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Perspectives: Mini-rounds: A Team Communication Tool
Interdisciplinary communication can be challenging, yet it is so critical on a rehabilitation unit. This paper describes the way our rehabilitation unit came together to ensure that everyone on the team has the information that they need. This new venue for team communication incorporates the entire interdisciplinary team, including two shifts of nursing staff.
On our rehabilitation unit, communication of information has been a continual challenge. Relaying information to the team meant communicating through taped report, e-mailed reports and discussions, a communication board, written notes, and team meetings. Despite the availability of all these various methods, there remained communication breakdowns between shifts—particularly between therapists and the nursing staff.
Nurses on the evening and night shifts voiced frustration over their lack of needed information. They did not feel a part of the team and did not have a good mechanism to relay or receive information. Other team members were frustrated when items were not followed up or when tasks were not completed by other shifts. In addition, the unit needed an effective way to communicate information from physician rounds and staffing meetings to the entire team.
In response to these issues, a small task group consisting of interdisciplinary staff members came together to come up with potential solutions. The idea that emerged was called “mini-rounds.”
It had been the custom at our facility for an interdisciplinary team meeting to be held once a week in the morning. Members of the therapy staff, the rehabilitation counselor, and a nursing representative would attend to discuss goals and patient progress. The task group proposed a new and improved version of these “mini-rounds” that would involve nurses, physical therapists, occupational therapists, speech therapists, therapeutic recreation, rehabilitation counseling, and the PPS coordinator. This interdisciplinary team meeting would be conducted on a twice-weekly basis. Since our rehabilitation counselor serves as our coordinator of care, she was identified as the individual who would lead the mini-rounds discussion and keep the meeting running on schedule.
To maximize the involvement of nursing, it was decided that the meetings would be held during day-to-evening-shift nursing report, thus replacing traditional nursing report with mini-rounds. This schedule allowed us to incorporate two shifts of nursing staff into one meeting, and since the evening-shift nurses would receive information firsthand, they would be better equipped to relay it on to the night shift. The format for discussion is as follows:
Benefits and Drawbacks
Mini-rounds has afforded our unit many benefits. Since it does involve such a large number of staff, mini-rounds has become the forum used to communicate a number of interdisciplinary issues. For example, we recently incorporated safety status and clarification of FIM ratings into our mini-rounds discussion.
Night- and evening-shift nurses now have a forum to discuss concerns with the rest of the team. In addition, therapists are able to relay items to these nurses personally. We are better able to emphasize things that are important for patients to work on outside of therapy, such as nighttime toileting. We also have a better perspective on the patients’ function over the 24-hour period.
Mini-rounds facilitate team discussion by bringing members of all of the disciplines together on a regular basis. It is a wonderful team-building experience, allowing all members to better understand the role that each person plays in our patients’ recovery.
It has been a difficult transition for some of the nursing staff who feel that they are missing out on nursing shift report, which they characterize as discussion about specific items, such as laboratory reports and bowel or bladder management. We continue to seek ways to work on this issue and have made some changes in our electronic report sheets in order to provide them with some of this information automatically.
Getting consistent attendance can be difficult. Nursing assistants work with the patients during mini-rounds so that nurses are able to attend. Mini-rounds are incorporated into the therapy schedules to ensure that therapy attendance is possible. In addition, we have made mini-rounds a priority for the unit. It is an expectation that all members of the team attend. The leadership of the unit is very supportive of the process and works to ensure good attendance by staff members.
Reviewing the goals, objectives, and background of mini-rounds with new staff is important to ensure their commitment to the process. To ensure its continued success, we view mini-rounds as a work in progress. We continue to make changes to the content and format as the need arises, while still ensuring that we meet our desired objectives.
The benefits of mini-rounds far outweigh any disadvantages. The communication that occurs is invaluable. CARF has cited mini-rounds as a best practice for our unit on two separate occasions. We are proud and happy about what mini-rounds have done to enhance our interdisciplinary communication and collaboration.
About the Author
Tami Dieruf, MSN RN CRRN-A ONC, is nurse clinician at Benefis Healthcare, Great Falls, MT. Address correspondence to her at 212 29th Ave. NE, Great Falls, MT 59404, or via e-mail to firstname.lastname@example.org
This article won third place in the 2004 Voices of Rehabilitation Nursing Writers’ Contest.