BIIROO FAYYAA OROMIYAATTI HOSPITAALA WALIGALAA DADAR
DEDER GENERAL HOSPITAL
MULTIDISCIPLINARY TEAM
ROUND PROTOCOL
DEDER WOREDA, EASTERN
HARARGHE, OROMIA
FEBRUARY 2022
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Introduction
Multidisciplinary rounds, a model of care in which multiple members of the care team
representing different disciplines come together to discuss the care of a patient in real
time, have proven to be a valuable tool in improving the quality, safety, and patient
experience of care. Many hospitals have achieved reduced patient days, reduced
central line days, and increased coordination of care through the use of
multidisciplinary rounds. Organizations that have been successful in implementing
multidisciplinary rounds often start in the intensive care and critical care units, and
conduct multidisciplinary rounds with multiple members of the care team (physicians,
nurses, and ancillary clinicians and staff) seven days a week, developing daily goals
for every patient. Additionally, some hospitals have successfully invited families into
their regular rounding process and have implemented multidisciplinary rounds on
non-critical care units.
What Are Multidisciplinary Rounds?
Multidisciplinary rounds are a patient-centered model of care, emphasizing safety and
efficiency, that enable all members of the team caring for patients to offer individual
expertise and contribute to patient care in a concerted fashion.1 With multidisciplinary
rounds, disciplines come together, informed by their clinical expertise, to coordinate
patient care, determine care priorities, establish daily goals, and plan for potential
transfer or discharge.
Many hospitals have reported improved communication and collaboration among
members of the care team, more reliable adherence to process measures, and better
patient outcomes through the use of multidisciplinary rounds. Although the effects of
multidisciplinary rounds have not been heavily researched, formal peer-reviewed
studies have found similar results. In one study, researchers at St. Luke’s Hospital
found that the adoption of multidisciplinary rounds in the medical intensive care unit
resulted in improved process and outcome measures. For example, the use of
multidisciplinary rounds has resulted in improved compliance with the IHI Ventilator
Bundle and a significant decrease in ventilator-associated pneumonia.1
In another study, researchers studied the impact of a three-part intervention that
included daily multidisciplinary rounds. Here, the intervention resulted in a positive
effect on the communication and collaboration among physicians and nurses.2
The importance of including pharmacists in daily rounds has also been researched.
Including a pharmacist on the ICU rounding team to make recommendations
regarding dosage or frequency adjustments was found to significantly reduce adverse
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events.3
A study in Archives of Internal Medicine reports that multidisciplinary care teams
appear to be associated with a lower risk of death among patients in the intensive care
unit. According to the authors, “Multidisciplinary rounds may facilitate
implementation of best clinical practices such as evidence-based treatments for acute
lung injury, sepsis, and prevention of ICU complications. Pharmacist participation on
rounds is associated with fewer adverse drug events and alone may be associated with
lower mortality among ICU patients. Multidisciplinary rounds may also improve
communication between health care providers.”4
Why Is It Important to Conduct
Multidisciplinary Rounds?
In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st
Century, the Institute of Medicine identifies continuity of care as one of the key areas
of concern in patient care delivery.5 Too frequently, decisions related to the care of a
patient occur without input from the key providers, including nursing, pharmacy,
social work, respiratory therapy, nutrition, physicians, physical therapy, and
occupational therapy. As a result, communication breakdowns occur, resulting in
fragmented and poor quality care. Some key benefits of implementing
multidisciplinary rounds are noted below.
Effective multidisciplinary rounds can be a powerful vehicle for:
o Coordinating care among disciplines
o Reviewing current patient status
o Clarifying patient goals and desired outcomes
o Creating a comprehensive plan of care
Multidisciplinary rounds provide a formal mechanism for daily communication
among the care team, patients, and families regarding:
o Identification of safety risks
o Identification of daily goals
Multidisciplinary rounds facilitate protocol or guideline use and understanding
among the care team, providing:
o A consistent approach
o Education and teaching opportunities
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• Multidisciplinary rounds provide consistency for process improvement
Potential Impact of Multidisciplinary
Rounds
Although the literature on the effectiveness of multidisciplinary rounds is still fairly
small, many hospitals have demonstrated an impact on the following outcomes:
Improved communication and teamwork across caregivers, which has been shown
to be an important contributing factor to high levels of safety and reliability of
care
Reduced errors
Reduced ventilator days
Reduced central line days
Reduced length of stay
Improved flow of patients through levels of care
Expedited discharge planning
Increased collaboration and satisfaction among all members of the multidisciplinary
team
Key Components of Reliable
Multidisciplinary Rounds
Many hospitals across the US have successfully implemented multidisciplinary
rounds. There are a variety of rounding models, including teaching rounds, safety
rounds, and rounds that focus on the patient’s discharge from the hospital. IHI uses
the term “multidisciplinary rounds” to mean any type of rounding that enables key
members of the team caring for the patient to come together and offer expertise in
patient care.
