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.