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Physician-Nurse rounding

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  • #25387

    sixsigmadeewana
    Member

    Is there any hospital which has Nurse-Physician rounding? (Nurse accompanies Physician during physician rounds)
    We are trying to develop a process for the same and need some input on the same. I am being told that our hospital used to have it several years ago and it was stopped.

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    #61198

    Brit
    Participant

    We used to have it and moved away from it – now we are going back.  We ar chnaging our nursing system to a patinet/team-centered model of care.  In the model, RN’s will round with physicians to help manage their LPN’s and techs.  We don’t plan on having this in place until March 07, so sorry I couldn’t be more help.

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    #61199

    sixsigmadeewana
    Member

    Brit
    What are some of barriers that your team is facing?
    Some of barriers for us are having physicians round at specific times, not having enough nursing staff, and increasing work load on nurses if they round with the physicians.Being a community hosp. it makes it harder to persuade physicians to do anything.

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    #61200

    Brit
    Participant

    We are in the same boat (community hospital, physician rounding issues, etc.).  I did an interesting analysis by unit showing how much later on average our discharges are than our admissions -essentially admitting patinets beofre we discharge, causing a bed issue.
    We also have nurse shortage issues and are temporarily being addressed via agency nurses – but that won’t last long ($).  We have put in a hospitalist program to assist in moving patinets out that can be, however, since the presiding physicians aren’t “our” doctors, we still have discharge issues.  On MD even likes to do rounds at 11:30 at night!  Frustrating.
    As we move to the different model of care, it will be imperative that the Rns have a complete understanding of the care via the MDs.  Basically we are moving  many Rns into a group management role for LPNs and others.  We are moving their responsibility, not adding to their time.  Does two things – allows you to run with less RNs and filling LPN positions is a bit easier.  Also increases the level of care understanding and teamwork between physician and nurse.

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    #61201

    sixsigmadeewana
    Member

    Thats interesting coz I did an analysis to support my argument. I calculated the average discharge time grouped by floors. It was anywhere between 3 to 9 hrs.
    Its interesting to see that you are pursuing similar things with similar issues and even solutions. Can you elaborate a bit more on how the responsibilities of your RN’s will change?

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    #61202

    Brit
    Participant

    Our model is being structured now.  I will certainly follow up as I get more design information.  Basically it is a design where the RN still has overall care duties for particular patients, however duties that can be done by LPNs are delegated by the Nurse, allowing for a samll increase in nurse/patient ration with no increase in physical workload.

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    #61746

    sixsigmadeewana
    Member

    Brit
    did you get any far on this project? we will be launching a pilot rounding process on one of our floors. big question for us is how will the nurses find time for this…
    – Anoop

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    #62502

    Kris Temple
    Participant

    We rounded not only with the Dr/nurse, but also pharmacist, social worker, dietician and I think physical therapy as well. Every morning at around the same time, all of us would discuss issues that pertained to the speciality. The rounds helped all of us gain important information about the patient so we could work as a group to improve the patient’s care. All of the nurses found this very benificial and rewarding. The problems were, Dr.s ready to round and one of the team was not able to attend, or all of the other disciplines were ready but the Dr. was called away as he/she covered the ER admissions as well. All in all, I thought it was great. I feel there were less calls made to the Dr. after he left the ICU, in regards to orders that were not written, or already addressed. I felt like we were more of a team, and the time allowed for open discussion instead of being afraid to interupt a Dr. while he was trying to take care of another patient.
    If your hospital is looking into rounding, I highly recommend it. I wish the Internal med docs that we have now would be more receptive to it. I hate feeling like I am just the task person when in fact I may have information for the Dr. that will help the patient.

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