The Effect of Multi Disciplinary Care 3.26.09

We systematically reviewed randomized controlled trials (RCTs) assessing the ef- fectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% con- fidence interval [CI]=0.85, 1.08; I2 = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I2 = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. (Am J Pub- lic Health. Published online ahead of print October 16, 2014: e1–e11. doi:10.2105/ AJPH.2014.302164)

Author: Michelle Kim

Health & Medicine

Results The effect of multidisciplinary care teams on intensive care mortality Michelle M. Kim MSc, Amber E. Barnato MD MPH, Derek C. Angus MD MPH, Lee F. Fleisher MD, Jeremy M. Kahn MD MS Department of Health Care Management and Economics, Wharton School of Business, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Anesthesia and Critical Care, Center for Clinical Epidemiology and Biostatistics, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania School of Medicine , Philadelphia, PA, Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, Department of Health Policy and Management, Graduate School of Public Health, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Background ,[object Object],Objectives Methods ,[object Object],[object Object],Conclusions ,[object Object],[object Object],[object Object],Limitations Policy Implications Table 2. Association between organizational models and 30-day mortality a Variable Odds Ratio (95% CI) Model 1: Multidisciplinary care staffing alone No multidisciplinary care 1.00 Multidisciplinary care 0.84 (0.76-0.93) Model 2: Intensivist physician staffing alone Low intensity 1.00 High intensity 0.84 (0.75-0.94) Model 3: Interaction between intensivist physician Staffing and multidisciplinary care Low intensity/ no multidisciplinary care 1.00 Low intensity/ multidisciplinary care 0.88 (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324. Table 1 . Hospital,Intensive Care Unit, Patient Characteristics Low intensity/no MDC Low intensity/ MDC High intensity/ MDC (n=54) (n=36) (n=22) Hospital characteristics Teaching 12 (22) 14 (39) 15(68) Number of beds 128 [77-208] 198 [83.5-311] 286 [144-645] Annual med ICU admissions 272 [147-402] 380 [196-705] 588 [304-1103] ICU characteristics Medical ICU 2 (4) 4 (11) 9 (41) Combined ICU 52 (96) 32 (89) 13 (59) Number of beds 11 [6-16] 15 [9-29] 21 [16-48] Patient characteristics Age 65.4 ± 17.9 64.3 ± 18.6 62.0 ± 17.8 Female (%) 50.7 50.7 48.9 Black (%) 5.8 12.8 18.2 ICU = intensive care unit ; MDC= multidisciplinary care Values are expressed as a frequency (percent), median [interquartile range], or {range}.

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Running head: STRATEGIC PLAN FOR CHANGE 1 STRATEGIC PLAN FOR CHANGE 2 Strategic Plan for Change Jennifer Zimmerman Walden University- NURS 6201 December 29, 2017 Improving Patient Experience who are Undergoing Chemotherapy from an Outpatient setting to an Inpatient Setting 1. Introduction and Statement of the Problem 1.1. What is the problem? Outpatient chemotherapy sessions are sufficient in most organizations, especially for those receiving curative intent chemotherapy (Davidoff et al. 2013). The patients who meet the set criteria end up receiving supportive care post induction chemotherapy, as well as different cycles as other outpatients. Outpatient management can be made safe and the transition to inpatient more efficient, which is considered a challenge for most healthcare organizations. The problem at hand in this section has been adequately analyzed, which involves the transition of patients receiving chemotherapy from outpatient to inpatient in healthcare facilities. 1.2. Why is it important enough to warrant a change? Outpatient care especially for most patient has become a familiar concept that is driven by increased healthcare costs and more so, the increased demand for existing inpatient resources in different organizations (Joana et al. 1987). Improved supportive care in inpatient is also another reason for the need to embrace the transition, and patient wishes to spend the least amount of time, especially in waiting for service delivery in the outpatient setting. With these concepts in mind, it is important enough to warrant a change. Patient satisfaction ought not to be ignored in different healthcare organizations. There is a need to, therefore, be on the forefront in enhancing adequate care, and embracing inpatient plans for the chronically ill patients. 1.2.1. Scholarly Reference #1 Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C., (1987). Case Mix and Changes in inpatient and outpatient chemotherapy. PubMed 8(4): 65-71. In most healthcare settings, the therapy provided in outpatient has been associated with substantial tumors, chemotherapy involving high doses, and then followed by autologous stem cell transplantation. Outpatient administration of consolidation cycles has been reported, which emphasizes the major problem in this scholarly soured. According to the authors, the transition to inpatient to outpatient care should be considered and priority to solve the efficiency problems at hand. 1.2.2. Scholarly Reference #2 Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan. This source deals with theory and practice of change management. Change management is an adequate practice in the healthcare setting. There is a need for all healthcare organizations to be at the forefront to ensure that healthcare, both inpatient and outpatient are realized. The source provides and explains outpatient inefficiency for chronic patients as the worst problem in the medical profession. Th ...

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comment1 Since the inception of CNL’s, documentation shows patients have shorter hospital stays, reduced readmission rates, and improved quality of care. Infection rates and falls decreased. Patient satisfaction increased, and nurse turnover rate decreased (HealthLeaders, 2009). Clinical Nurse Leaders had such a positive impact on patient care by applying evidence-based practices. This includes but is not limited to planning, implementing and evaluating patient care. Working across the different disciplinaries, coordinating, delegating and supervising patient care has benefitted patients and hospitals alike (Vadurro, 2018). This leadership position works directly with the patients, so it is important the CNL enjoys direct patient care, as well as mentoring fellow nurses. The CNL should have qualities such as strong problem-solving skills and critical thinking (RegisteredNursing.org, 2018). Formal education requires the RN to BSN, passing the N-Clex, and continuing to a Master of Science degree. The advanced courses include pathophysiology, clinical assessment and pharmacology. After successful completion of those requirements, an RN is able to obtain the CNL Certification from the Commission on Nurse Certification (RegisteredNursing.org, 2018). comment2 Clinical nurse leader influences the direct patient care in the hospital settings. For example they give patient education including individuals, families and other care givers. They will be part of the ongoing assessment and modification if necessary of the plan of the care. They perform a comprehensive assessment of the client and family/caregiver upon initial contact. A Clinical Nurse Leader acts as a systems analyst or risk anticipator by anticipating patient safety risks, reviewing critical incidents, and evaluating client care delivery options. The CNL is also work with other care providers go for day-to-day information or issues related to the care of the specified patient cohort in the hospital settings. CNLs are also uniquely positioned to plan and coordinate care across entire patient populations or service lines, working with the multidisciplinary healthcare team across the care continuum, and helping organizations reduce length of stay and prevent readmissions. Clinical Nurse Leaders are also adept at using technologies and information systems to improve healthcare outcomes for their units and patients (Eira I. & Klich, H (n.d.). According to a study in University Hospital in Augusta, GA, piloted a CNL role in an acute care environment and documented significantly improved, patient-centered care through CNL assessment and advocacy. These CNLs communicated carefully with patients to determine their needs other than those specific to the current medical diagnosis. In each case the CNL’s ability to assess the patient’s unique needs and advocate with the healthcare team led to significant realignment of the treatment plan with the patient’s needs and preferences (Reid, & Denniso ...

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