Ward leaders at Orange Hospital in New South Wales, Australia, recognized that their ward processes were not optimized to deliver effective patient care. Their ward rounds were failing to deliver good information fast enough to prevent mistakes and keep length of stay down.
To improve care, the team decided to pilot structured interdisciplinary bedside rounds (SIBR®), a program originally developed at Emory Healthcare in the US and adopted in parts of New South Wales, Australia, through the work of the Clinical Excellence Commission (CEC). Jason Stein, MD, associate vice chair for quality in the Department of Medicine at Emory University School of Medicine, helped the CEC adapt Emory’s model of care across hospitals in New South Wales, Australia.
Orange Health Service became the first organization in the state to implement a custom, structured, and efficient rounding process tailored to the Australian public system. Orange Hospital chose SIBR® because it addressed the common challenges of rounding through a highly structured yet flexible process.
- Introduce patient, review case
- Summarize overnight; safety check
- Allied health, pharmacist, discharge planner summarize plans
- Patient, family ask questions
- Outline daily plan; estimated date of discharge
- Patient, family
- Junior doctor
- Bedside nurse
- Nurse unit manager
- Allied health (i.e., OT, PT, SW)
At Orange Hospital, the team used the SIBR® methodology to focus on four critical components of rounding: maintaining full round attendance, keeping the rounds quick, actively involving the patient and family, and delineating clear next steps post-round.
Component 1: Proactively address barriers to full attendance
SIBR® rounds require all care team members be present for the round, but this can be extremely challenging to achieve when clinicians have differing schedules and outside responsibilities. The SIBR® methodology addresses this challenge by ensuring clinicians are unit-based and realigning their schedules to align with one another. However, that is a major shift for most clinicians, and will only work if they are fully onboard for the change.
At Orange, team leaders discussed the shift in staffing and rounding with each care team constituency. Leaders described what SIBR® rounds were and what changes were necessary. They also encouraged clinicians to tell them what problems SIBR® rounds would probably cause on the unit. This process allowed Orange to identify each groups’ barriers to change and make SIBR® work for them. Ultimately, leaders could show how the new model would benefit all clinicians.
Component 2: Ensure rounds are time efficient
SIBR® rounds reduce inefficiency by setting out clear guidelines for when the round will start, how long it will take, and how long each patient can be discussed. Orange Hospital found that even this structure wasn’t enough to maintain efficiency if clinicians came to the round unprepared to discuss their patients.
To maintain the round as a clear time for decision-making, leaders structured the morning hours prior to SIBR® rounding for information gathering. With medical and nursing rounds accomplished before SIBR® rounds, the team can come together quickly to make decisions on care changes before going back to their other work.
Component 3: Set aside time for patient and family participation
Involving patients and their families in decision-making processes is often seen as time consuming and is frequently left out of rounding processes. Orange Health used the SIBR® round structure to incorporate patient and family involvement into the rounding process without derailing the meeting. Each patient has dedicated time to ask questions or make comments on what the care team has discussed. If a question requires additional time, a team member commits to following up on the question after the round has finished.
Additionally, clinicians avoid using medical terminology when discussing care decisions. Instead, they use language the patients and families will understand.
Component 4: Track owners and next steps in real time
The team at Orange Health uses a standardized template to record discussion during the SIBR® round and update the patient’s plan for the day. The template has space for next steps to be recorded, and the team assigns clear task ownership at the end of each round. Next steps are typically larger tasks that are deliberately saved to be done after the round ends, to maintain round efficiency. Smaller tasks are completed during the round, as possible.
Key components of effective management of next steps include:
- Using a standardized template to summarize the discussion, record the patient’s daily care plan, and update their estimated date of discharge
- Generating a list of follow-up tasks based on the information shared during the round and assigning clear ownership
- Saving all larger tasks or to be done for late so as not to derail the conversation
Orange Hospital committed to a substantial change in rounding procedures when they decided to use the SIBR® rounding model. That commitment and the way in which Orange has implemented the rounds has paid off, with impressive improvements in both ward efficiency and quality metrics. Notably, they experienced a 9% decrease in average length of stay after one year of SIBR®.