Team•rounds
Team•rounds are an important part of Stanford Health Care's (SHC) commitment to outstanding patient care. Team•rounds are daily interdisciplinary meetings during which representatives from all disciplines of the care team gather to discuss treatment plans for the patients under their care. The goal of team•rounds is to improve the patient experience from admission through discharge by:
- Ensuring that the entire interdisciplinary team is working toward a common care plan.
- Identifying and addressing potential barriers to patient care transitions and discharges.
As the primary coordinators of patients' daily plans of care, nurse involvement is critical to the success of team•rounds. Resource nurses facilitate or co-facilitate team•rounds meetings, update the team on pertinent nursing updates, document these interdisciplinary discussions in the patients' charts, and, most importantly, discuss care plans with bedside nurses, patients, and patients' families.
Depending upon the patient's needs, participants may include the following:
Key discussion points for team•rounds meetings
- Goals for the day
- Estimated discharge date (EDD)
- Does patient still require telemetry?
- Discharge needs?
- Mobility progression?
- Barriers to progress or discharge?
- Is the patient or family aware of the care plan?
- Does the patient have transportation arranged for discharge?
- Follow up on yesterday's discussion and assign follow up items for the day's discussion.
Based on the agreed-upon care plans, bedside clinical nurses:
- Ensure that tests and procedures are completed in a timely manner.
- Help patients understand what to expect between admission and discharge.
- Educate patients and their families in preparation for discharge.
- Identify patient concerns and/or potential delays and escalate these to the resource nurse or medical team as appropriate.
Patient satisfaction outcomes:
Since launching team•rounds, SHC has seen improvements in each Press Ganey question correlated to smooth discharges and interdisciplinary coordination, including:
- Extent felt ready for discharge.
- Speed of discharge process.
- Staff worked together to care for me.
Staff anecdotes
"It's great having all the disciplines in the room at the same time. We all have the opportunity to know the plan of care first hand and deliver a consistent message to the patients and there seem to be a lot fewer "last minute" surprises and delays. It's really been very exciting to be able to sustain this high level of communication."
-Martha Berrier, RN, patient care manager, D1
"Team•rounds has had a positive effect on collaboration and teamwork with other disciplines. This in turn has created safer and higher quality patient care, has improved patient outcomes, and has increased staff professionalism and communication."
-Karen Brandt, RN, Assistant Patient Care Manager, C2
"...By attending [team•rounds], not only can we learn the plan for patient discharges, which [helps with] planning pharmacy workflow, we can also perform daily profile reviews and catch or address any outstanding medication issues without having to page each individual MD. Team•rounds allows me to interact with staff from every clinical discipline. Before team•rounds, I would rarely (if ever!) have interactions with them …I now have a better understanding of each person's role in the goal of providing optimal patient care."
-Sean Carlton, Pharm D
"I find team•rounds invaluable to the work I do. These rounds provide an opportunity for multiple disciplines to gather and discuss patient care in a more holistic manner. In addition, team•rounds afford a brief opportunity for team building, as these rounds are often times the only instance in which multiple services involved in patient care are able to meet face to face."
-Jennifer Smart, MSW
"Team•care is an excellent forum for members of the medical team to streamline discharge planning."
-Michaela Sullivan, MSN, RN, Float Case Manager