Daily multidisciplinary discharge rounds in a trauma center: a little time, well spent

Patient flow in a trauma center can be improved by multidisciplinary discharge rounds (MDR), but the content and logistics of MDR discussions have not been well quantified for purposes of improvement and adoption. We characterized the discussion content and time spent during MDRs and measured success rates in implementing communicated plans.

Bedside MDRs in seven patient care units were observed during consecutive working days in a major academic trauma center.

Discussions were timed and their content coded. Coding reliability was assessed with kappa statistics. Implementations of communicated plans were assessed during sequential working days.

MDRs over 23 days comprising 1,769 patient-discussions were observed. MDRs lasted a median of 34 minutes for a median of 78 patients. Kappa statistics for the discussions were 0.63 to 0.96. Each patient-discussion lasted a median of 13 seconds (range, 2 seconds-233 seconds), and 96% lasted less than a minute. Clinical topics were presented in 71.5%, new complications in 12%, discharge plans in 67%, surgical plans in 19%, and care advancement in 8% of them. Discussions >30 seconds duration were likely to contain exploration of care advancement, systems related, and clinical topics (p < 0.05). Advancement of care exploration correlated moderately with census of the trauma center (r = 0.53, p = 0.01). Ninety-four percent of the communicated plans were implemented with most delays caused by systems factors (82%).

The short duration and goal-focused communication may have made MDRs sustainable. Given the benefits of successful implementation of communicated plans and previously demonstrated improved patient outcomes, time for MDRs is well spent.