Posts:
104
Registered:
9/23/08
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ATS September 2009: Dissecting multidisciplinary cardiac surgery rounds
Posted:
Sep 9, 2009 9:30 AM
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[nobr]ATS September 2009: Cardarelli et al. Dissecting multidisciplinary cardiac surgery rounds. Ann Thorac Surg 2009;88:809-13.
In the September 2009 Annals, we find an interesting paper in which the authors assess the actual value of the more or less traditional multidisciplinary rounding practises found in most academic medical centers. Such rounds in the critical care environment have, according to the authors, demonstrated increased communication, a reduction in medical errors, a shorter hospital stay, and consequently, economic savings. The reporting team analyzed video-recorded weekly multidisciplinary teaching rounds on cardiac patients in a PICU. Rounding time was categorized as presentation or discussion and was measured in minutes. In a novel analysis, the cost of a round was calculated by multiplying the hourly salary of all healthcare professionals present by the time spent rounding.
Median rounding time per patient was 15 minutes (range, 5 to 29). Patient presentation took between 2 and 8 minutes (median 4), or 26% of the rounding time. Time needed for discussion,including teaching and planning, varied between 2 and 25 minutes (median 10.5). Median number of participants was 13.5 (range, 11 and 16). Mean cost in salaries per patient rounded was US$140.87 (95% confidence interval: $106.80 to $174.90).
The authors maintain that multidisciplinary rounds are a low-cost medical practise withproven benefits. Available tools and rounding cultural changes should be adopted to shorten data retrieval and presentation time to the benefit of discussion and teaching. Current billing requirements for rounding multidisciplinary teams do not reflect the realities of their time use.
This paper is an excellent example of application of commonly used business practise to the cardiac surgical environment. Obviously an analysis of this type would be influenced by many local factors, but might be worth doing. Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/88/3/809 and add your own comments in the Dilemmas in Pediatric Cardiac Surgery discussion forum. Other models of care would be of particular interest. [/nobr]
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