The old adage says that two heads are better than one and in terms of patient care, Emory Saint Joseph’s Hospital has determined that having a collaborative health care team meeting with patients in their rooms to discuss their daily plan of care is indeed very effective and efficient. The hospital has implemented two Accountable Care Units (ACUs) featuring the SIBR® (structured interdisciplinary bedside rounding) program.
Pronounced “cyber” this concept of shared human interaction is better than technology. We recently had a chance to observe SIBR® rounds and catch up with team members to find out exactly how the program works. Tigisti Kidane, staff nurse, Ginger Parks, unit director, Dr. Dhaval Desai and Dorothy Pang, PharmD all contributed to the discussion.
Pulse: What do you see as the major benefits of SIBR® rounds?
Parks: SIBR® rounds really put the focus back on the patient. Sometimes patients feel like things are being done “to” them rather than “with” them. We want to create an environment where we are truly partnering with the patient to develop the best plan of care for them. To me, the greatest impact of SIBR® for the patient is that there is a set time each day when the patient knows that their team will be coming to talk to them, as a group. The team can then solve problems together, and come up with a clear, cohesive plan. Everyone is on the same page, and caregivers do not have to spend as much time chasing down information during the course of the day.
Desai: Pain management is a key symptom that we like to identify to focus on symptom control in the inpatient unit. During SIBR®, the nurse helps the patient relay what their pain is or other symptom that needs better control. The physician then discusses with the patient, and team, and the pharmacist immediately places the appropriate medications as a new order. The response towards the patient’s concern is immediate.
Kidane: As a nurse, the major benefits of SIBR® rounds are that there is transparency in the care we provide our patients. SIBR® rounds help patients/family be active in their care. Having a set starting time allows the patients and family to prepare their questions in advance.
Pang: Families know what time we round everyday so they come with the expectation to be proactive already. I’ve had several incidences of patient’s not being sure of what their allergic reaction to a certain medication was, but their family member in the room knew exactly. For example, if a patient were allergic to codeine we normally wouldn’t give the patient morphine for pain and consider another alternative instead. However, if the patient or their family member states that the reaction was just an upset stomach we might consider that to be more of a side effect and not a true allergy, and therefore the physician may consider giving the drug. So, clarifying drug allergies during rounds has been one major benefit. Another is medication reconciliation, the process of accurately recording patients’ medication lists from home. Sometimes patients don’t remember all their medications they are taking from home upon admission, and during rounds their home medication list can sometimes be clarified between the patient and their family members.
Pulse: What has been patient response?
Desai: Patient response has been excellent. They feel empowered and grateful. They do actively participate, and really appreciate the time spent by the team. The families really enjoy this aspect of care, as they see the entire team working together in action towards their loved ones. And, they know what time to expect this during the day.
Parks: Patients and families love knowing when their team is coming to see them. It reduces the anxiety that if you step out for a moment, you will miss the doctor. It also reduces the confusing messages that are sometimes received. It is especially helpful if the patient cannot clearly express to the family what is going on. Patients have shared that they didn’t realize what all was being done for them until they hear the safety checklist, plan of care, and discharge plans during rounds. We use comment cards for feedback and one patient recently singled out rounds as exceeding his expectations, stating, “Good discussing with Charge Nurse and team re: goals.”
Pulse: Is there empirical data that supports the effectiveness of SIBR®?
Parks: Our most recent patient satisfaction data puts us over the 90th percentile, which is very exciting. The safety portion of the Rounds keeps us on our toes, and this unit has not had a CLABSI (Central Line-Associated BloodStream Infection) or CAUTI (Catheter-Associated Urinary Tract Infection) since we started this process. Daily conversation helps us recognize and correct gaps in care, and keeps things moving forward. This has resulted in a reduced Length of Stay for this unit. Pulse: Is it difficult to stick with the 4-6 minute window of time for each patient?
Desai: SIBR® is a very scripted approach led by the physician. The physician leads the team with introductions, and key parts. The physician will jump in and redirect a patient who often times may get tangential, and redirect them towards the primary issue or redirect the patient indicating that the physician (or particular team member who can address the concern) will come back later to talk about this.
Kidane: Sometimes, our elderly patients are anxious with the team presence, we assure them that they don’t have to remember everyone’s name and that usual helps them calm down.
Pulse: Tell us a bit about the development of SIBR® and how you’re sharing it.
Parks: The SIBR® Rounds are a part of the model for an Accountable Care Unit. This model includes leadership collaboration between the nursing director and the medical director, with shared accountability for quality and outcomes. This accountability occurs at the unit level. The different components include staff huddles to start the shift, bedside shift report, and the SIBR® rounds. This arose out of a project initiated within Emory Healthcare by Bryan Castle, which is now a granted program. He is the overall project coordinator. We have one or two seed units in each of our larger facilities, including two here at Emory Saint Joseph’s. Our goal is to expand the program to other units so that many more patients can benefit.
Before we launched in February, we had a class on the ACU process and an opportunity to observe at one of the existing ACU units. Once a seed unit is established, training and observation can be done internally. We also host groups from other facilities who would like to observe the process and perhaps launch their own programs.
