P3B406: Integration of an Innovative Technology Rendering Time Transparency to Facilitate Multidisciplinary, Family-centered Rounding Practices in a Neonatal Intensive Care Unit

Introduction: Family-centered, multi-disciplinary rounding has been shown to lead to improved communication, enhanced efficiency, better patient outcomes, shared decision-making, greater patient/staff satisfaction, and overall enhanced quality of care. While having the entire team together for rounds at the same time is a best practice, coordination to ensure that all key multidisciplinary team members (e.g., providers, nurses, patients, families, interpreters, consultants) are present on rounds is difficult. Researchers at the University of Minnesota developed Q-rounds, a novel team rounding software tool that provides real-time updates on when to expect the team for rounds and provides families one-click access to join remotely if not able to be there in person. An early version of Q-rounds was well received by users despite lacking electronic health record (EHR) integration; we wished to test the feasibility of integrating this technology into the EHR to create more functional workflows for rounding clinicians. We chose the neonatal intensive care unit (NICU) as an initial test site for this integrated version.

Case Description: A functional beta-version of the Q-rounds rounding solution provides real-time text updates to patients, families, and providers regarding the timing of rounds. As part of a multi-pronged, IRB-approved study (IRB-STUDY00017619), we collaborated with the M Health Fairview Health Services IT members, and Q-rounds developers to integrate Q-rounds into the NICU workflow, including with Health IT. We integrated Q-rounds bi-directionally with Epic, leveraging Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs), and Health Level7 (HL7). We integrated Q-Rounds with Interpreter services and ASCOM phones using text messaging and conferencing APIs.

Discussion: The novel rounding solution was successfully integrated behind the health system’s firewall, as depicted in Figure 1. We have demonstrated that this workflow is functional in a testing environment and we are moving the solution into production in late April 2023. As the next steps, we will be evaluating the impact of Q-rounds on rounding practices leveraging a mixed-method, pre-and post-implementation study. In addition to analyzing objective/subjective data (e.g., presence of nurses and family members during rounds, time spent on each patient, days spent in NICU, level of satisfaction), we plan to scrutinize data from a lens of social determinants of health, including the ability to have families present for rounds who otherwise would not be able to be there.

Conclusion: Integration of Q-rounds provides clinicians and team members with real-time shared up-to-date rounding information. We are validating current functional testing and will be fully implementing it soon. We hypothesize that by providing families with real-time updates on the timing of rounds and the ability to join remotely, we will see more patient/family-centered care, improved patient and provider experience during rounds, and eventually, enhanced care delivery and health outcomes.