds to Simultaneously Improve Quality Outcomes, Enhance Resident Education, and Shorten Length of Stay

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Abstract

BACKGROUND

Hospital-based clinicians and educators face a difficult challenge trying to simultaneously improve measurable quality, educate residents in line with ACGME core competencies, while also attending to fiscal concerns such as hospital length of stay (LOS).

OBJECTIVE

The purpose of this study was to determine the effect of multidisciplinary rounds (MDR) on quality core measure performance, resident education, and hospital length of stay.

DESIGN

Pre and post observational study assessing the impact of MDR during its first year of implementation.

SETTING

The Norwalk Hospital is a 328-bed, university-affiliated community teaching hospital in an urban setting with a total of 44 Internal Medicine residents.

METHODS

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) core measure performance was obtained on a monthly basis for selected heart failure (CHF), pneumonia, and acute myocardial infarction (AMI) measures addressed on the general medical service. Resident knowledge and attitudes about MDR were determined by an anonymous questionnaire. LOS and monthly core measure performance rates were adjusted for patient characteristics and secular trends using linear spline logistic regression modeling.

RESULTS

Institution of MDR was associated with a significant improvement in quality core measure performance in targeted areas of CHF from 65% to 76% (p < .001), AMI from 89% to 96% (p = .004), pneumonia from 27% to 70% (p < .001), and all combined from 59% to 78% (p < .001). Adjusted overall monthly performance rates also improved during MDR (odds ratio [OR] 1.09, CI 1.06–1.12, p < .001). Residents reported substantial improvements in core measure knowledge, systems-based care, and communication after institution of MDR (p < .001). Residents also agreed that MDR improved efficiency, delivery of evidence-based care, and relationships with involved disciplines. Adjusted average LOS decreased 0.5 (95% CI 0.1–0.8) days for patients with a target core measure diagnosis of either CHF, pneumonia, or AMI (p < .01 ) and by 0.6 (95% CI 0.5–0.7) days for all medicine DRGs (p < .001).

CONCLUSIONS

Resident-centered MDR is an effective process using no additional resources that simultaneously improves quality of care while enhancing resident education and is associated with shortened length of stay.

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Acknowledgements

We thank the Norwalk Hospital and its MDR attendees for their dedication to and support of this process.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, Norwalk Hospital, 24 Stevens Street, Norwalk, CT, 06856, USA

    Stephen O’Mahony MD, Eric Mazur MD, Pamela Charney MD & Jonathan Fine MD

  2. Yale University School of Medicine, New Haven, CT, USA

    Stephen O’Mahony MD & Eric Mazur MD

  3. Albert Einstein College of Medicine, Bronx, NY, USA

    Pamela Charney MD

  4. Center for Outcomes Research, Yale University and Yale New Haven Health, New Haven, CT, USA

    Yun Wang PhD

  5. Hinds Center for Lung Studies and Health Informatics, Norwalk Hospital, Norwalk, CT, USA

    Jonathan Fine MD

Authors
  1. Stephen O’Mahony MD
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  2. Eric Mazur MD
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  3. Pamela Charney MD
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  4. Yun Wang PhD
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  5. Jonathan Fine MD
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Corresponding author

Correspondence to Stephen O’Mahony MD.

Additional information

This study was presented in part in workshop and oral format at the 27th Society of General Internal Medicine Annual Meeting, May 12–15, 2004, Chicago, IL

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O’Mahony, S., Mazur, E., Charney, P. et al. Use of Multidisciplinary Rounds to Simultaneously Improve Quality Outcomes, Enhance Resident Education, and Shorten Length of Stay. J GEN INTERN MED 22, 1073–1079 (2007). https://doi.org/10.1007/s11606-007-0225-1

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  • DOI: https://doi.org/10.1007/s11606-007-0225-1

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