Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) Vol.
9 No 2.
April 2025
E-ISSN: 2865-6583
P-ISSN: 2868-6298
INTERDISCIPLINARY BEDSIDE ROUNDS AND ITS IMPACT ON HOSPITAL LENGTH OF STAY
* Ida Bagus Yudistira Nugraha Yustama 1.
Atik Nurwahyuni 2.
Dumilah Ayuningtyas3 1Department of Health Administration & Policy.
Faculty of Public Health.
University of Indonesia | e-mail: nugraha.
nugraha@gmail.
Abstract Introduction: Health-care services has developed towards patient-centered care (PCC).
Currently, cases of the prolonged length of stay in hospital arises due to the lack of holistic approach.
This study aims to analyze the role of IBR .
nterdisciplinary bedside round.
implementation and its impact on hospital LOS .
ength of sta.
Methods: This scoping review was adapting the PICOS framework and reporting guidelines by Prisma.
Google scholar.
PubMed.
Cochrane, and Embase were systematically searched for key IBR words and concepts from 2019.
Eligibility of the study uses inclusion and exclusion Seven articles met inclusion criteria and underwent data abstraction.
Results: IBR implementation was able to decrease LOS as it empowers communication between interprofessional teams and patients/families during rounds and improves patient outcomes.
However, it was still debated as IBRAos implementatios were found innefective due to multiple confounding factors including elderly patient with acute illness combined with comorbidities of dementia, delirium, and gap of language barrier as the external factors, and the team readiness as the internal factors .
Discussion: This scoping review highlights IBRAos impact on reducing the LOS and the need for further studies which considers the confounding Keywords: Interdisciplinary bedside rounds, length of stay, scoping review Abstrak Latar Belakang: Pelayanan kesehatan telah berkembang menuju pelayanan yang berpusat pada pasien.
Saat ini, telah terjadi peningkatan lama rawat inap di rumah sakit akibat kurangnya pendekatan holistik.
Studi ini bertujuan untuk menganalisa peran dari penerapan IBR .
onde bedside interdisipline.
dan dampaknya terhadap LOS .
ama rawat ina.
di rumah sakit.
Metode: Reviu cakupan ini mengadaptasi kerangka kerja PICOS dan pedoman pelaporan Prisma.
Google scholar.
PubMed.
Cochrane, dan Embase ditelusuri secara sistematik untuk kata kunci dan konsep IBR sejak 2019.
Eligibilitas studi menggunakan kriteria inklusi dan eksklusi.
Tujuh artikel memenuhi kriteria inklusi dan ekstraksi data.
Hasil: Implementasi IBR mampu menurunkan LOS oleh karena meningkatkan komunikasi antar tim interprofesional dan pasien/keluarga saat ronde dan memaksimalkan hasil perawatan pasien.
Namun, efektifitas IBR masih diperdebatkan karena karena adanya faktor penyulit yakni pasien lanjut usia dengan penyakit akut dikombinasikan dengan komorbiditas demensia, delirium, dan keterbatasan Bahasa sebagai faktor eksternal, dan kesiapan tim sebagai faktor internal.
Diskusi: Reviu cakupan ini menegaskan dampak IBR dalam menurunkan LOS dan dibutuhkannya studi lanjutan yang mempertimbangkan faktor penyulit.
Kata kunci: Lama Rawat Inap.
Reviu cakupan.
Ronde bediside interdisipliner Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) Vol.
9 No 2.
April 2025 Introduction Through several decades, healthcare servicesAo point of view in a hospital setting throughout the world has changed (Edgman-Levitan Schoenbaum.
It was once started from a paternalistic health care models (Hobden et al.
, 2.
, which does not enable the patients' individual needs or choices to be considered for in the decision-making Currently, it has turned into a model where the patient becomes the center of the treatment itself and treated by a well-organized health-care provider, called patient-centered care (PCC).
It was proposed in the 1950s (Pilnick, 2.
, and developed ever since the year of 1988 (Edgman-Levitan and Schoenbaum, 2021.
with the core concept of implementing shared decision making through patient autonomy (Grover et al.
, 2.
As it was begun to be realized on how it could affect the quality of care, by allowing the patient to take part on how they are willing to be treated .
oncerning the patientAos righ.
Thus, the mentioned-concept above, through giving the choices and participation, will enhance the patientAos effectiveness of the treatment (Ferla et al.
Moreover, that concept will also provide the patient a holistic treatment professionalAos perspectives (Desideri.
Montano and Sesti, 2.
The proclaimed PCC concept has not been fully implemented yet (Ernawati and Lusiani, 2.
Several studies have shown, in chronic cases groups, where paternalistic health care models are still used instead of PCCAos (Hobden et al.
