The Exec: Multidisciplinary Team Rounds Crucial in Inpatient Care

Multidisciplinary rounds boost care team communication, which improves clinical outcomes, bolsters patient experience, and reduces medical errors, this new CMO says.

For hospitalized patients, multidisciplinary team rounds drive several benefits, including reduced length of stay and decreased readmission rates, according to the new CMO of Riverside Community Hospital.

Shesh Rao, MD, MPH, MBA, became CMO of Riverside Community Hospital in November. Prior to taking on the CMO role at the HCA Healthcare hospital, Rao served as CMO of Ascension Saint Joseph Hospital in Chicago.

Multidisciplinary team rounds play a pivotal role in improving communication between care team members, according to Rao.

"Communication or the lack of communication is one of the most important reasons for a multitude of outcomes in a hospital," Rao says. "The lack of communication can result in bad clinical outcomes, poor patient experience, and medical errors."

By design, multidisciplinary team rounds bring key stakeholders to the table, including case managers, social workers, nurses, physicians, residents, and pharmacy staff, Rao explains.

"They can discuss issues such as what is preventing patients from getting a safe discharge," Rao says. "In this way, we can make sure everybody is on the same page. Multidisciplinary rounds can avoid confusion, miscommunication, and delays in patient care."

Rao says the primary drivers of hospital readmission include patients lacking transportation to get to a doctor's office for follow-up care, patients failing to get follow-up care within seven days of hospital discharge, and patients lacking access to medications and home health services. Addressing these kinds of issues during multidisciplinary team rounds can reduce readmissions, according to Rao.

"The multidisciplinary team should find out about the home environment, whether the patient has access to transportation, whether the patient has access to medication, and whether the patient can see a primary care doctor or specialist within seven days of discharge," Rao says. "These issues should be addressed while the patient is in the hospital."

Shesh Rao, MD, MPH, MBA, is CMO of Riverside Community Hospital in California. Photo courtesy of HCA Healthcare.

Optimizing Physician Documentation

A hospital CMO should be engaged in efforts to improve physician documentation and reduce documentation fatigue for physicians, Rao explains.

"In the hospital, you need to educate and re-educate physicians about the dos and don'ts for documentation," Rao says. "For example, Riverside Community Hospital is a teaching hospital, and we educate residents about not duplicating clinical notes and making sure that the appropriate items in a clinical note or progress note are properly updated."

Timeliness is essential in physician documentation, according to Rao.

"Notes should be written on the same day as a patient encounter because the longer a physician waits to complete a note, the more likely the physician is to forget elements of the interaction with the patient and there can be mistakes," Rao says.

Documentation fatigue is a driver of physician burnout, and a CMO should make sure measures are taken to mitigate the administrative burden that comes with documentation, Rao explains.

One strategy that many health systems and hospitals have pursued to address documentation fatigue is adoption of AI scribes.

"AI tools such as AI scribes can help physicians improve the timeliness of documentation and reduce errors," Rao says. "AI scribes can tease out peripheral conversations with patients, which can reduce documentation fatigue."

Using clinical note templates in the electronic medical record is another effective strategy for reducing documentation fatigue, according to Rao.

"With the help of IT staff and clinical educators, a physician can come up with a template in the EMR that is tailored to their particular specialty and remove items that do not need to be in their notes," Rao says. "This reduces the time that it takes to generate a note."

Importance of Case Management Staff

Effective case management teams are essential to delivering care in the hospital setting. Rao explains that case management teams should be trained well in care dynamics and prior authorization.

"Case managers and social workers should be talking with a patient and their family beginning on Day 1 of a hospitalization about issues such as home care needs and the support patients have in the home," Rao says. "They should be planning for discharge to post-acute care facilities or the home as soon as possible."

Rao gained an appreciation for case management staff early in his career, when he was working as an internal medicine resident.

"Initially, I thought clinical work such as diagnosing a patient and treating them would be the majority of my day-to-day work," Rao says. "As time went on, I recognized that clinical care was only half of the work because the care team needed to address social issues and make sure that the patients had well-established support systems outside of the hospital so they could stay healthy."

Case managers and social workers can be extremely helpful in identifying patient needs, making recommendations to physicians, and helping to place patients in the right setting after they are discharged from the hospital, Rao says.