Abstract
Background: Interprofessional collaboration (IPC) is an essential component of care delivery needed to achieve optimal patient and system level outcomes within healthcare systems.
Purpose: The purpose of this quality improvement project was to measure the impact of a structured IPC model, called RAMPED-UP, on hospital length of stay (LOS) in the surgical trauma population. The RAMPED-UP model had three components: daily structured IPC rounds; consistent use of an IPC instrument; and documentation on and access to the instrument by the IPC team.
Methods: The design was a prospective cohort with a historical comparison group study design. The project was conducted on a 28-bed surgical trauma unit of a Level 1 trauma center. A convenience sample of 195 participants was used. Trauma patients admitted from October to December 2016 constituted the pre-RAMPED-UP group (n=98). The RAMPED-UP group received the IPC model and constituted trauma patients admitted from October to December 2017, (n=96).
Results: The two groups were similar in demographics and were predominantly single, male, with an average age range of 40-45 years. The overall hospital LOS was not statistically significant between groups. The median RAMPED-UP LOS, defined as the number of days the patient received RAMPED-UP rounds, was 3 days. Patients in the RAMPED-UP group were more likely to be discharged home and the discharge-by-noon (DBN) rates were higher by 18.2% (p= 0.005). A statistically significant correlation was found between incentive spirometry (I/S) values and hospital LOS and RAMPED-UP LOS in the RAMPED-UP group, (95% CI: rs -0.301, P=0.008) and (95% CI: rs -0.270, P= 0.018).
Conclusion: While the implementation of the RAMPED-UP model did not decrease hospital LOS, the model did significantly improve DBN and RAMPED-UP LOS compared to the institutional goal of 6.1days. The RAMPED-UP model bridged the communication gaps among the IPC team, patients, and families. Additional exploration of incentive spirometry as a predictor of LOS is warranted. The use of a structured IPC model supports the evidence that patient outcomes can be positively improved with a consistent, structured process that includes essential members of the IPC team and patient and family.
Keywords: length of stay, acute care, critical care; patient care team, multidisciplinary care team, patient care planning, interprofessional collaboration, and instrument.
