Multidisciplinary Team (MDT) Patient Rounds pOLICY

MIDEGA PRIMARY HOSPITAL

March,2024
Midega,Oromia
DR. IBSA, QUALITY OFFICER
Table of Contents
Introduction...........................................................................................................................................2

What we mean when we say?...........................................................................................................2

Why do MDT with Patient Rounds?.....................................................................................................2

Features of an MDT with Patient Rounds.............................................................................................3

How an MDT with Patient Round works..............................................................................................5

Structure and Roles...............................................................................................................................6

Getting Started......................................................................................................................................7

1. Management Support....................................................................................................................7

2. Team Establishment......................................................................................................................8

3.Standard Operating procedure........................................................................................................9

4. Start...............................................................................................................................................9

Annex 1:MULTIDISCIPLINERY ROUND LOG BOOK............................................................................10

Annex 2 MULTIDISCIPLINARY FEEDBACK ASSESSMENT...................................................................10

Further reading...................................................................................................................................12

Page 1 of 7

DR. IBSA, QUALITY OFFICER

Introduction
Effective teamwork and communication are foundational elements in a culture of safety and
are key elements of high reliability organisations1. Our inability to communicate effectively
within teams and with patients and their careers is directly linked to patient harm.

Multidisciplinary Team
 The multidisciplinary team (MDT) refers to a group of health care workers representing
different disciplines (for example, nursing, allied health, medical and pharmacy) who are
working together towards shared goals for patients
Point-of-Care
 Point-of-care is where clinicians deliver health care to patients at the time of patient care. In
this document point-of-care will also include, for example, at the bedside, chairside or a
community setting

 At the point-of-care, multi-disciplinary team members collaborate, informed by their

clinical
expertise, to coordinate patient care, identify current risks, establish patient goals, and
develop plans for risk reduction and for transition of care
Multidisciplinary Team (MDT) with Patient Rounds is identified as a Safety Fundamental
for Teams. Safety Fundamentals for Teams are practical tools and behaviors some of which
require a short implementation time and, when applied according to the key principles, will
yield measurable gains.

What we mean when we say?

Why do MDT with Patient Rounds?

There are multiple reasons for partnering with patients and including them in
multidisciplinary team discussions about their care.

Such us the growing body of evidence which reports:

 decreased length of stay,

 increased patient safety and
 enhanced patient and staff experience.
Page 2 of 7

DR. IBSA, QUALITY OFFICER

  We have also gained learnings through root cause analysis data and patient reported
experience.

MDT with Patient Rounds is an opportunity to bring together disciplines and integrate the
diverse perspectives arising from a mix of skills, knowledge, education and training.
Including the patient’s voice provides a more comprehensive view and has the potential to
reduce clinician risk of diagnostic anchoring and bias. Through shared decision-making a
robust plan for transition of care is commenced early following the patient’s admission to
hospital.

These rounds are a tool for encouraging open, collaborative communication and ensuring the
health care team and the patient and their family/carer are working towards a common goal
for the patient.

Features of an MDT with Patient Rounds

MDT with Patient Rounds occur at the point-of-care and are a process which brings together
all relevant members of the health care team. A senior decision-making clinician must be
present to ensure the patient’s treatment progresses. They are an opportunity for staff and
patients to hear in one forum, input from the cross section of team members caring for them.

The MDT meets with the patient and (where possible) their
family/carer/advocate, to agree on a plan of care which is inclusive
and patient centred. The round focuses on what needs to happen
next, and by whom.

They are forward focused and provide an opportunity for

collaborative cross checking to ensure everyone, including the
patient, has a clear understanding of the current treatment plan.
Patient safety concerns are identified, discussed and an action plan
is agreed. This reduces the risk for error or adverse events.

Page 3 of 7

DR. IBSA, QUALITY OFFICER

 They are scheduled to occur daily or weekly, depending on the
clinical specialty. For maximum effectiveness they would occur for
all patients at least three times each week. A reduced frequency
might be more appropriate in units where a longer length of patient
stay is common (for example, rehabilitation units).

These rounds can be adapted to suit all clinical environments.

