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Collaborative Rounding in Cardiac Surgery Proves Successful

02/12/08

Beebe Medical Center is setting a high standard of care in its Cardiac Surgery Program, which is in affiliation with Christiana Care Health System. One of the program's distinguishing characteristics is collaborative rounding, which cardiac surgeon and program Medical Director Fernando M. Garzia, M.D., implemented at the program's start a year ago.

"The power of this process is that the patient is involved in the discussion about what is good for the patient," explains Dr. Garzia. Those who attend this meeting include the cardiac surgeon, the cardiac surgery physician assistant, the bedside nurse, a respiratory therapist, and representatives from pharmacy, cardiac rehabilitation and occupational therapy. Caseworkers and dieticians also attend. The key to the success of collaborative rounding is that the discussion takes place in the patient's room, not in the hallway. The patient is part of the process and participates in the discussion.

Dr. Garzia explains that the patient becomes an essential member of the team, which helps in the recovery process. Not only is the patient able to ask questions and give information, but interested family members also are invited to attend.

"Healthcare occurs through oral communication," says Dr. Garzia, who introduced and used collaborative rounding at Lehigh Valley Hospital-Muhlenberg, Bethlehem, PA. "We rely on each other to talk about things. The best way to communicate about patient care is by getting people together."

"I was very impressed," said Milford resident George Miller, whose wife Ann had bypass surgery in October 2007. "There must have been 10 people there. The same people got together with us the same way again as we were getting ready to leave. They left me with very little to ask."

This collaborative rounding process has two components. One component is the daily meeting with the patient. The other component is a systems component in which the healthcare team members meet together weekly to discuss general issues regarding cardiac patient care and whether there are any glitches that need to be improved so that team members can do their job better and so that the patients are happier.

"I think that this process is phenomenal," says Kathy Cannatelli, RN, BSN, Nurse Manager of Beebe Medical Center's Critical Care Unit, and of the new Cardiovascular Step Down Unit and Chest Pain Observation Unit. "It's better coordination of care for the nurses and much more efficient. We are able to get all the information we need at one time."

Brian C. McCarthy, PA-C, Chief Physician Assistant, Cardiovascular Surgery, said that collaborative rounding as an example of the high standard of care Dr. Garzia demands.
"I've worked side by side with Dr. Garzia since the beginning. He is a visionary, a forward thinker, and instills a sense of wellness in his patients. I am privileged to be a part of his team."

The idea for such a process was born out of a healthcare executive program at the Kennedy School of Government that Dr. Garzia attended some years ago, he recalls. Also attending was Cardiac Surgeon Paul Uhlig, MD, MPA, who introduced the concept to the cardiac surgery program at Concord Hospital in New Hampshire. Dr. Garzia said that he visited Concord Hospital to see how collaborative rounding, called the "Concord Collaborative Care Model," was working. He then introduced it at Lehigh Valley Hospital-Muhlenberg.

Concord Hospital found that patient satisfaction scores were climbing and outcomes were improving. In 2002, the National Quality Forum and the Joint Commission on Accreditation of Healthcare Organizations presented Concord Hospital with a John M. Eisenberg Patient Safety Award for System Innovation for developing and implementing a structured communications protocol that "...broke down hierarchical role boundaries and improved the care of cardiac surgery patients."

Dr. Garzia experienced the same positive results at Muhlenberg where he says patients participated in their own care and recovered on average, faster than the norm.

"Collaborative rounding is going to be a distinguishing characteristic of Beebe's program," predicts Dr. Garzia. "And one which other hospitals will replicate."

Dr. Garzia is a member of the Christiana Care Cardiac Surgery group, which is associated with Christiana Care Health System, nationally recognized for cardiac surgery and care.

Beebe Medical Center is a not-for-profit community medical center with a charitable mission to encourage healthy living, prevent illness, and restore optimal health with the people residing, working, or visiting in the communities we serve. For more information, please visit us online at www.beebemed.org.