Background: Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient‐centered care. However, there is limited understanding of optimal IDR structures and procedures.Objective: This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication.Designs, Settings and Participants: Trained observers audited general medicine ward rounds at an academic medical center using a standardized tool to record physician and nurse behavior and communication in 1007 patient encounters in October 2019 to March 2020.Results: There were significant differences in physician and nurse interaction time among physicians with different levels of training, with attendings demonstrating higher interaction time than residents (5.4 ± 4.6 vs. 4.3 ± 3.7 min, p = .02) and interns or medical students (3.0 ± 3.2 min, p = .002). Attendings were more likely to initiate a conversation about nurse concerns (76.9%) compared to residents (67.9%) and interns or medical students (59.3%, p = .03). Early nurse participation in bedside visits was associated with increased physician and nurse interaction time (5.0 ± 4.6 vs. 1.9 ± 1.7 min, p < .001) and physician initiative to ask about nurse concerns (74.8% vs. 64.3%, p = .04). In addition, physician initiative to ask the nurse for concerns rather than waiting for the nurse to offer concerns without being prompted was associated with a subsequent conversation about those concerns (74.5% vs. 61.8%, p < .001) and the physician asking about patient or family concerns (94.2% vs. 88.4%, p = .01).Conclusions: Implementing IDR structures and procedures that promote attending physician involvement, physician initiative, and early nurse participation could optimize interdisciplinary communication and quality of care.

Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure. An observational study of 5089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status. Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0 % of patients had received an influenza vaccine, 76.2 % had received a pneumococcal vaccine, and 83.3 % had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza (aOR = 0.75, 95 % CI = 0.66-0.86), pneumococcal (aOR = 0.65, 95 % CI = 0.55-0.75), and COVID (aOR = 0.74, 95 % CI = 0.62-0.89) compared to patients with HFpEF. Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF.

Background: Discharge planning is a complex and critical process that ensures continuity of care, reduces postdischarge complications, and prevents hospital readmissions. Bedside nurses, central to this process, offer valuable perspectives on barriers to safe discharge and care transitions. This study aimed to identify common challenges in discharge planning and highlight nurse-driven solutions to improve patient safety. Methods: A cross-sectional survey was conducted with nurses from medical telemetry, cardiac observation, and short-stay observation units at a 520-bed tertiary academic teaching hospital from March 21 to April 30, 2022. Using the Agency for Healthcare Research and Quality’s IDEAL Discharge Planning and Implementation Handbook as a framework, the survey assessed key challenges related to discharge and transitions of care. Participants rated their agreement with identified challenges, proposed solutions, and provided additional insights through an anonymous, 1-time survey. Results: Of 217 nurses contacted, 108 completed the survey (50% response rate). The majority identified significant barriers, including communication failures among care teams, care coordination gaps, medication reconciliation issues, and inadequate patient preparedness for discharge. Proposed solutions included implementing structured interprofessional communication protocols, enhancing discharge education strategies, and optimizing medication reconciliation processes. Conclusions: This study underscores the systemic and operational barriers to safe discharge from the perspective of bedside nurses. Implementing targeted, evidence-based interventions informed by frontline staff insights can improve patient outcomes, reduce preventable harm, and enhance the discharge experience for patients and families.

Purpose: Interdisciplinary team rounding improves communication in hospital settings by bringing together multiple disciplines to collaborate on a patient’s plan of care. While prior research has demonstrated the benefits, the relationship between time spent at the bedside and the delivery of key clinical content remains less understood. This study examined whether physician bedside rounding time and nurse-physician interaction time influenced discussions of care plan elements and engagement of care team members. Methods: We conducted an observational descriptive study at a quaternary academic medical center. Using a standardized observation tool, trained student observers recorded data from a sample of 1007 patient encounters during morning internal medicine rounds. Logistic regression was used to assess associations between bedside rounding time, nurse-physician interaction time, and discussions of the plan of the day, overall hospitalization goals, and anticipated discharge, as well as nurse and patient/family involvement. Results: Of the 1007 encounters, 64.7% (n=652) included a nurse-physician interaction, with a mean interaction time of 6.1 minutes (SD=4.8). Longer bedside rounding time increased the likelihood of discussions about hospitalization goals (OR=1.60, 95% CI: 1.09– 2.54) and anticipated discharge (OR=1.25, 95% CI: 1.02– 1.54). Longer nurse-physician interaction time significantly increased the likelihood of nurse involvement across all three discussion topics and was also associated with greater patient/family engagement. Conclusion: Longer bedside rounding and structured nurse-physician interaction both enhanced communication during rounds. Nurse-physician interaction time was the stronger predictor of inclusive discussions, underscoring the importance of structured approaches to engage nurses in interdisciplinary rounding.