A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement.
OBJECTIVE
In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evaluate the process of medical care on the inpatient wards. Using standard continuous quality improvement (CQI) methods, a team of medical interns, nurses, and other health professionals involved in patient care on the medicine inpatient service designed interdisciplinary, daily work rounds to improve the care of patients on the inpatient wards.


METHODS
The authors conducted a randomized, controlled firm trial of the impact of interdisciplinary rounds on the inpatient medicine services. The trial lasted 6 months (November 1993-April 1994) and included 1,102 admissions randomly assigned to experimental or control teams by the pre-existing firm system. Of the 1,102 admissions included in the study, 535 were randomized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds. The outcomes studied included length of stay (LOS), total hospital charges, provider satisfaction, and ancillary service efficiency.


RESULTS
Unadjusted analysis for log-transformed data showed lower length of stay and total charges for the interdisciplinary group. The mean LOS for interdisciplinary rounds was 5.46 days, compared with 6.06 days for traditional care (P = 0.006), whereas mean total charges were $6,681 and $8,090 (P = 0.002) for the two groups, respectively. After multivariate regression analysis using a propensity score that included gender, age, marital status, admission source, diagnosis-related group (DRG) weight, and primary diagnosis by International Classification of Diseases, Ninth Revision (ICD-9) cluster, these differences remained statistically significant.


CONCLUSIONS
Previous studies of interdisciplinary teams have failed to show statistically significant cost savings. This study involving more patients shows both cost and LOS decreases with the use of interdisciplinary teams. At the end of the 6-month trial, interdisciplinary rounds were instituted on all medicine inpatient services.
School of Medicine, Case Western Reserve University, MetroHealth Medicl Center, Cleveland, OH 44109, USA.
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Curley
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McEachern
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Speroff
D003142:Communication; D017598:Efficiency, Organizational; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006757:Hospital Units / Q000592:standards*; D006766:Hospitals, County; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007400:Interprofessional Relations; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008332:Management Quality Circles / Q000458:organization & administration*; D008485:Medical Audit / Q000379:methods* / Q000458:organization & administration; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio; D017060:Patient Satisfaction; D012044:Regression Analysis; D017749:Total Quality Management / Q000458:organization & administration*