, 2.
On the other hand, prolonged length of stay at hospital becomes one of the E-ISSN: 2865-6583
P-ISSN: 2868-6298
findings which was highlighted, increased, and was suspected to be caused by the inability to implement the PCC itself (G/egziabher et al.
, 2022.
Belayneh et al.
Furthermore, even though a medical team composed of multiple specialists are working together, it can be fragmented and uncoordinated due to challenges such as imbalance of authority, limited understanding of otherAos roles and responsibilities (Myrhyj et al.
, 2.
They will only explain and elaborate based on their own expertise without trying to make a clear comprehensive plan of care to the patient (Lai et al.
, 2.
Thus, clearly indicates that it has deviated from its core virtue, as it returns to the previous obsolete style of medical services which based-on physician-induced demand (Yu et , 2.
Although in certain complex cases, an occasional team meeting can be done to solve things, (Kotsougiani-Fischer et al.
, 2.
it is still not representing the initial purpose of PCC itself.
It is neither creating clear discharge planning nor preventive effort to avoid the prolonged length of stay for the patient as theyAore the core subject of the treatment in PCC (Kotsougiani-Fischer Consequently, the patient will often feel uncertain and doubtful as the team itself does not have the leader nor solid team in the very beginning of the treatment (Pilnick, 2.
On the other hand.
IBRAos .
nterdisciplinary bedside round.
method has already been implemented in the developed country to represent the implementation of PCC itself (Heip et al.
IBR is a rounding method which brings more than one kind of health professions .
physicians, nurses, pharmacist.
together with the purposes of which to interact with patients and their Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) Vol.
9 No 2.
April 2025 families in order to give thorough information and collaborate with the medical team to ensure the patient plan of care (Blakeney et al.
, 2.
This study will aim to critically appraise several scientific articles / papers which were done since 2019 with the purpose of becoming the pilot study to analyze the IBRAos implementation and its impact on the quality of health services focused on the parameter of hospital average length of The literature which is used derives from the database of Pubmed.
Embase.
Cochrane Library, and Google Scholar with the topic of which is IBR.
Their eligibility will be determined by inclusion and exclusion Furthermore, the quality of the paperAos used method will be scored with PRISMA .
preferred reporting item for systematic review and meta-analysi.
Method This is a scoping literature review study which collects and evaluates the previous studies/literatures on a specific topic (Mak and Thomas, 2.
Starting this study, it needs a clear specific research question or problem as mentioned at the introduction should IBRAos implementation be a solution to shorten the LOS, and creates keywords based on it, connecting them with AuORAy or AuANDAy at the advanced search windows on the preferred journals databases to find all of the potential studies which relate to the topic.
The following terms, selected from the terminology developed from the Medical Subject Headings (MeSH) of the National Library of Medicine, and the keywords were used: Interdisciplinary bedside rounds (IBR), and Hospital length of stay (LOS).
E-ISSN: 2865-6583
P-ISSN: 2868-6298
Data Source An electronic search without language restrictions was carried out in Google Scholar.
PubMed.
Cochrane, and Embase with a cut-off date in 2019 to avoid the selected-paper to be out of date or not being relevant to the current concern of the topic.
Titles and abstracts of all search results were screened in order to exclude Subsequently, the full texts of all potentially eligible articles were obtained and screened using the eligibility criteria.
Quality Assessment In order to obtain a good systematic literature review, scooping review, or any primary studies, the quality assessment on this topic using preferred reporting items for systematic review and meta-analysis (PRISMA).
The steps of which included identification, screening, eligibility, and the included clinical trials or cohort studies.
Eligibility Criteria Inclusion criteria are including, .
All study must be in the form of research paper, .
Derives from the database (Cochrane.
PubMed & Embas.
, .
Categorize as open-access journal or the full text is available, and .
The language which is used in each of the potential research paper are either in Bahasa or English, .
The study type of participant are hospitals which have been implementing the IBR as part of the PCC and those who have not.
Studies or trials that do not follow a systematic methodology, technology assessments were not included in this study.
Synthesis and Data Extraction The following items were extracted from the included systematic literature review, scooping review, or any primary studies: authorAos name, year of publication, characteristics of the researchAos subject, types of intervention, comparators, outcomes, design of primary studies, main results, and conclusions.
Result and Discussion A total of 49 potentially relevant articles were initially found by searching the online databases.
After removing the duplicates, and screening of the titles and abstract, 9 papers were reviewed as full texts and passed the eligibility criteria.
The PRISMA flow diagram is shown below.
The main general characteristics, results, and conclusion of the included systematic literature review, scooping review, or any primary studies are all reported in the table The 49 papers decreased into 7 papers due to the exclusion criteria including the type of the research like systematic reviews, book chapters, and animal-based experiment type research.
