Perceptions of Interprofessional Bedside Rounding in an Acute Stroke Care Unit: Qualitative Mid-implementation Study
Interprofessional bedside rounding (IBR) is a strategy for delivering high value care and teaching patient-centered care but is not consistently implemented effectively in hospitals. We pilot-tested an IBR model in a brain rescue unit at an urban teaching hospital and conducted a qualitative study examining perceptions of IBR among the interprofessional healthcare team (I-HCT).
Using a semi-structured interview guide, we conducted phone interviews with 15 physicians (six attendings, two fellows, seven residents), six nurses, and one pharmacist within one year of piloting the IBR model. A qualitative content analysis of the interview data was performed through an iterative process to categorize data into themes.
Four primary themes emerged: efficiency, patient/family engagement, teamwork, and learning/teaching. I-HCT member perceptions of IBR efficiency varied by physician experience, patient cognitive/communication status, patient follow-up duration, preparation of team members, and equipment availability. Patient and family engagement was viewed positively by most I-HCT members, who perceived that IBR enhanced patient motivation and engagement in the daily plan of care and understanding and appreciation for their care. I-HCT teamwork was perceived to improve with practice over time. Most I-HCT members knew their roles and felt comfortable speaking, although nurse participation was inconsistent, with nurses only contributing input when invited at the end. Learning and teaching during IBR were viewed inconsistently by I-HCT members. While attendings believed that residents felt uncomfortable learning in front of patients, residents reported learning through observation of attendings communicating with patients. Nurses reported learning valuable information that enhanced competence in providing timely care.
Understanding the perceptions of I-HCT members is critical to optimizing and sustaining the IBR process. These findings will be used to adapt the IBR model to better meet the needs of our patient population and to educate and support I-HCT members to use it more consistently. Future studies will examine patient and family experiences with IBR.
Transitioning to IBR from traditional rounding formats requires formalized education procedures and has involved a learning curve for I-HCT members and patients. Despite challenges, many benefits can be achieved with efficiency, patient/family engagement, teamwork, and learning/teaching. IBR may improve patient outcomes, patient and I-HCT member satisfaction, and high value care. It is crucial to consider perceptions of all HCT members when transitioning to IBR. This work describes practical knowledge gained when implementing an interprofessional clinical practice bedside rounding model, including learners and aligning with the NEXUS theme.