Improvement in Multidisciplinary Provider Rounding (Surgical Rounds) in the Pediatric Cardiac ICU: An Application of...

Area of Science:

• Quality Improvement
• Healthcare Management
• Pediatric Cardiology

Background:

• Multidisciplinary rounds are crucial for optimal outcomes in pediatric cardiac intensive care units (ICUs).
• Existing processes within surgical rounds often contain waste and non-value-added work.
• Improving rounding efficiency is essential without sacrificing patient care quality.

Purpose of the Study:

• To apply Lean methodology to identify and reduce waste in surgical rounds.
• To improve the efficiency and reduce the duration of multidisciplinary rounds.
• To maintain or improve the quality of patient care discussions during rounds.

Main Methods:

• A single-center improvement science study was conducted in a tertiary pediatric cardiac ICU.
• Lean methodology was implemented through technology automation, work instructions, standardized presentations, provider training, and role assignment.
• Observational and interventional phases were used to compare pre- and post-intervention processes.

Main Results:

• Rounds duration decreased by 26% (p = 0.0003), and preparation time decreased by 50% (p < 0.0001).
• Transition time between patients decreased by 66% (p < 0.0001), with fewer provider changes (p < 0.0001).
• Critical discussion duration and balancing measures (bedside rounds, surgical start times) remained unchanged.

Conclusions:

• Lean methodology effectively reduces waste and inefficiency in multidisciplinary rounds within cardiothoracic surgery/cardiac ICU settings.
• Interventions led to significant decreases in preparation time, transition time, and overall rounds duration.
• The study demonstrated improvements in efficiency without negatively impacting patient care or key operational timelines.