1. Questions for your Doctor:
Reframing Interprofessional Rounds
Alex Ashton1, Geoff Boyer1, Alison Essary1, MHPE, DHSc, PA-C, Sarah Snell2, MD
Arizona State University School for the Science of Health Care Delivery, HonorHealth John C. Lincoln Medical Center2
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CompliancePercentage
Week
HonorHealth JCLNM Interprofessional Rounding 6E Pilot: Overall Unit HCAHPS & "Pilot Package" Correlation
All 3 Pilot Measures Together
Overall HCAHPS rating
Background
References
1. Gonzalo JD, Wolpaw DR, Lehman E, Chuang CH. Patient-centered interprofessional
collaborative care: factors associated with bedside interprofessional rounds. J Gen Intern Med.
2014;29(7):1040-1047. doi:10.1007/s11606-014-2817-x.
2. O’Leary KJ, Darling T a., Rauworth J, Williams M V. Impact of hospitalist communication-skills
training on patient-satisfaction scores. J Hosp Med. 2013;8(6):315-320. doi:10.1002/jhm.2041.
3. Rao JK, Anderson LA, Inui TS, et al. Communication Interventions Make a Difference in
Conversations between Physicians and Patients : A Systematic Review of the Evidence Linked
references are available on JSTOR for this article : Communication Interventions Make A
Difference in Conversations Between Physicians and Patients A Systematic Review of the
Evidence. 2016;45(4):340-349.
4. Aelbrecht K, Rimondini M, Bensing J, et al. Quality of doctor-patient communication through
the eyes of the patient: variation according to the patient’s educational level. Adv Health Sci
Educ Theory Pract. 2014;20(4):873-884. doi:10.1007/s10459-014-9569-6.
5. Baxter P. Patient satisfaction with communication from hospitalists in an acute care setting: a
dissertation submitted to the Caspersen School of Graduate Studies Drew University in partial
fulfillment of the requirements for the degree , Doctor of Medical Humanitie. 2015.
Physicians and Nurses were requested to round together to
address patient concerns for 16 weeks. Nurses collected patient
concerns via a green laminated card (Figure 1) posted in the
patients room prior to the physician rounding. Three measures
were recorded in order to determine: 1) Did the physician and
nurse rounded together? 2) Were patient concerns were
addressed? and 3) Were concerns addressed first before any other
matters were discussed? Responses reported by the nurses were
collected by the unit’s charge nurse once daily at the end of the
nursing “day shift”. Once 16 weeks of data was collected the
results were compared to five pre-identified HCAHPS categories.
These measurements were: Overall rating, nurse Communication,
physician communication, medication communication, transition of
care. Relationships between these scores and the three lead
measures were analyzed for correlation and overall
improvement.
Methodology
Results
Conclusions & Reccomendations
Figure 2: Correlation between compliance with all three measures, physician and nurse rounded
together, patient concerns were addressed, and patient concerns were addressed first, and the
overall satisfaction with JCLNM 6E
Table 1: Pre and post intervention HCAHPS scores for five categories identified as
needing improvement
Figure 3: P-Chart illustrating average compliance and
variance in the pilot program lead measure, did the
physician and nurse round together
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ComplianceRate
Week
HonorHealth JCLNM Interprofessional Rounding 6E Pilot: "Physician Rounding with RN" Compliance Weeks 1-16, P-Chart
Physician/RN Rounding Rate
UCLp
LCLp
Average Physician/RN Rounding Rate
As pay-for-performance reimbursement structures become
increasingly utilized, it is essential for health care organizations
to make the patient experience a top priority.1 One proven
method for increasing satisfaction scores is to improve physician
communication skills with both patients and nurses.2,3 Team based
care that leverages the relationships patients have with nurses,
with the limited time they have to speak with their doctor leads
to higher patient satisfaction and better health.4,5 The “Questions
for your Doctor: Reframing Interprofessional Rounds” pilot,
implemented at HonorHealth aimed to establish a best practice
for coordinating care between nurses, physicians, and patients. A
response card was placed in each room, to be filled out by the
patient’s nurse and addressed by the physician at the beginning
of team rounds. Successful roll out answered several questions
corresponding to interprofessional communication and team
based care, including how best to coordinate team rounds, how
to increase patient involvement in their care, and how integration
of those two elements will translate into increased patient
satisfaction as measured by HCAHPS scores.
 Fate of the HCAHPS category “overall rating” was moderately correlated to
successful compliance with the Pilot Package, verified with a correlation
coefficient of 0.534.
 All five categories, the aforementioned overall rating, physician communication,
nurse communication, medication communication, and transitional care all saw
increases of 8 to 16 points in the post intervention period.
 In almost all cases if the first lead measure, the physician and nurse rounding
together, was adhered to, then the other two measures were also complied with.
For this reason, predictability of the process was tied to that first measure. If
HCAHPS truly are correlated with compliance of the pilot lead measures, an
improved system of reporting will be essential in order to make solid claims
regarding those relationships.
 Further efforts should also be made to establish of a more streamlined process for
physicians to identify and meet up with the nurse assigned to their patient prior
to rounding, as this seemed to be the most commonly reported barrier to
compliance.
 Overall, initial analysis seems to suggest that the Questions for your Doctor pilot
did begin to stabilize a process for initiating team based rounding, while at the
same time increasing patient satisfaction with their HonorHealth hospital
experience.
Figure 1: Patient Response Card
JCLNM 6E HCAHPS Before Pilot (%) After Pilot (%) Increase (Pts)
Overall Rating 54.7 70.6 15.9
Nurse Communication 69.9 78.1 8.2
Physician Communication 71.1 84.1 13
Medication Communication 53.9 67.5 13.6
Transitional Care 43 54.8 11.8