Efficient patient care depends on close communication between the trauma team, other surgical providers, nursing, physical therapy, and discharge planners. Communication is hampered by the number of services involved, the workload of each service, and the institution’s training mission. We hypothesized that daily multidisciplinary “discharge rounds” would improve patient flow and increase readiness.
A senior trauma center physician leads discharge rounds, focusing on each patient’s plan of care, including surgeries, diagnostic tests, and anticipated date of discharge or transfer. Present at rounds are the fellows leading each trauma team; an orthopedic surgeon; the hospital bed manager; the unit’s discharge planner; the unit nursing staff; and physical, occupational, and speech therapists.
Discharge rounds cover 90 inpatient trauma service beds in approximately 60 minutes each day. Discharge rounds have had a dramatic effect on patient flow. While maintaining the daily census, we have seen a 36% increase in patient volume and a 15% decrease in length of stay. “Bypass” status—inability to accept admissions—has been virtually eliminated. This effect has been sustained.
By providing a forum for clear communications among all providers, discharge rounds have streamlined the care of complex trauma patients. As health care resources become ever more constrained, this sort of multidisciplinary effort is a viable option for senior physicians to directly impact hospital performance.
From the R Adams Cowley Shock Trauma Center (R.P.D., C.C., A.J., S.L., M.E.K., T.M.S.) and the Departments of Anesthesiology (R.P.D.), Surgery (C.C., T.M.S.), and Orthopedic Surgery (A.J.), University of Maryland School of Medicine, Baltimore, Maryland.
Submitted for publication November 12, 2002.
Accepted for publication August 8, 2003.
Poster presentation at the 61st Annual Meeting of the American Association for the Surgery of Trauma, September 26–28, 2002, Orlando, Florida.
Address for reprints: Richard P. Dutton, MD, MBA, Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201; email: email@example.com.