Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay
Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-12-01
|
| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/11/4/e002045.full |
| _version_ | 1811311793999446016 |
|---|---|
| author | Nila S Radhakrishnan Frederick S Southwick Kiran Lukose Richard Cartwright Andressa Sleiman Nicholas Matey Duke Lim Tiffany LeGault Sapheria Pollard Nicole Gravina |
| author_facet | Nila S Radhakrishnan Frederick S Southwick Kiran Lukose Richard Cartwright Andressa Sleiman Nicholas Matey Duke Lim Tiffany LeGault Sapheria Pollard Nicole Gravina |
| author_sort | Nila S Radhakrishnan |
| collection | DOAJ |
| description | Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%–11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care. |
| first_indexed | 2024-04-13T10:23:54Z |
| format | Article |
| id | doaj.art-65d5fbb65a13445b8e8f14d3ea73291d |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-04-13T10:23:54Z |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-65d5fbb65a13445b8e8f14d3ea73291d2022-12-22T02:50:22ZengBMJ Publishing GroupBMJ Open Quality2399-66412022-12-0111410.1136/bmjoq-2022-002045Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stayNila S Radhakrishnan0Frederick S Southwick1Kiran Lukose2Richard Cartwright3Andressa Sleiman4Nicholas Matey5Duke Lim6Tiffany LeGault7Sapheria Pollard8Nicole Gravina9Department of Medicine, University of Florida, Gainesville, Florida, USADepartment of Medicine, University of Florida College of Medicine, Gainesville, Florida, USADepartment of Medicine, University of Florida College of Medicine, Gainesville, Florida, USAOffice of Clinical Quality and Patient Safety, University of Florida Health, Gainesville, Florida, USADepartment of Psychology, University of Florida, Gainesville, Florida, USADepartment of Psychology, University of Florida, Gainesville, Florida, USADepartment of Nursing, University of Florida Health, Gainesville, Florida, USADepartment of Nursing, University of Florida Health, Gainesville, Florida, USADepartment of Nursing, University of Florida Health, Gainesville, Florida, USADepartment of Psychology, University of Florida, Gainesville, Florida, USAProtocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%–11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.https://bmjopenquality.bmj.com/content/11/4/e002045.full |
| spellingShingle | Nila S Radhakrishnan Frederick S Southwick Kiran Lukose Richard Cartwright Andressa Sleiman Nicholas Matey Duke Lim Tiffany LeGault Sapheria Pollard Nicole Gravina Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay BMJ Open Quality |
| title | Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay |
| title_full | Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay |
| title_fullStr | Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay |
| title_full_unstemmed | Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay |
| title_short | Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay |
| title_sort | prospective application of the interdisciplinary bedside rounding checklist temp is associated with reduced infections and length of hospital stay |
| url | https://bmjopenquality.bmj.com/content/11/4/e002045.full |
| work_keys_str_mv | AT nilasradhakrishnan prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT frederickssouthwick prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT kiranlukose prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT richardcartwright prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT andressasleiman prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT nicholasmatey prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT dukelim prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT tiffanylegault prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT sapheriapollard prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay AT nicolegravina prospectiveapplicationoftheinterdisciplinarybedsideroundingchecklisttempisassociatedwithreducedinfectionsandlengthofhospitalstay |