Multidisciplinary team (MDT) rounds are a cornerstone of coordinated, high‑quality patient care. When they function smoothly, clinicians share critical information, align treatment plans, and make decisions that reflect the expertise of every discipline involved. Yet many institutions struggle with inconsistent attendance, unclear communication pathways, and inefficient use of time. Redesigning MDT rounds can transform them from a routine checkpoint into a dynamic, patient‑focused forum that drives better outcomes and staff satisfaction. Below are best‑practice guidelines to help leaders and clinicians systematically revamp their rounding process while keeping the changes sustainable and adaptable to evolving clinical environments.
Understanding the Current State of MDT Rounds
Before any redesign, conduct a focused assessment of how rounds are currently conducted. Use direct observation, brief staff interviews, and simple process maps to capture:
- Sequence of activities – from patient identification to decision documentation.
- Timing patterns – average duration per patient, start‑and‑stop times, and any bottlenecks.
- Participant mix – which disciplines are present, how often, and at what points they contribute.
- Information flow – sources of data (e.g., bedside monitor, paper chart, electronic view) and how they are shared.
A concise “as‑is” snapshot highlights gaps that are ripe for improvement without requiring extensive data‑analytics infrastructure.
Defining Clear Objectives and Scope
A successful redesign starts with specific, measurable goals that are relevant to the team’s daily work. Typical objectives include:
- Reducing average round time per patient while preserving decision quality.
- Increasing the proportion of patients discussed with all core disciplines present (e.g., physician, nurse, pharmacist, therapist).
- Improving clarity of the care plan as reflected in post‑round documentation.
Limit the scope to a manageable unit—such as a single ward, service line, or patient cohort—so that changes can be piloted, refined, and then expanded.
Engaging the Right Stakeholders
Involve representatives from each discipline early in the redesign process. Their input ensures that the new workflow respects professional expertise and practical constraints. Key steps:
- Form a short steering group (3‑5 members) with a balanced mix of physicians, nurses, allied health professionals, and a unit manager.
- Hold a brief kickoff meeting to share the assessment findings and proposed objectives.
- Solicit “pain points” and “quick wins” from the broader team through informal huddles or a simple electronic survey.
Stakeholder buy‑in is built on transparency and the promise that their concerns will shape the final design.
Standardizing Roles and Responsibilities
Clarity about who does what eliminates duplication and prevents critical tasks from falling through the cracks. Consider the following role matrix:
| Discipline | Primary Responsibility | Secondary Contribution |
|---|---|---|
| Attending Physician | Lead decision‑making, final care plan approval | Clarify diagnostic rationale |
| Resident/Fellow | Present patient summary, propose differential | Capture teaching points |
| Charge Nurse | Verify medication reconciliation, highlight safety concerns | Coordinate discharge planning cues |
| Pharmacist | Review medication list, suggest adjustments | Flag drug‑interaction alerts |
| Physical/Occupational Therapist | Summarize functional status, recommend therapy goals | Identify equipment needs |
| Social Worker | Highlight psychosocial barriers, arrange support services | Update family communication plan |
Document this matrix in a visible location (e.g., a laminated poster in the rounding room) and revisit it quarterly to accommodate staffing changes.
Optimizing Physical and Virtual Environments
The setting of MDT rounds influences both efficiency and engagement.
- Physical layout – Arrange chairs in a semi‑circle around the patient’s bedside to promote eye contact. Keep a whiteboard or flip chart within arm’s reach for quick note‑taking.
- Technology placement – Position a mobile device or tablet on a stand so that the electronic health record (EHR) can be viewed without crowding. Ensure the screen is angled for all participants.
- Virtual participation – For disciplines that cannot be physically present (e.g., dietitian on another floor), use a secure video link with a dedicated microphone and speaker. Test connectivity before each session to avoid delays.
A well‑designed environment reduces the time spent fiddling with equipment and keeps the focus on patient discussion.
