Finding Meaning at the Bedside: A Family-Centered Tool for Improving the Patient Experience Kelly Rabah, MSW, CPHQ Teresa Zryd, MD Albert Painter, Psy.D

Disclosures Kelly Rabah- Nothing to Disclose Teresa Zryd – Nothing to Disclose Albert Painter- Nothing to Disclose

Bedside Rounding Tool

Questions asked to validate the tool Questions for Validating Family Medicine Provider Experience with Bedside Rounding Tool: Does this tool help you to organize your daily visit with the patient & family? (“Focus”, “Goals” & “Questions”.) Does this tool and scripting sample help you introduce yourself and your team members? Do you believe this tool will make a positive difference in the patient’s experience by being more involved and informed? Do you think this tool will help with medicine reconciliation? Do you think this tool will help with proactive D/C planning? Do you think family members will appreciate the tool giving them the opportunity for inclusion? Do you think this tool can save you time by having the patient record questions in advance? Do you think this tool can help improve communication between and within the IDT?

Guidelines for using the bedside rounding tool: You can complete the form before you enter the room or as you are talking with the patient. Introduce yourself as you enter the patient’s room and have other team members do the same. Do everything possible to avoid answering your phone or pager once in a patient’s room. If it cannot be helped, explain before you begin you are committed to minimize interruptions and focus on the patient. Sit down next to the patient and maintain eye contact. Avoid having others standing on top of the patient. If there are not enough chairs for the team, be respectful of the patient’s personal space so as not to overwhelm him/her. Explain the purpose of your visit and of the tool: You want the patient to be a partner with you in their care and have a place to write questions down so they will remember when you comeback. You also want to leave them with information about their diagnosis and their plan of care in case they don’t understand or can’t recall everything you say. Ask the patient who they want you to share information with. Get permission to speak in front of others who may be in the room. Show the photos of team members and explain their role if varied. Ex. “This is Dr. Harding and she will be responsible for talking with you about the results of your blood work tomorrow.” Show the back of the form and encourage patient and family who have permission to write down any questions. Explain this helps you be more prepared and efficient on the patient’s behalf. Every day the patient gets a new form with updates. *DON’T FORGET to look at the form the following day to make sure you answer any questions they write down.* SAMPLE SCRIPTING: Dr. Smith: “Hi Mrs. Jones, I’m Dr. Smith. Who’s this you have with you?” Mrs. Jones: “Oh, this is Tom, my husband.” Dr. Smith: “It’s a pleasure to meet you Tom. Because we will be talking about personal health issues, I need to ask you Mrs. Jones if you would prefer Tom to step out of the room while I examine you and we talk? ” Mrs. Jones: “Oh no! That’s okay. He can stay.” OR “ Yes, can we talk to him afterwards?” Dr. Smith: “Okay. Is there anyone else that will be visiting or calling that you would like to give me permission to speak with as well, or is Tom the only contact?” Mrs. Jones: “Oh, our daughter Susie may stop by- you can talk to her too. But don’t talk to my mother if she calls. Tom will handle her.” Dr. Smith: “I’m here today to visit with you and discuss your diabetes and heart failure. How are you feeling today…? Yesterday, we started X medicine orally and we also gave you Y medicine intravenously. The reason we drew your blood this am is to determine how well those interventions are working. We might be right on track. Or, we may need to make some adjustments. Your blood work will be back later today and we will discuss the results with you tomorrow am when we return. We anticipate discharging you as soon as we can get your blood sugar stable and your heart failure a little better controlled. At this point, we are thinking 2-3 days. It’s important to for you to understand that it could change depending on your progress. Our goal is to get you back home as soon as possible. So what are your questions for me/us today?”

Resources “Engaging Patients at the Front Lines of Primary Care Redesign: Operational Lessons for an Effective Program,” in the December 2014 issue of The Joint Commission Journal on Quality and Patient Safety. (Oak Brook, Ill.) Patient engagement in practice improvement projects resulted in enhancements to the health care delivery system at University of Wisconsin (UW) Health, Madison, Wisconsin.The Joint Commission Journal on Quality and Patient Safety Bedside Change –of - Shift Reporting: A Strategy to Increase patient Safety. Ashley Currier, RN, BSN,CMSRN, Patien Care Manager at Northwestern Memorial Hospital Chicago, Il. A Newsletter from the National Patient Safety Foundation, Volume 14, Issue 1, Harvard Business Review Blog: A Framework for Reducing Suffering in Healthcare. November 14, Deirdre Mylod, Ph.D, Senior Vice President Press Ganey and Associates, and Thomas H Lee, MD, CMO, Press Ganey and Associates. Bedside Report, Ensures Quality Handoff, Ann Fedwish, October 8, aper.aspx#.VOTJVKNTHKw. http:// aper.aspx#.VOTJVKNTHKw.

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