These rounds are inclusive where input is invited from all key
members of a patient’s care team and from the patient. This will
have a direct positive impact on patient safety and patient and staff
experience.

Page 4 of 7

DR. IBSA, QUALITY OFFICER

How an MDT with Patient Round works

The team leaders will prioritise the round order following a brief
overview of current patients at the patient board list. Depending on the
unit, teams will choose to round on all patients or specific patients
such as:

 Sick and decompensating patients

Pre round  New admissions

briefing  Patients ready for a transition of care

 The MDT meets with the patient and (where possible) their
family/carer/advocate at the point-of-care
 Team members share information which is brief, current and
focused on progressing the patient towards the next transition of
care
 The patient and their representative are given the opportunity to
provide input and seek clarification before a way forward is agreed

MDT with  Each patient encounter is brief and ends with a plan, stated
Patient estimated date of transition of care and accountability agreed

 Confirm escalation of issues

 Plan to bring patient outliers back to the ward
 Document in the patient’s health care record
 Ensure all team members are clear on ongoing management plans
Post round
and accountabilities
debrief

Page 5 of 7

DR. IBSA, QUALITY OFFICER

Structure and Roles
All team members agree to arrive on time, balance speaking in plain English
versus medical jargon, and provide patients with reasonable time to participate
while maintaining the focus of the round.

All team members

Meet at patient record board (or station)

• Brief overview of current demand for the

day, deteriorating patients, planned
admissions, outliers, expected transfers

Senior clinician
• Provide summary of each patient and

Pre Point-of- include recent (past 24 hours) medical

Care round – issues, barriers to transition, waiting for
briefing/huddle what

• Introduce patient and team

• Give brief update in plain language of
current medical issues and include current
diagnosis (avoid discussing sensitive issues
Nurse /data clerk
at the Point of-Care)
• Include relevant investigation results or
results pending
• Check in with patient and/or family/career

• Succinct update on relevant information

such as vital sign status, overnight changes
or reviews, other concerns, waiting for what,
Nursing staff
current goal
• Targeted risk assessment
• Check in with patient and/or family/carer

MDT with • Provide update of relevant information such as Allied health staff /
Patient specific dates for discharge planning and Nursing staff

Page 6 of 7

DR. IBSA, QUALITY OFFICER

 packages

• Confirm plan for next 24-48 hours

• Flag any changes to care and allocate
actions
• Assign estimated day of discharge Senior medical
• Ensure patient’s understanding
• Invite patient to express concerns or seek
clarity, utilise teach back and agree goals

• Raise workforce issues such as planned and Senior Medical or

unplanned leave, reliance on temporary staff nursing
• Assign actions for waiting for what of
patients with long length of stay
• Plan for transfer of outlying patients
• Update patient list board and bed
management information
Post round • Document on MDT log book and feedback
brief assessment

Getting Started
1. Management Support

Confirmation of Management Support prior to a process change will increase

the chance of sustainable change. Executive leadership provides organizational
support and will ensure a shared vision in line with the values of the
organization.

Ways that Management team have demonstrated their support to clinical teams
include:

• Visiting teams, hearing their concerns and supporting their plans for change

Page 7 of 7

DR. IBSA, QUALITY OFFICER

• Allocating extra staff for one-off focus groups and stakeholder engagement
sessions
• Supporting time-in-lieu for staff who attend improvement planning sessions
out of hours
• Providing morning or afternoon tea for one-off stakeholder engagement
sessions
• Celebrating and sharing the successes

2. Team Establishment

Ensure all stakeholders are included in the planning to support a coordinated

approach. Members of the team will include;

 nursing,
 senior clinician,
 case team head,
 clinical pharmacy,
 vice matron,
 lab head,
 medical director,
 quality officer,
 IPPS Focal person,
 Dietician (if available)
 and patient`s caregiver.
Support can also be obtained from facility leaders

Page 8 of 7

DR. IBSA, QUALITY OFFICER

3.Standard Operating procedure

I. WHO WILL ATTEND THE ROUND?

Every member of MDT team should appear on GRAND MDT ROUND
II. WHAT TIME WILL THE ROUND COMMENCE?

