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The increasing complexity of pediatric inpatients requires that all providers understand a comprehensive child’s medical and social needs. A survey administered to Children’s Mercy Hospital inpatient providers identified gaps in knowledge regarding the daily plan of care and discharge planning needs among Complex Chronic Care (CCC) patients. Multidisciplinary rounds (MDRs) create a shared decision model among all team members to ensure that all aspects of care for CCC patients are addressed.

To improve provider knowledge of the plan of care and discharge planning needs for CCC patients admitted to the Hospitalist service, from 40% to 75% of providers by implementation of MDRs.

All CCC patients (defined by ICD-10 code diagnosis; Fuedtner, et. al.) admitted to the Hospitalist service were candidates for MDRs. Patients with CCCs on resident teaching service were excluded. MDR team included a hospitalist, bedside nurse, nurse care manager, social worker, pharmacist and nutritionist. Providers were notified of qualified patients for MDRs three times a week prior to rounds. The MDR team members discuss the medical plan, address medication change, nutrition status, social and discharge needs. The process measure included the frequency of provider’s attendance at MDRs; the time spent rounding per patient was the balancing measure. Pre-round huddles were implemented 6/1/2017 to facilitate discussion of CCC patients among team members unable to attend bedside rounds (Figure 1). Statistical process control charts were used to assess the impact of pre-round huddles on percent provider attendance at MDRs. Following implementation of MDRs, providers completed subsequent surveys reflecting their knowledge on the plan of care for CCC patients.

MDRs were implemented 8/1/2016. Attendance remained unchanged until the introduction of pre-round huddles which significantly improved provider attendance (p

Implementation of the pre-round huddles had the most impact on providers’ attendance at MDRs, without increase the rounding time per patient. While providers reported some improvement in understanding of care for CCC patients, the impact of provider attendance at MDRs or pre-round huddles on readmission rate of CCC patients remains to be determined.

MeSH Keywords

Chronic Disease; Patient Care Team; Child, Hospitalized


Chronic care patients; multidisciplinary rounds; medically complex patients



Impact of Huddles on Provider’s Knowledge of Medically Complex Patients

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Pediatrics Commons