Records identified through database searching: Cochrane .
Embase .
PubMed .
Google Schoolar .
Excluded n .
Records after n .
Screening Note Prolonged Length of Stay (LOS) Intervention IBR Comparison Regular Ward Round Outcomes Length of stay (LOS) Statistical analysis Systematic Literature Review.
Scooping Reviews.
Any Primary Studies Records screened at title level n .
Records excluded at title level n .
Records screened at abstract level n .
Records excluded at title level n .
Eligibility Components Problem
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P-ISSN: 2868-6298
Full-text articles assessed for n .
Included Table 1.
Study Domain with PICOS Identification Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) Vol.
9 No 2.
April 2025 Studies included n .
Figure 1.
Study search and selection flow There are 3 primary studies which consist of 1 cohort prospective study, 1 case control study, and 1 controlled-trials.
There is no limitation on the research date which was purposely done by the writer to gain more data and prospectively see the development of the research regarding the current-researched topic.
The other Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) Vol.
9 No 2.
April 2025 studies used are 2 systematic reviews, 1 scooping reviews, and 1 literature review.
The 7 papers examined in the present study are all according to the requirement of participants, intervention, comparators, and outcomes of interest (PICO) approach for organizing research questions and inclusion criteria.
Those 7 papersAo samples are all patients who were admitted at the ward of hospital, treated with IBR method and the efficacy of which was determined by several parameters including the length of stay.
The researcher limited the date of the study with 2019 as the least year to avoid any bias to the current needs and correlation with the topic.
IBR (Interdisciplinary Bedside Round.
Design and Concept From those 7 articles.
IBRAos definition is the rounds which are conducted by a nurse, physician, and at least one other discipline .
, pharmacist, social worker, dietician, et.
depends on the patientAos/familyAos needs or requests (Heip et al.
, 2.
IBR implementation can be done twice weekly, as proposed by Basic 2021, which will bring a rounding checklist to aid in structured patient presentation by the IBRAos team (Basic et al.
, 2.
IBR implementation allows the medical staff involved to communicate efficiently to other professionals, the patient, and the patientAos family as they will not repeat/double the visits as it will cause redundancy hence decreasing the patient's Moreover, with IBRAos implementation, the medical team will become proactive on delivering the plan of care, hence will relieve anxiety and reduce the patientAos efforts to seek for elaborated information (Heip et al.
, 2.
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IBR also empowers the patient and their family by being well informed and able to express anxiety, to discuss the medicine/treatment, and to use a shared decision-making approach, contributing to patient participation and empowerment.
Thus, patient-centered care is achieved, as theyAore also more satisfied with treatment coordination and updates, and also the discharge planning (Heip et al.
, 2.
Other things which needs to be noted was the IBR implementation is also a way to show empathy and caring as an important element to address the emotional needs of patients as it will affect the clinical outcomes (Blakeney et al.
, 2.
IBRAos Impact on Hospital Length of Stay The intervention aspect of PICO at those 7 papers were clearly defining the IBR implementation than those who were not treated with the method.
The outcome aspect of PICO was also shown in all of those 7 papers which showed the length of stay impact by doing the IBR.
From 7 studies, the 3 primary studies and 1 systematic review, which were done in 2019 and 2022, stated that IBR implementation did not affect the length of However, the latest reviews or studies which were done in 2022 Ae 2024 were all supporting the notion that IBR was able to shorten the LOS in the hospitalAos There are several reasons why IBR able to decrease the hospital length of stay, includes .
it encouraged patients and families to make fast decisions on homecare/treatment placement earlier than they would have without IBR as the medical team becoming the proactive agent of information, .
IBR provides clarity as it Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) Vol.
9 No 2.
April 2025
E-ISSN: 2865-6583
P-ISSN: 2868-6298
enhances and fosters the team factors which made IBR failed to be understanding about the patient plan of delivered effectively (Heip et al.
, 2.
care, the ability to address patientAos Other study using prospective cohort anxiety, staff efficiency and patient safety, design by Clay in 2018, which was and staff perceptions of care quality (Heip mentioned by Heip in 2022, was also et al.
, 2.
supporting those twoAos results as IBR could IBR implementation, as mentioned not affect the LOS due to the above, was able to decrease LOS as it complexity/comorbidities of the elderly (Heip et al.
, 2.