Key components of reliable multidisciplinary rounds include the following:
Develop and refine your aim for rounds
The structure of rounds is essential
Leadership is key
Engage the patient and family
• Measurement matters
Key points needed to be reviewed during the MDT Round
- All points listed below in the process of MDT round
- Patients follow up
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- Pain score and management
- Nursing care plan completeness and adherence
- Completeness of evidences for medical care given.
- Nutrition
- Infection prevention activities.
-
Team compositions of MD ROUND
TEAM
[Link]
Roles By whom Responsibilities
1 Ward round lead Senior - Coordinates and takes responsibility for
physician/GP/IESO decision-making Sets the culture of collective input
to decision-making
- Agrees roles of other team members
- Ensures the correct priorities and pace of the ward
round
- Checks accuracy of documentation
- Facilitates and/or delivers multidisciplinary
education
-
2 Summarizer GP/IESO if the - Summarises key elements of the input for decisions
MD ROUND and the agreed decisions for documentation and
TEAM is lead by communication
Senior or head
nurse/midwife if
the MD ROUND
TEAM lead by
GP/IESO
3 Note keeper Head nurse/ - Completes structured ward round documentation
midwife
4 Patient and family Social worker - Ensures input of patient, family and carer questions,
advocate goals and priorities
- Summarises the answers to the patient’s questions
and decision for the patient, ensuring their agreement
- Ensures follow-up communication around progress
of plans to the patient
5 Safety checker Ward master - Ensures completion of safety checklist
6 Staff member who A nurse owning the - Updates the team on patient’s current state, including
knows the patient best bed relevant physiological observations and monitoring
– usually nurse - Updates the team on any changes in the patient’s
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directly caring for condition since the last review
patient
7 Other Clinical Pharmacy - Ensures medication review
multidisciplinary team - Ensures update on functional status in hospital and at
members, eg doctor, home
physician associate, - Manages emergent issues to prevent delays
pharmacist, therapist
etc
8 -
Processes of MD Team Round
Before round
• Structured information from shift handovers should be available.
• Results of investigations should be available and prepared by attending nurse
• Ensure patient questions and concerns are gathered head nurse
• Board round or huddle to prioritize patients and highlight issues from the
whole team.
• Undertake individual professional reviews to inform multidisciplinary bedside
review attending physician and nurse
• Put in place arrangements for patients with translation needs or other
communication difficulties.
• Get ready all necessary supplies needed during round by- Head nurse or
equivalent.
During round
• Begin by assigning roles and setting expectation of learning.
• Confirm diagnosis and problems.
• Address patients’ questions and concerns.
• Review patients’ progress against plan.
• Confirm or revise escalation plans.
• Check safety measures, including medication review.
• Summarize a revised plan, goals and actions with the team.
• Progress actions during ward round when possible.
• Teach and learn.
• Revise plan with patient.
• Communicate and document the review and plan, assigning key actions
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After round
• Debrief the team to discuss the ward round and for learning points.
• Multidisciplinary team board round should confirm plans, actions and
prioritization.
• Continue to update the patient on progress.
• White boards should be updated with progress and goals.
• Afternoon huddle to check progress and people who can be discharged before
that day and the next day.
• Includes weekend handover plans on a Friday
Round Environment
A ward round’s physical environment is important, and can be conducive to
conducting effective ward rounds. The following key elements should be considered:
• Modern ward rounds The environment A quiet environment to aid
communication and cognition by the care team and patient
• Other activities in the vicinity should be minimized to prevent interruptions
or distractions Seating should be available to allow a team member to
communicate with the patient at eye level
• Charts that need reviewing as part of the care process should be available,
preferably at the bedside, or taken to the office if an office-based discussion is
incorporated into the process
• Hand washing and personal protective equipment materials must be available
for infection prevention purposes Patients’ case records must be available,
either in paper of electronic format.
• Paper records should be prepared before the ward round with relevant
documents being available If computerized information is used then the
equipment to review that information must be maintained, appropriate and
• Each ward area should keep up-to-date patient status ‘at a glance’ boards in a
location that preserves patients’ confidential information, in order to enable
board rounds, a communication focus and progress updates for all team
members Places must be made available for confidential conversations, and
for the uninterrupted work of staff preparing or following up actions from the
ward round.
