Enhancing Patient Care Through Dyad Partnerships and Care Team Visits

It takes a team."


That's the motto of the nurses and providers who are taking part in Dyad Partnerships and Care Team Visits, two new twists on patient care that are leading to higher quality patient care at University Hospital.


"The dyad teams are comprised of the nurse manager and a physician," says Ann Malec, DNP, RN, NEA-BC, director of medical nursing. "The idea is that these two leaders partner together on things that affect unit operations and various quality initiatives. They discuss priorities for the unit and review different case studies and data for quality issues such as hospital acquired conditions."


Dyad teams are comprised of nurse managers and physicians partnering together to discuss priorities for their units and review different case studies and data for quality issues.One of the first dyad teams came about when hospitalist Rob Hoffman, MD, and nurse manager, Deb Dalsing, MSN, RN, CNML, started meeting informally several years ago to discuss quality and discharge issues. "We work closely on implementing Care Team Visits and conduct twice-a-month huddles, where we discuss data and where we think we can improve," reports Dr. Hoffman.


The positive effects are easy for Dalsing to pinpoint. "One thing that we've really had success with is getting our central lines pulled more quickly. When we can't get a central line out, Rob will step in and work with the primary service and help us get it out quicker.


"Having this open communication, where we get a different perspective is important," she adds. "That's what makes the dyad team such a unique relationship."


The Care Team Visit is one of the most prominent projects implemented with the help of the dyad team program. The name came from members of the UW Health's Patient- Family Advisory Committee (PFAC), who shared that the term ‘rounds' was perceived as provider centric. "Based on the PFAC's suggestion, we adopted the term ‘Care Team Visit' to convey a meaningful partnership between the care team, the patient and the family," Malec explains.


Malec breaks down the essential steps in this enhanced daily ‘round':

  1. The nurse initiates the daily visit, because the patient and family align with the nurse.
  2.  Every member of the care team introduces him- or herself.
  3. The nurse informs the patient and family of the purpose of the visit.
  4. The nurse states the patient's primary goal or concern for the day, which is discussed amongst the care team.
  5. The nurse gives a brief 24-hour summary of events.
  6. The nurse reviews a defined quality/safety checklist.
  7. The provider gives a clinical update.
  8. Discharge planning is discussed jointly.
  9. The nurse asks the patient if he or she has any remaining concerns.

Feedback from patients and their families has been positive, Malec says. "One patient's family member said it made her feel safe to see the nurse and provider talking together, coordinating her loved one's care. This family member also pointed out that it was reassuring to see the nurse taking a strong lead in initiating the visit and contributing important information to the patient's individualized plan of care."


"Patients and families really like to see the nurse and doctors partnering together," confirms Dr. Hoffman. "They identify the nurse at the bedside as their advocate, spend the whole day with them, and rely on them for communicating with everyone else in the care team.


"It elevates the nurses' role," he concludes. "Nurses are involved actively and explain to the entire team what's most important to the patient today as well as the main goal. Care Team Visits have improved communication and created an environment of always putting the patient first."