The grand MDT round will happen twice weekly on Tuesday and Thursday
The twice daily business round (for newly admitted, deteriorating patient, transfer or
discharge patient)

The round commences on:

• Morning Rounding (~8:00PM-10:00PM)

• Evening rounding (2:00AM-3:00AM)

III. TOOLS AND STRUCTURED FORMAT

Agreed on a communication strategy to ensure staff and patients are aware of the process and
know what their participation involves. See annex parts for checklist and formats.

4. Start

• Include the patient in the conversation

• Only share vital information from each discipline present
• Agree on the plan for the progress of the patient to the next transition of care
• Ensure everyone is aware of their accountabilities
• After the round hold a brief huddle (3-5 minutes’ maximum) to consider:
o What worked well?

o What do we need to change?

o What was the patient experience?
o Update patient list board and bed management information
o Document on MDT log book and feedback assessment
.

Page 9 of 7

DR. IBSA, QUALITY OFFICER

Annex 1:MULTIDISCIPLINERY ROUND LOG BOOK
NO DATE CHART NURSING IPPS CLIENT CLINICAL ISSUE OR
MRN CARE EDUCATION PHARMACY CARE CONCERN
AND
SATISFACTION

Annex 2 MULTIDISCIPLINARY FEEDBACK ASSESSMENT

DAT PATIENT STAFF READMISSIO OBSERVENTIO OBSTACLE LENGT

E SATISFACTIO SATISFACTIO N RATE N OF PROCESS INTERFERIN H OF
N N G WITH STAY
DISCHARGE

Page 10 of 7

DR. IBSA, QUALITY OFFICER

 Midega Hospital
MORNING PRESENTATION SHEET
ID: SEX: AGE:
Hospital Day:

Subjective:
Yesterday:
Overnight:
Objective:
PE: vitals:
CV:
Lungs:
Pertinent finding:

Labs: ---/---/---< >------<

Imaging:
Assessment:
1._________________________ 3. __________________________
2.________________________ 4. __________________________

Treatment Plan:
PROBLEM 1: ______________________ 3. __________________________
PROBLEM 2: ______________________ 4. __________________________

Discharge plan:

Page 11 of 7

DR. IBSA, QUALITY OFFICER

Further reading
Clinical Excellence Commission, 2019, NSW Health Literacy Framework. 2019-2024,
Sydney: Clinical Excellence Commission

Henkin, S, Chon, T et al. 2016, Improving nurse-physician teamwork through

interprofessional bedside rounding, Journal of Multidisciplinary Healthcare 9 201-205

Improvement Map. Getting Started Kit: Multidisciplinary Rounds How-to Guide. Cambridge,
MA: Institute for Healthcare Improvement; 2010. (Available at www.IHI.org)

Kroning, M Janowski, K et al. 2019, Patients – The ultimate winners of multidisciplinary

rounding, Nursing Management, 50(9) 8-10

Provost, S, Lanham, H et al. 2015, Healthcare huddles: managing complexity to achieve

high reliability, Healthcare Management Review 40(1) 2-12

Ryan, L, Scott, S and Fields, W 2017, Implementation of interdisciplinary rapid rounds in

observation units, Journal of Nursing Care Quality 32(4) 348-353

Seigel, J, Whalen, L et al. 2014, Successful implementation of standardized multidisciplinary

beside rounds, including daily goals, in a pediatric ICU, The Joint Commission Journal on
Quality and Patient Safety Vol 40 (2) 83-90

Stickney, C, Ziniel, S, Brett, M and Truog, R 2014, Family participation during intensive care
unit rounds: goals and expectations of parents and health care providers in a tertiary
pediatric intensive care unit, The Journal of Pediatrics 165(6) 1245-1251

Young, E, Paulk, J et al. 2017, Impact of altered medication administration time on

interdisciplinary bedside rounds on academic medical ward, Journal of Nursing Care Quality
32(3) 281-2

Page 12 of 7

DR. IBSA, QUALITY OFFICER