Other glitches which may inhibit the IBR implementation and patients/families during rounds and also the limitation for the current issues are improves patient outcomes, however, it including, .
inconsistency in the was still debated as LOS itself is determined attendance by healthcare providers, and .
by multiple factors which include hierarchical barriers, as these hierarchies organizational culture, bed availability, often diminish effective and safe numbers and mix of staff, accessibility of communication by the term of seniority in subacute services, an individual patientAos medical practices and degree or needs and cultures of the local population, discrimination over the other professions not just IBRAos alone (Ratelle et al.
, 2.
(Heip et al.
, 2.
controlled trial study by Dunn in 2017.
Through all of those gaps which were which was mentioned by Heip in 2022, found, it could be divided into external and stated that IBR did not has significant internal factors.
The internal factors will be statistic value on reducing the LOS nor the patients itself as IBRAos implementation preventing the deteriorationAos process could not effectively done due to language because at that time, during the research barrier gap, acute illness of the elderly with was done, there was lack of accountable great case complexity or comorbidities, care unit to implement IBR (Heip et al.
and the external factors of which was the A Case controlled study by Hyunn in team readiness itself to run the IBRAos.
2017 which was also mentioned by Heip in Hence, further elaborated primary 2022, also stated that IBR did not has research needs to be done but with great significant difference on reducing the LOS consideration to those factors mentioned for the elderly with acute illness as dementia and delirium becoming the Table 2.
Included research First Author.
Participant Intervention & Outcomes Study Design Year Comparison Huynh et al inside Heip patients in 12 Twice weekly SIBR and compared to the other ward which contains There was no difference in the .
nterquartile Case Control 1682 patients whom were not treated with SIBR.
LOS before and during SIBR .
Ae.
compared to the control group 8 .
Ae.
days respectively.
P = 0.
The multivariate of SIBR had no significant effect on Length of Stay.
The effect of SIBR on LOS was not modified by delirium or the ability to speak English hence there was no language-barrier.
Clay inside Heip 2022
patients in 12
SIBR
and compared to the other ward which was not treated with SIBR There was no difference .
between the intervention and control wards in the change in LOS over time Prospective Cohort Dunn inside Heipp 2022 patient in 12 A bedside model .
obile care rounds [MICRO]) was MICRO featured a defined scripting, patient engagement, and Bedside IDR did Controllednot reduce overall Trial LOS or clinical deterioration .
a patient safety Ratelle inside Heip, 29 articles used .
RCT & 21 Cohor.
IBR compared to non-IBR based treatment at the BR have limited effect on patient-centred outcomes, able to reduce LOS.
Systematic Review Blakeney, 79 articles used IBR compared to non-IBR based .
Quantitative treatment at the randomized, 6 mixed method, qualitative 5.
RCT 3, descriptive 2.
Uncategorized majority of studies reported positive impacts of IBR across an array of team, patient, and care quality/delivery Scoping Review Srinivas, 5 articles used MDR compared to non-IBR based treatment at the MDRs have evolved to reduce patient mortality, length of stay, and readmissions, and they enhance satisfaction and utilization of ancillary services.
Literature Review Heip, 2022 32 articles used IBR implementation at IBR reduced the length of stay and cost of care.
Systematic Review .
prospective cohort, 1 cohort, and 1 .
cross sectional, 3 RCT, 1 controlled trial, 1 Prospective study, 7 descriptive, 2 pre-post study, 2 prospective cohort, 1 study, 2 study, 1 review, 5 studies, 1 mix method, 1 case study, 1 casecontrolle.
Conclusion This scoping review highlights the impact of IBR on reducing the LOS and the need for further studies of IBRAos implementation which focused on decreasing the LOS.
Although the impact on LOS was still being debated, it needs more elaborated primary study which hopefully considers the confounding factors as mentioned by this review, to prove on whether IBR has the ability to decrease LOS as part of the PCC in healthcare delivery system.
Abbreviations PCC: Patient-centered care.
IBR:
Interdisciplinary Bedside Rounds.
LOS:
Length of Stay.
PICOS: Problem.
Intervention.
Comparison.
Outcomes, and Statistical analysis.
Declarations Not applicable.
Conflict of Interest The authors declare that there is no professional, or personal interests that might have affected the reviewAos result.
Availability of Data and Materials Data and material research can be provided at Cochrane.
Google Scholar.
PubMed & Embase.
AuthorsAo Contribution Developed studyAos methodology (IYY.
AN.
DA).
review and evaluate (AN.
DA).
wrote and created original manuscript draft (IYY).
Funding Source Not applicable.
Acknowledgment Ethics Approval and Consent Participant The authors would like to thank the Faculty of Public Health.
Universitas Indonesia, for their technical support and all the contributors who helped in this study.
higher quality by designing care through the patientAos eyesAo.
Israel Journal of Health Policy Research, 10.
, p.
Available at:
https://doi.
org/10.
1186/s13584-02100459-9.
References