• Tyler N Brown, Lindsey Justice, Farhan Malik, David Lehenbauer, Alan O'Donnell, James M Brown, Tricia Powers, Smriti Neogi, David S Cooper, and Kenneth E Mah.
• The Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
• Pediatr Crit Care Me. 2023 Jun 1; 24 (6): e282e291e282-e291.

ObjectivesProvider-only, combined surgical, and medical multidisciplinary rounds ("surgical rounds") are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times.DesignSingle-center improvement science study with observational and interventional phases from February 2, 2021, to July 31, 2021.SettingTertiary pediatric cardiac ICU.ParticipantsCardiothoracic surgery and cardiac intensive care team members participating in daily "surgical" rounds.InterventionsImplementation of technology automation, creation of work instructions, standardization of patient presentation content and order, provider training, and novel role assignment.Measurements And Main ResultsSixty-one multidisciplinary rounds were observed (30 pre, 31 postintervention). During the preintervention period, identified inefficiencies included prolonged preparation time, redundant work, presentation variability and extraneous information, and frequent provider transitions. Application of targeted interventions resulted in a 26% decrease in indexed rounds duration (2.42 vs 1.8 min; p = 0.0003), 50% decrease in indexed rounds preparation time (0.53 vs 0.27 min; p < 0.0001), and 66% decrease in transition time between patients (0.09 vs 0.03 min; p < 0.0001). The number of presenting provider changes also decreased (9 vs 4; p < 0.0001). Indexed discussion duration did not change (1 vs 0.98 min; p = 0.08) nor did balancing measures (bedside rounds and surgical start times) change (8.5 vs 9 min; p = 0.89 and 38 vs 22 min; p = 0.09).ConclusionsLean methodology can be effectively applied to multidisciplinary rounds in a joint cardiothoracic surgery/cardiac intensive care setting to decrease waste and inefficiency. Interventions resulted in decreased preparation time, transition time, presenting provider changes, total rounds duration indexed to patient census, and anecdotal improvements in provider satisfaction.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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