title: Structured interdisciplinary bedside rounds do not reduce length of hospital stay and 28-day re-admission rate among older people hospitalised with acute illness: an Australian study.
abstract: Objective Structured interdisciplinary bedside rounds (SIBR) are being implemented across many hospitals in Australia despite limited evidence of their effectiveness. This study evaluated the effect of SIBR on two interconnected outcomes, namely length of stay (LOS) and 28-day re-admission. Methods In the present before-after study of 3644 patients, twice-weekly SIBR were implemented on two aged care wards. Although weekly case conferences were shortened during SIBR, all other practices remained unchanged. Demographic, medical and frailty measures were considered in appropriate analyses. Results There was no significant difference in median (interquartile range) LOS before and during SIBR (8 (5-15) vs 8 (4-15) days respectively; P=0.51). In an adjusted analysis, SIBR had no effect on LOS (hazard ratio 0.97; 95% confidence interval 0.90-1.05). The presence of dementia or delirium, or the ability to speak English, did not modify the effect of SIBR (P>0.05 for all). Similarly, SIBR had no effect on 28-day re-admission rates (20.3% vs 19.0% before and during SIBR respectively; P=0.36). Conclusions Although ineffective interdisciplinary communication is associated with negative outcomes for patients and healthcare services, models of care that aim to improve communication are not necessarily effective in reducing LOS or early re-admission. Clinical services implementing SIBR are encouraged to independently evaluate their effects. What is known about the topic? Ineffective interdisciplinary communication may harm patients and increase LOS. Only two publications have evaluated the implementation of SIBR, a new model of care that aims to improve interdisciplinary communication and collaboration. One paper reported that SIBR reduced unadjusted LOS and in-hospital mortality, whereas the other found that SIBR improved teamwork, communication and staff efficiency. What does this paper add? The effect of SIBR among acutely unwell older people on aged care wards is unknown. The present study is the first to evaluate the effects of SIBR in this population. It shows that the implementation of SIBR did not reduce LOS or early re-admission, and suggests that existing communication strategies may have weakened the effects of SIBR. What are the implications for practitioners? Policies and practice that promote the addition of communication strategies, such as SIBR, may not be effective in all patient populations. More research is needed to determine whether SIBR reduce these and other outcomes, particularly for services with weaker communication frameworks and protocols.
authors.affiliation: University of New South Wales, Aged Care Research Unit, Liverpool Hospital, LMB 7103, Liverpool BC 1871, NSW 2170, Australia. Email:.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Huynh
authors.affiliation: University of New South Wales, Aged Care Research Unit, Liverpool Hospital, LMB 7103, Liverpool BC 1871, NSW 2170, Australia. Email:.
authors.forename: David
authors.initials: D
authors.lastname: Basic
authors.affiliation: University of New South Wales, Aged Care Research Unit, Liverpool Hospital, LMB 7103, Liverpool BC 1871, NSW 2170, Australia. Email:.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Gonzales
authors.affiliation: University of New South Wales, Aged Care Research Unit, Liverpool Hospital, LMB 7103, Liverpool BC 1871, NSW 2170, Australia. Email:.
authors.forename: Chris
authors.initials: C
authors.lastname: Shanley
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000369:Aged, 80 and over; D001315:Australia; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data; D015397:Program Evaluation; D056164:Teaching Rounds / Q000379:methods