A Proactive Approach to Maximizing Referrals and Minimizing Workplace Violence

Abstract: Past investigations into the merits of proactive rounding have focused on volume of consults, effects on length of stay and caregiver satisfaction. Some studies have found doubled or quadrupled volume and length of stay decreases from 0.6 to 1.2 days (Oldham et al, 2021). Given past benefits demonstrated for nursing retention (Oldham et al, 2021), we sought to expand previous work by focusing on the effects of proactive rounding on violence and other members of the interdisciplinary team while seeking to replicate the previous results on volume and length of stay. Our team (collaborating physician, psychiatric nurse practitioner and social worker) employed the systematic approach and early detection previously noted as cornerstones of proactive rounding services (Oldham et al, 2021). Before interventions, we were already engaged in twice weekly meetings with interdisciplinary teams to discuss barriers to discharge for complex patients. Over 3 months we successfully implemented several approaches including systematic screening, proactive clinical engagement and efforts to further expand interdisciplinary team engagement while monitoring effects during these and the next two months. The number of consults per day increased (1.77 vs 3.03). The number of behavioral codes due to violence decreased and the incidence of workplace violence reports decreased below the mean and median compared to pre-implementation, though not to a statistically significant level (p = 0.331 and p = 0.278, respectively). The average length of stay was unchanged (p = 0.774). There was an unexpectedly significant difference in average age of patients (55.23 years old vs 62.64 years old, p = 0.003). Questionnaires to assess interdisciplinary satisfaction with these changes and their perceptions on the impact on care are in progress. We suspect the increase in average age of patients likely reflects the increased number of patients with delirium or dementia with behavioral disturbances for which we were not previously consistently being consulted. The lack of significantly decreased length of stay would mirror the findings of previous studies that did not find a decreased length of stay with proactive rounding targeting delirium (Choi et al, 2023). The increased number of consults as well as the decrease in violence has further fostered engagement within the interdisciplinary team.