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INTRODUCTION

Ultimately the residents thought these meetings were an efficient use of their time. They thought: We have all the people that we probably need to talk to today about discharge planning at one table. What a gold mine. We can get all of this done, and then we won't get paged five times by them for the rest of the morning.

Cross-functional meetings are a coordinating mechanism that is intended to foster real-time coordination, incorporating information as it becomes available.163 Meetings provide a forum for interaction among people who are engaged in the same work process. Whether scheduled or unscheduled, meetings give the participants in the process an opportunity to coordinate their tasks interactively, on the spot.164 Face-to-face interactions are expected to have particular relevance in ensuring effective communication because of their high bandwidth, immediacy, and ability to build connections among participants through the use of nonverbal cues.165 Although informal or unscheduled meetings sometimes are said to be more productive than formal meetings,166 informal meetings tend to take place among those who are similar. Formal, or scheduled meetings may be needed to ensure interactions among staff members from different functions who would otherwise tend not to meet.

Patient rounds are a type of cross-functional meeting in which physicians, residents, nurses, and others responsible for the care of a patient get together to discuss the patient's case either at the bedside or in a separate conferencing area. The goal of rounding is for people who are involved in the care of a particular patient to get information from the patient and from one another so that better decisions can be made about subsequent care or the patient's discharge. We found that the combination of care providers who rounded separately or in combination varied greatly across hospitals, based on historical practice and scheduling issues.

In most of the hospitals studied here, two types of patient rounds were conducted. Physician rounds, in which an individual physician visits each of his or her patients, typically were conducted on a daily basis. These rounds usually were conducted by the physician alone or with a resident. In one hospital, however, physicians were accompanied on their daily rounds by a nurse, a case manager, a social worker, and a therapist. Face-to-face communication was therefore achieved on a daily basis among the core members of the healthcare team.

Interdisciplinary rounds traditionally were held weekly, typically in a conference room. These meetings usually included a nurse manager, a case manager, and nurses from the unit. In some hospitals the rounds included other disciplines—for example, a resident to represent the physician perspective, a physical therapist, a nutritionist, a pharmacist, and even a chaplain. As the length of patient stays dropped, however, weekly meetings became less useful. Often by the time the group could sit down and discuss a patient's needs, the patient had been discharged or had ...

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