Structuring the Round Flow
A repeatable sequence helps the team stay on track. A practical template includes:
- Pre‑Round Huddle (2‑3 min) – Quick verification of patient list, assignment of presenter, and identification of any urgent issues.
- Patient Presentation (3‑5 min) – Resident or nurse shares a concise summary: demographics, current problem list, recent labs/imaging, and key vitals.
- Focused Discipline Input (1‑2 min each) – Each core member adds discipline‑specific insights, using the role matrix as a guide.
- Decision Synthesis (2‑3 min) – Attending physician restates the agreed‑upon plan, highlighting any pending orders or follow‑up actions.
- Documentation Prompt (1 min) – Designate a scribe (often the resident) to enter the plan into the EHR immediately after the patient leaves the bedside.
Adhering to this cadence minimizes drift and ensures that every patient receives a comprehensive, coordinated review.
Incorporating Real‑Time Information Sharing
Effective rounds rely on up‑to‑date data. Implement these low‑tech practices:
- “Snapshot” sheets – A one‑page printout placed at the bedside containing the latest labs, medication list, and imaging results. Update it daily during the nursing shift change.
- Rapid‑fire verbal updates – Encourage the charge nurse to announce any new safety alerts (e.g., fall risk, isolation status) before the presentation begins.
- EHR shortcuts – Configure a “Round View” dashboard that aggregates the most relevant tabs (vitals, labs, medication) into a single screen, reducing navigation time.
These tactics keep the conversation grounded in current facts without requiring sophisticated analytics tools.
Ensuring Patient and Family Participation
When appropriate, involve patients and their families directly in the discussion. Benefits include increased adherence, clearer expectations, and a stronger therapeutic alliance.
- Invite the patient to sit at the bedside and listen, unless clinical urgency dictates otherwise.
- Allocate a brief “patient voice” moment (30 seconds) for them to express concerns or preferences.
- Summarize the plan in plain language before concluding, confirming understanding with a “teach‑back” question.
Incorporating the patient’s perspective transforms rounds from a provider‑centric activity into a collaborative care event.
Implementing Continuous Feedback Loops
Even after a redesign is launched, ongoing refinement is essential.
- Post‑round debrief (2 min) – At the end of the session, the team leader asks, “What went well? What could be improved?” Capture responses on a sticky‑note board.
- Weekly “pulse” check – Review aggregated feedback during a short staff meeting to identify recurring themes.
- Iterative tweaks – Adjust the round template, role assignments, or environment based on the most frequent suggestions.
A simple, rapid feedback cycle sustains momentum without the overhead of formal change‑management programs.
Training and Skill Development
Consistent performance hinges on shared knowledge of the new process.
- Orientation modules – Develop a brief (10‑minute) video that walks new staff through the round structure, role matrix, and documentation steps.
- Simulation drills – Conduct quarterly mock rounds using a standardized patient case to rehearse timing, communication, and hand‑off techniques.
- Mentorship pairing – Pair less‑experienced clinicians with seasoned round leaders for on‑the‑job coaching during the first month of implementation.
Targeted training embeds the redesign into everyday practice and reduces variability.
Monitoring Performance and Sustaining Improvements
While the focus here is on evergreen practices, a minimal set of metrics helps confirm that the redesign is delivering its intended benefits.
- Average round time per patient – Track weekly; aim for a modest reduction (e.g., 10 %).
- Discipline attendance rate – Percentage of core team members present for each patient discussion.
- Plan‑completion compliance – Proportion of patients whose care plan is entered into the EHR within 15 minutes of the round.
Display these metrics on a simple dashboard in the staff lounge. Celebrate incremental gains publicly to reinforce the value of the new process.
By systematically assessing the current state, defining focused objectives, clarifying roles, optimizing the environment, and embedding continuous feedback, healthcare teams can revitalize multidisciplinary rounds. The result is a more efficient, collaborative, and patient‑centered workflow that endures beyond any single improvement initiative. Implementing these best practices equips organizations to deliver higher‑quality care while fostering a culture of teamwork and shared responsibility.
