INTERPROFESSIONAL ROUNDING TEAMS Group 6 November 28th, 2012
BACKGROUND • Interdisciplinary healthcare teams are defined as involving two or more health professions with complementary skills assessing, planning, or evaluating patient care.Xyrichis, A. and Ream, E. Teamwork: a concept analysis. Journal of AdvancedNursing (2008); 61, 232-241.
BACKGROUND• Teamwork in healthcare can save lives, improve the quality of patient care, reduce errors, enhance patient flow, improve communication, and increase satisfaction.• THIS IS WHY WE NEED TEAMWORK!!!Bharwani, Aleem M., MD, MPP, Harris, G. Chad, and Southwick, Frederick S., MD. Perspective: ABusiness School View of Medical Interprofessional Rounds: Transforming Rounding Groups IntoRounding Teams. Acad Med. 2012; 87:00-00.
WHAT DISCIPLINES ARE INVOLVED?• Medicine • Respiratory• Nursing • Physician Assistants• Pharmacy • Nurse Practitioners• Physical Therapy • Social Work• Occupational • Etc. Therapy• Nutrition• Case Management
DISCIPLINES FOR THIS PROJECT• Medicine• Nursing• Pharmacy• PT/OT• Nutrition
MEDICINE• Attending Physician• Medical Resident • Medical Intern• Medical Student
OCCUPATIONAL THERAPY,PHYSICAL THERAPY, AND NUTRITION• Floor/Department
WHY IS THIS IMPORTANT?• In 2006, the Joint Commission reported that 70% of medical errors were caused by lack of communication between team members.Joint Commission on Accreditation of Health Care Organizations. Root causes for sentinelevents. http://www.jointcommission.org/Sentinel_Event_Statistics /.
COMMUNICATION(INTERDISCIPLINARY AND INTRADISCIPLINARY) ISSUE
SIX FUNCTIONS• Provision of detailed case-related information• Confirmation of case-specific details• Articulation of concern or ambiguity• Decision making• Team building and camaraderie• Education
Surgical Safety Checklist to Reduce Morbitiy and Mortality in a Global Population. Haynes AB, Weiser TG, Berry WR, LipsitzSR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B,Gawande AA; Safe Surgery Saves Lives Study Group. N Engl J Med 2009; 360:491-9.
L Lingard, S Espin, B Rubin, et al. Getting teams to talk: development and pilot implementation of a checklist topromote interprofessional communication in the OR. Qual Saf Health Care 2005 14: 340-346
EXAMPLE - FASTHUG• Used in ICU (intensive care unit)• F-feeding• A- analgesia• S- sedation• T- thromboembolic prophylaxis• H- head of bed elevation• U- stress ulcer prophylaxis• G- glycemic control
OUTCOMES • The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).Surgical Safety Checklist to Reduce Morbitiy and Mortality in a Global Population. Haynes AB, Weiser TG, Berry WR, LipsitzSR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, TaylorB, Gawande AA; Safe Surgery Saves Lives Study Group. N Engl J Med 2009; 360:491-9.
OUTCOMES• One example aimed to provide timely pain medication by having nurses observe every four hours for pain. • Reduced the likelihood of a patient’s experiencing untreated pain from 41% to 3%• Another was a checklist for patients on mechanical ventilation • Proportion of patients who didn’t receive the recommended care dropped from 70% to 4% • The occurrence of pneumonias fell by 25%; • 21 fewer patients died than in the previous year• “The research shows that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.”Gawande, Atul. Annals of Medicine: The Checklist. The New Yorker. December 10, 2007.
WHAT IS A CARE PATHWAY? • Also known as care map, critical pathways, or integrated care pathways. • Definition: Complex interventions to organize care for patients. • Although research shows that implementing care pathways can be challenging for teams, the overall consensus with proper management customized care pathways can improve patient care.Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Carepathways lead to better teamwork: results of a systematic review. Soc Sci Med. 2012 Jul;75(2):264-8.
SYSTEMATIC REVIEW • Level III evidence from a trial showed that pathways significantly reduced prescribing error by 30% (p=0.002) • CONS- trouble implementing care pathwayDeneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Carepathways lead to better teamwork: results of a systematic review. Soc Sci Med. 2012 Jul;75(2):264-8.
HMcD/Steering Group Care Pathways for People with MND - In patient diagnosis Northern Ireland July 2003 Referral Screening if potential MND urgent appointment 3-4 weeks Seen at Outpatients Admission (tests etc) Contact made with Care Centre Co-ordinator DIAGNOSIS Care Centre Co-ordinator available/present at diagnosis: or referral made to Co-ordinator to follow up immediately after diagnosis. Follow up appointment Onward with neurologist (variable GP/Primary Care Referral to Care Centre to meet needs 2-6 weeks Leaflet to GP Services as Co-ordinator appropriate available at Info on MND support Outpatients clinic Referral Via Association To MDT Refer to RCA Re-offer services of Care Centre Follow up contact within two weeks (telephone or visit) Liaise with Care Centre RCA makes initial visit, checking statutory services Co-ordinator If no contact wanted and Association servicesGNDH/11.8.05 Maintain contact or contact with AV
EDUCATION(PRE-PROFESSIONAL AND POST-PROFESSIONAL) SOLUTION #3
IMPACT OF INTERPROFESSIONAL EDUCATION ON COLLABORATION ATTITUDES, SKILLS, AND BEHAVIOR AMONG PRIMARY CARE PROFESSIONALS • Interprofessional education session consisted on 3 workshops which lasted 2 to 3 hours. • Brief interprofessional education (IPE) sessions results in significant improvement in the teams’ attitudes other professions.Sarah Robben MD, Marieke Perry MD, PhD, Leontien van Nieuwenhuijzen MSc, Theo van Achterberg RN, PhD,Marcel Olde Rikkert MD, PhD, Henk Schers MD, PhD, Maud Heinen RN, PhD, René Melis MD, PhD. Impact ofinterprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. Journalof Continuing Education in the Health Professions. 32(3): 186-204, 2012.
BUSINESS SCHOOL VIEW OF ROUNDING TEAMS• Scenario-based situations followed by video critiques are also shown to an effective form of interprofessional education for healthcare teams.Bharwani, Aleem M., MD, MPP, Harris, G. Chad, and Southwick, Frederick S., MD. Perspective: ABusiness School View of Medical Interprofessional Rounds: Transforming Rounding Groups IntoRounding Teams. Acad Med. 2012; 87:00-00.