What is the importance of multidisciplinary rounds in a Neuro Intensive Care Unit (Neuro ICU) setting?

Multidisciplinary Rounds in the Neuro ICU

Multidisciplinary rounds (MDR) should be implemented as a routine, structured practice in the Neuro ICU to improve communication, reduce errors, enhance family satisfaction, and optimize patient outcomes through coordinated care delivery. 1, 2

Core Structure and Implementation

Standardized approach with defined roles is essential. The quality of rounds improves significantly when conducted by a multidisciplinary team with explicitly defined roles, using a standardized structure and goal-oriented approach that includes a best practices checklist. 3 Implementation of a simple toolkit that can be incorporated into existing workflow results in measurable improvements in staff engagement and overall communication. 2

Team Composition

The multidisciplinary team should include:

• Intensivists (preferably leading the rounds) 4
• Neurologists and neurosurgeons 1, 5
• Nursing staff (bedside nurses must actively participate) 2, 3
• Pharmacists 1
• Respiratory therapists 3
• Social workers (to improve family satisfaction) 1
• Physical and occupational therapists 3

International consensus from the Neurocritical Care Society, European Society of Intensive Care Medicine, and Society for Critical Care Medicine emphasizes that this multidisciplinary approach is fundamental to neurocritical care delivery. 1

Evidence-Based Benefits

Communication and Error Reduction

Nurse participation dramatically increases with structured rounds. After implementing standardized MDR:

• Nurse participation during patient data presentation increased from 36.2% to 71.8% in surgical ICUs and from 34.8% to 100% in medical ICUs 2
• Nurse participation during generation of daily plans increased from 51.1% to 80.8% in surgical ICUs and from 30.4% to 99.1% in medical ICUs 2
• Miscommunications and errors were corrected in nearly half of observed rounding episodes 2

Family-Centered Outcomes

Family participation in rounds improves satisfaction and engagement. The Critical Care Medicine guidelines recommend offering family members the option to participate in interdisciplinary team rounds to improve satisfaction with communication and increase family engagement. 1 When conducted well, interdisciplinary family conferences are associated with increased family satisfaction with communication and trust in clinicians, while reducing conflict between clinicians and family members. 1

Clinical Outcomes

Intensivist-led multidisciplinary teams improve patient outcomes. An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery and has been shown to beneficially impact patient outcomes and reduce costs. 4 Greater participation by all disciplines in achieving patient and family outcomes, increased early recognition of patients at risk, and improved communication among healthcare team members have been documented. 6

Essential Components for Neuro ICU Rounds

Monitoring and Assessment Focus

Rounds must address the unique monitoring needs of neurocritical patients:

• Neurological examination status using Glasgow Coma Scale combined with pupillary assessment or FOUR scale for comatose patients 7
• Multimodality monitoring data including intracranial pressure, cerebral perfusion pressure, brain tissue oxygenation (PbtO2), and continuous EEG when indicated 1, 7
• Hemodynamic parameters with attention to cerebral blood flow and oxygenation goals 5
• Sedation and pain assessment using validated scales (RASS, SAS for sedation; BPS or CCPOT for pain in non-communicative patients) 7

Goal-Oriented Structure

Each patient discussion should systematically address:

• Current neurological status and trends 7, 5
• Secondary brain injury prevention strategies (avoiding hypoxemia, hypercapnia, hyperthermia, hypotension) 7
• Specific monitoring thresholds and interventions (e.g., PbtO2 <20 mmHg requires intervention) 7
• Early mobilization protocols when appropriate (safe in most neurocritical patients following structured protocols, can reduce ventilator-associated pneumonia) 7
• Family communication needs and conference scheduling 1

Common Pitfalls and How to Avoid Them

Poor information retrieval and documentation is a significant barrier. 3 Address this by:

• Ensuring all monitoring data is readily accessible and displayed
• Using standardized documentation templates
• Reviewing trends rather than isolated values

Interruptions and long rounding times reduce effectiveness. 3 Mitigate by:

• Establishing protected time for rounds
• Silencing non-urgent pages during rounds
• Using a structured format to maintain focus

Allied healthcare providers feeling undervalued undermines team function. 3 Prevent this by:

• Explicitly soliciting input from all team members
• Defining clear roles for each discipline
• Ensuring nursing staff present patient data and participate in plan generation 2

Failure to integrate multimodality monitoring data into decision-making. 1 Avoid by:

• Systematically reviewing all monitoring modalities
• Discussing how monitoring data influences treatment decisions
• Recognizing that no monitor alone changes outcomes—interpretation and integration into clinical decision-making determines impact 1

Process Improvement Framework

Standardized protocols and care bundles should be used. 4 Process improvement is the backbone of achieving high-quality ICU outcomes, and institutional support for comprehensive quality improvement programs should be provided. 4 The use of best practices checklists during rounds facilitates measurable processes and outcomes. 3

Continuous evaluation and refinement of the rounding process is necessary, using quality improvement science methodologies to beneficially impact patient outcomes. 4