Introduction: Increased multidisciplinary provider involvement in team discussions about patients has been demonstrated to reduce provider burnout and moral distress, increase engagement in patient care, and lead to better patient outcomes.  In response to concern about decreasing multidisciplinary engagement in a large U.S. children’s hospital’s heart transplant program, a quality improvement initiative was undertaken to better understand factors leading to this trend and to implement change.
Methods: A Plan-Do-Study-Act (PDSA) methodology was utilized to develop, implement and evaluate tests-of-change.  Heart transplant weekly rounds participants completed a baseline survey of perceptions of engagement in rounds, and data was collected regarding number of minutes non-physician team members spoke in rounds over 4 time points.  Following a 9-month implementation of the first test-of-change (direct physician solicitation of non-physician perspectives on care of each patient during rounds), rounds participants re-completed the survey questions about perceptions of rounds involvement and questions about perceptions of the impact of the test-of-change.  Number of minutes that non-physicians spoke in rounds was also collected.
Results: 70% of rounds participants (n=31) completed the baseline survey and 71% of rounds (n=29) participants completed the follow-up survey. There was no significant effect of the intervention on the number of minutes spoken by a non-physician per hour of rounds (0.52 and 1.25 minutes per 60 minutes at baseline and follow-up respectively; t5=-2.3; p=.073).  On repeated-measures t-tests of responses for those participants who completed surveys at both time points (n=24), following the test-of-change there was a significant increase in non-physician multidisciplinary team members’ ratings on items “Team members express interest in my perspective” (t11 = -1.37; p=.013) and “I feel comfortable giving an unsolicited opinion or update about patient care from my perspective” (t11=-3.52; p=.005).  Open-ended survey responses indicated mixed perspectives on intervention efficacy.
Conclusion: Non-physician team members’ perception of engagement in rounds appeared to increase as a result of the intervention, despite little objective evidence of change in minutes spoken.  Implications for this finding on future tests-of-change for this project will be discussed, as well as the benefits of using an iterative QI approach to address multidisciplinary team process challenges in pediatric transplant.