"We're all truly pulling in the exact same direction": A qualitative study of attending and resident physician impressions of structured bedside interdisciplinary rounds.

ABSTRACT

BACKGROUND: Physicians often hold leadership roles in implementing interdisciplinary rounds (IDR) in clinical settings, thus understanding physician perspectives of bedside IDR is crucial. OBJECTIVE: To understand physicians' perspectives of structured bedside IDR. DESIGN: Qualitative descriptive study. SETTING AND PARTICIPANTS: Medical and transitional year resident and hospitalist physicians participating in structured bedside IDR in a community teaching hospital affiliated with a large academic center. METHODS: We conducted semi-structured interviews and focus groups with study participants about their experiences with participating in structured bedside IDR between July 2017 and April 2018. All interviews were recorded and professionally transcribed. We used thematic analysis to identify key themes. RESULTS: We interviewed 41 resident physicians and 10 hospitalist physicians and discovered five key themes that highlight physician impressions of bedside IDR. Bedside IDR decreased unnecessary care, screened for risks/errors, created a shared mental model of care, and increased physician empathy for the patient and the interprofessional care team. Physicians felt patients valued the streamlined communication they experienced but questioned the intrusiveness of large healthcare teams. Challenges to bedside IDR included the meaningful engagement of key stakeholders and, particularly for resident physicians, the difficultly of managing unstandardized communication in a standardized time-sensitive setting. CONCLUSIONS: Structured bedside IDR have the capacity to improve patient care, interprofessional teamwork, and physician empathy for patients and the interprofessional team. However, sustained leadership support and clearly defined rounds goals and objectives are necessary ingredients to maximize the benefits and address the challenges of bedside IDR.