Why Multidisciplinary Rounds are not Multidisciplinary

Abstract

Multidisciplinary rounds in the critical care environment have demonstrated improved communication, enhanced efficiency and better patient outcome. However, the mechanisms by which they work are not fully understood. Particularly, few studies have investigated the degree to which multidisciplinary rounds are indeed multi-disciplinary, and which factors contributed to their multidisciplinary nature. Very few tools have been developed to facilitate collaborative work for the rounding team. We attempt to fill some of these gaps by observing and evaluating multidisciplinary rounds in a Neonatal Intensive Care Unit. We observed morning rounds on 44 patients and analyzed auditing records of rounds on 62 patients. Analysis focused on participation and contribution of different disciplines, interactions between rounding members, and dimensions of the multidisciplinary nature of rounds. The analysis showed wide variation in the level of participation and contribution across disciplines. The main factors that contributed to rounds’ multidisciplinary nature fell into five categories, including number of participants, specific disciplines participating, and their interactions. A paper-based tool that was used to facilitate the rounds incorporated a significant amount of input from the nurses, but not other specialists. These findings suggest important implications in the implementation of multidisciplinary rounds and the development of information systems to facilitate collaboration.