October 20: 2:30-3:30

Primary Presenter:  Tigist A. Mannaye, MPH, BSN, RN, CRRN – RN, Inova Health System

Background and Significance: Trio rounding connecting the nurse, physician and patient at the bedside is a key strategy to measurably improve patient care outcomes and communication (Breger, 2015; Cleveland Clinic, 2015) as well as coordination and efficiency (Gonzalo, Kuperman, Lehman & Haidet, 2014).

Problem Statement: Audits and observation of Trio rounding in acute inpatient rehabilitation units revealed it was not working. Trio rounding effectiveness in acute rehabilitation has not been explored. Picker’s Eight Principles of Patient Centered Care provided a framework to explore Trio rounding in rehabilitation (RNAO, 2015).

Purpose/research question: What are nurse and physician perceptions of the process, benefits and challenges of patient centered Trio rounding in acute inpatient rehabilitation units?

Methods/Approach: A qualitative study with focus group interviews involving 27 nurses and physicians was conducted. Demographic and Trio rounding practices data was analyzed using descriptive statistics, and qualitative content analysis of 76 narrative pages using Dedoose.

Results: Participants (N = 27) were primarily female (88.9%; n=24), middle aged (44.4%; n=12), worked day shift in direct patient care (74%; n=20), and averaged 7.8 years rehabilitation experience. Most nurse participants (n=23) were BSN prepared (78.3%; n=18) with CRRN (43.5%; n=10). Few participants self-reported consistently conducting Trio rounding but 6 types of rounding were reported. The primary themes identified as benefits were collaboration of inter-professional team, patient safety/quality of care, and communication/education and patient/family partnering; the primary challenge to conduct Trio rounding was synchronicity of work flow. Participants recommended development of rehabilitation Trio rounding standard work.

Discussion: Trio rounding in rehabilitation inpatient units is challenging.  Previous studies in general units noted the difficulties of having nurses and physicians available daily to round (Gonzalo et al., 2014; Gonzalo, Chuang, Huang & Smith, 2010; Williams, Ramani, Fraser &  Orlander, 2008). This challenge is compounded in rehabilitation where patients are frequently, inconsistently away from their room for various therapies. Participants identified Trio rounding benefits for patients and inter-professional team collaboration outweighed the challenges.

Implications: Rounding standard work specific for rehabilitation is being developed, with plans to evaluate after implementation. Patients/families will be included in future research.

Learning Objectives:

Participants will discuss the process of Trio rounding in acute inpatient rehabilitation units.

Participants will discuss the benefits/challenges of Trio rounding in acute rehabilitation units.

Meeting Link: ARN REACH 2020