Optimal ICU management involves teamwork and coordination between multiple providers and disciplines. This multidisciplinary model usually includes a rounding process that integrates members of the various disciplines. The plan of care formed during daily rounds in the ICU is dependent on accurate data and may be enhanced by multidisciplinary input.
We hypothesized that including respiratory therapist (RT) presentations on daily rounds would increase the accuracy of the presented data and improve satisfaction with daily rounds.
A pediatric critical care (PCC) division covering 29 beds across two units (multidisciplinary Pediatric ICU and Pediatric Cardiac ICU) altered the rounding process so that the RT presents respiratory support, ventilator settings, and respiratory concerns during daily rounds. Immediately before and 6 months after the implementation of RT presentations on rounds, an anonymous survey was given to PCC attending physicians, fellows, nurse practitioners, and respiratory therapists. Perceptions of rounds were measured using a 5 point Likert scale and compared using paired t-tests.
Thirty three practitioners responded, a survey response rate of 97% (7 PCC attending physicians, 16 PCC fellows and nurse practitioners, 10 RTs). Following addition of RT presentation on rounds, PCC providers reported that ventilator settings were more accurately presented (p<0.0001), perceived that RTs provided valuable input to plan formation (p=0.004), and reported that RTs were integral to the rounding process (p=0.0002). However, there was no difference in perceived efficiency (p=0.1) or overall satisfaction with rounds (p=0.6). RT perception of their own role in the unit (including their impact on patient care, comfort in speaking on rounds, and ability to make independent decisions) was positive and remained unchanged with their increased involvement on rounds.
Including RT presentation and input on daily rounds in the Pediatric ICU is a simple intervention to improve accuracy of presented data and better integrate RT input into the daily plan. More research is needed to determine the effect of changes of this nature on clinical outcomes. Case Reports: