A FIRM TRIAL OF INTERDISCIPLINARY ROUNDS ON THE INPATIENT MEDICAL WARDS - AN INTERVENTION DESIGNED USING CONTINUOUS QUALITY IMPROVEMENT

OBJECTIVES. In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evalu ate the process of medical care on the inpatient wards. Using standard continuous quality improvement (CQI) methods, a team of medical inter ns, 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. METHOD S. The authors conducted a randomized, controlled firm trial of the im pact of interdisciplinary rounds on the inpatient medicine services. T he 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 stud y, 535 were randomized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds. The outcomes s tudied included length of stay (LOS), total hospital charges, provider satisfaction, and ancillary service efficiency. RESULTS. Unadjusted a nalysis for log-transformed data showed lower length of stay and total charges for the interdisciplinary group. The mean LOS for interdiscip linary rounds was 5.46 days, compared with 6.06 days for traditional c are (P = 0.006), whereas mean total charges were $6,681 and $8,090 (P = 0.002) for the two groups, respectively. After multivariate regressi on analysis using a propensity score that included gender, age, marita l status, admission source, diagnosis-related group (DRG) weight, and primary diagnosis by International Classification of Diseases, Ninth R evision (ICD-9) cluster, these differences remained statistically sign ificant. CONCLUSIONS. Previous studies of interdisciplinary teams have failed to show statistically significant cost savings. This study inv olving more patients shows both cost and LOS decreases with the use of interdisciplinary teams. At the end of the 6-month trial, interdiscip linary rounds were instituted on all medicine inpatient services.