Introduction to Interdisciplinary Team Care

1. Introduction to Interdisciplinary Team Care David Geffen School of Medicine at UCLA Division of Geriatrics

2. Learning Objectives • Define interdisciplinary team (IDT) care • Identify roles of various IDT members • Learn structure of IDT Conference • Understand goals of IDT Conference • Identify ways to run IDT Conference efficiently • Discuss common pitfalls of IDT Conference

3. What is IDT Care? • Coordinated, collaborative, interdependent delivery of care • Focuses on issues best addressed by interdisciplinary teams • Provided by a group of practitioners from various healthcare disciplines sharing common patient population & common patient-care goals • Relies on coordination, communication, and shared responsibility

4. What is IDT Care? Challenges of IDT Conference: • Time commitment • Logistics • Local politics • Staying on track • Different perspectives of different disciplines • Communication styles HOWEVER….

5. What is IDT Care? Potential Benefits of IDT Care: • Improved patient’s rating of health status • Decreased mortality • Decreased functional decline • Decreased hospital length of stay • Potential hospital savings

6. Roles of IDT Members • Attending physician • Oversees patient’s medical care, supervises resident MD • Resident physician • Manages patient’s medical care under supervision of attending MD • Nurses (RN, NP, LVN) • Provide direct care of patient • Other roles vary depending on training and institution

7. Roles of IDT Members • Social worker • Offers psychosocial support & community resources for patient & family, assesses patient’s home situation and financial resources • Discharge planner/Case manager (nurse or social worker) • Assists with finding placement for patients (e.g. SNF rehab) or arranging home health services • Physical / occupational therapists • Assess patient’s function/mobility, makes recommendations regarding appropriate disposition for patients (e.g. SNF vs. home) & adaptive equipment • Speech therapist • Assesses patient’s swallowing ability / speech, recommends appropriate food texture, speech therapy

8. Roles of IDT Members • Dietitian • Assesses & makes recommendations regarding patients’ nutritional needs • Psychologist • Provides psychosocial support • Chaplain / Spiritual counselor • Provides spiritual counseling • Pharmacist • Helps reconcile meds, make recommendations regarding dosing, drug-drug interactions

9. Structure of IDT Conference • Meet regularly • Select moderator • Standardize content to improve communication, work flow & efficiency to meet team’s needs • Mention only pertinent information • Not all IDT members need to present if no new information to add

10. Structure of IDT Conference • Clarify order in which different team members talk/present information • Set time limits for cases and what can be covered • Use a board to organize information

11. Structure of IDT Conference Workflow Presentation

12. Structure of IDT Conference Workflow Presentation (cont’d.) Nurse practitioner facilitates board and ensures plan of care is stated and documented

13. Goals for IDT Conference Examples: • Coordination of care • Planning care for the day, hospital stay • Discharge planning/transitions of care • Problem solving of medical cases • Improve team dynamics • Communication • Emotional support to team members

14. Running an IDT Conference Sample Organization Board

15. Running an IDT Conference IDT conference elements: Core Measures that RNs report at IDT Conference Sample Standardized Form

16. Running an IDT Conference Sample Discharge Checklist 2 days before discharge 1 day before discharge Day of discharge

17. Common Pitfalls of IDT Conference • Absent team member • Team member not ready to present • Distractions or interruptions • Some team members not paying attention • A case that needs more time

18. References & Suggested Readings • Baldwin DC. The role of interdisciplinary education and teamwork in primary care and healthcare reform. Rockville, Maryland: Health Resources and Services Administration, Bureau of Health Professions, 1994. • Bokhour BG. Communication in interdisciplinary team meetings: What are we talking about? Journal of Interprofessional Care. 2006;20:4: 349-363. • Curley C, McEachern JE, Speroff T. A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care. 1998 Aug;36(8 Suppl):AS4-12. • Grant RW, Finocchio LJ, California Primary Care Consortium Subcommittee on Interdisciplinary Collaboration. Interdisciplinary collaborative teams in primary care: a model curriculum and resource guide. San Francisco, California: Pew Health Professions Commission, 1995. • Mudge A, Larcacy S, Richter K, Denaro C. Controlled trials of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care. Internal Med J. 2006 Sep;36(9):558-63. • Schmitt MK, Heinemann GD, Farrell, MP. Discipline differences in attitudes toward interdisciplinary teams, perceptions of the process of teamwork and stress levels in geriatric healthcare teams. In Snyder JR (ed.) Interdisciplinary Healthcare Teams: Proceedings of the 16th Annual Conference. Chicago: School of Allied Health Sciences, Indiana University School of Medicine, Indiana University Medical Center. • Westberg J, Jason J. Collaborative clinical education; the foundation of effective healthcare. New York: Springer-Verlag, 1993. • Zwarenstein M, Goldman J, Reeves S. Interprofessionalcollaboratioon: effects of practice-based interventions on professional practice and healthcare outcomes. Conchrane Database Syst Rev. 2009 Jul 8;(3):CD000072. doi: 10.1002/14651858.CD000072.pub2.

19. Acknowledgements • Donald W. Reynolds Faculty Development to Advanced Geriatric Education • UCLA Academic Geriatric Resource Center (AGRC), David Geffen School of Medicine at UCLA, Division of Geriatrics • Dr. Hong-Phuc Tran for creation of PowerPoint presentation • Drs. David Reuben, Bruce Ferrell, Zaldy Tan, Nancy Weintraub, and Dan Osterweil, Deborah Ballantine, Ming Lee, Christy Ann Lau, and Anne Hu for input on PowerPoint presentation

20. Questions?