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Measurement plan of the implementation of the
MDT Round protocol.
The implementation of this protocol will be monitored monthly with
structured checklist and the performance outcomes of the
measurement will include the following:
Number of disciplines involved in multidisciplinary rounds
Percentage of patients with a documented daily goal in their patient
record
Number of days per week that multidisciplinary rounds occur
Length of stay by diagnosis category and total length of stay
Variety of attending the MDT
Patients knowledge about their condition
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BEDSIDE TEACHING
BedsideT time:
o After regular MDT round
Doctors on duty can spend a maximum of 45 minutes on each teaching round.
Over time must be noted accordingly of the time spent on each round only;
The maximum time for bedside teaching and ward rounds on
a given patient should not exceed more than ONE hour.
Wherever extra time is deemed necessary for ward rounds/
bedsides should be justified and prior patient permission secured.
Whenever teaching rounds are not conducted, regular rounds should be
conducted DAILY for ALL inpatients by the ward specialist /physician.
Findings, change in treatments, complains and any other relevant
information during ward rounds and bedsides should be documented in the
patients’ medical records/folder. All documentations should be accurate and
legible.
All Teaching rounds are monitored by Specialists, and senior Residents in
charge or by most senior clinician assigned there, or by staff assigned from the
collage .
On Duty medical Officer should visit ALL Inpatients Minimum ONCE every
shift.
Critically ill patients should be routinely monitored by On-duty Medical
officer and should be seen by admitting specialist minimum ONCE in each
Shift and whenever the need arises.
Inpatient medications should ONLY be changed with consultation and advice
from the Admitting Doctor. However; documented standing orders should be
carried out and where necessary informed to admitting doctor.
Emergencies should be attended immediately and critical situation to be
managed, informed and discussed with on-call physician wherever possible at
the earliest. Priority should be given to stabilizing the patient;
Case discussions should be conducted among doctors for ALL critically ill
patients, However; these discussions should not exceed more than 30minutes
and Doctors involved should be from relevant areas ONLY
All referrals and consultations should be communicated to the
on-duty doctor and to the specialist and documented in the patient
medical record/folder
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Appendices
Appendix- one
Documentation and clinical records
- Clear documentation of diagnosis, problems, assessments, goals, progress and
plans is essential.
- Structured records help to organise documentation to act as prompts to ensure
that no important component is missed.
- Checklists are helpful when incorporated into structured records and should
be used for key safety risks.
- Information recorded at the ward round should make clear the thinking around
the clinical decisions, and include clinical criteria for discharge.
- Records form the basis for clinical coding, clinical audit and for the
production of the discharge summaries, and should be structured to aid this.
- Clearly documenting discussion with patients, families and colleagues is a
high priority. A written summary for patients and relatives is encouraged
Appendix-two
Individual patient review during ward round
1. Introduction
Preparation of information Confirm patient identity Introductions to patient
Explanation of process Checking patient questions, concerns and symptoms
2. Document
Reviews completed Clinical reasoning Working diagnosis and problems Assigned
actions, including discharge preparations Planned next review and escalation plan and
triggers Discharge plans and objectives Communication with patient Clinical criteria
for discharge
3. Discussion and decisions
Confirm team understanding of*: Current working diagnosis and problems Progress
on plans since last review Changes in patient status or events since last review
Emotional, psychological and cognitive status Observation chart / triggers / NEWS2
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Fluid balance, nutrition and bowel function Speech and swallow assessment Infection
control status Investigation schedule, results and trends VTE risk assessment and plan
Medicines chart review, including allergies and antibiotics IV cannulas, lines,
infusions, drains and catheters Falls risk, skin care, pain, mobility Social care status
and effect on discharge planning
4. Pause
Agree diagnosis, and problems, progress, daily goal and plan with team and patient
5. Agree
Communications of actions and timescales Next time of review
Supplies needed for MD ROUND Team
➢ Trolley
➢ Minor sets
➢ Gloves
➢ Alcohol hand rubs
➢ Stethoscope
➢ BP apparatus
➢ Thermometers
➢ Round book
➢ Pulse oximeter
➢ Etc.. as per FMACA standards.
Frequency of round
1. Nurse should make round and asses 4p’s
a. Every one hr for critical patient
b. Every 3-4 hrs for stable patienr
2. Physician twice aday for critical patient nd daily for stable
patient ( excluding duty hrs )
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