Interdisciplinary Collaboration in the ER

¶ … Interdisciplinary Teams and the Importance of Collaboration By those who know, collaboration in the medical field is generally considered to be the future of medicine. It's important to acknowledge that in medicine today, there are still large gaps of knowledge in the ways that clinical practice is applied: this is why successful collaboration within interdisciplinary teams is so crucial and so fundamental for successful patient outcomes as it offers a means of closing the gap, and of insuring that patient outcomes are as high-quality as possible.

"Healthcare has very disparate collaborative experiences. As individual providers, nurses, PAs, physicians, physician consultants and pharmacists all work closely together to treat a hospitalized patient. However, on the other hand, physicians are trained to be independent in thought and care and do not think of themselves as depending on others. In residency, asking for help is often viewed as a weakness" (Campbell, 2013).

This is often a result of the fact that in healthcare the culture is one which prizes self-reliance over collaboration, a priority which views things such as "this is my decision, my patient, my practice, my call to make." While leadership is important and crucial in order to have quality patient outcomes, a team approach to care can often be the most successful in allowing health care delivery to shine at its brightest. The importance of the team approach revolves around an interdisciplinary method to health care.

An interdisciplinary method to healthcare means that there's a strong focus on the different ranges of expertise of various professionals and their ability to deliver healthcare to patients. An interdisciplinary approach is the way forward as it relies on the strengths of a range of professionals, allowing the weaknesses or lack of knowledge of one professional to be made up for by the expertise of another professional.

Collaboration in the ER In many hospitals, the shared interests and joint responsibilities in the ER are crucial, but the reality is that there often isn't nearly enough collaboration between ER physicians and hospitalists, beyond brief encounters which discuss specific patients (Pollack, 2012): "These specialists do not routinely work together globally, missing opportunities to examine evidence, develop protocols for hospital admission, design referral programs for outpatient services that may allow avoidance of admission, conduct quality reviews of co-managed patients, and assess ways to enhance communication on throughput, patient handoffs, medication reconciliation, and feedback regarding a patient's subsequent course" (Pollack, 2012).

As a result of the growing importance of shared patient care among emergency physicians and hospitalists, there is an aggravated need to improve interdisciplinary teamwork in these two arenas, one which is long overdue (Pollack, 2012). One analogy which demonstrates this necessity is when tumor boards gather medical oncologists, surgical oncologists, pathologists, and radiation oncologists so that they are able to assess the best course of treatment for patients that can be co-managed effectively and with teamwork and shared responsibilities and a communal vision.

Cancer wings of hospitals are often shining examples of the benefits and importance of interdisciplinary teamwork, as they depend on a mix of skills and specialties in order to aggressively fight the spread of cancer. One arena in the emergency department that absolutely needs to be improved is the realm of improved decision-making. With better decision-making among the different departments, there is a greater consensus and use of expertise and knowledge.

Better decision-making occurs when all members are able to use their expertise to come to the best verdict in terms of patient care. One of the most key and most fundamental decisions that can occur in the emergency department is the decision on whether or not to hospitalize someone, and this is a decision that needs to be made in an inter-disciplinary fashion. Whether or not to hospitalize someone is one of the most expensive medical decisions that are ever made in the overall context of the emergency department.

This decision needs to be critically evaluated so that cost can be reduced. Hospitalists are absolutely fundamental when it comes to achieving this goal, along with pinpointing alternatives to admission (Pollack, 2012). "Hospitalists are often knowledgeable about outpatient care strategies not typically utilized by emergency physicians, such as peripherally inserted central catheter (PICC) lines, outpatient parenteral antibiotic therapy, and transfers to skilled nursing facilities and hospice settings.

Interdisciplinary expertise on the management of patients in clinical decision units allows a short-term ED care plan to help further determine need for hospital care. Avoidance of unnecessary admissions will be increasingly important as the CMS and other payers continue to focus on both 1-day admissions and 'inappropriate' admissions (Pollack, 2012). Interdisciplinary teams thrive in real emergency departments when people generally know their limits and understand that they need to defer to other people with more expertise within a team setting.

At some hospitals which have effective emergency rooms, like Mark Twain Joseph's hospital, they view collaboration as a way of life. Often this occurs from just knowing one's limits: if patients need a higher level of care, it's time to call in the specialists and defer to hospital professionals that have more specific expertise. "In June of 2011, MTSJ began a partnership with EmCare, a firm that provides physician services to hospitals throughout the United States. Through EmCare, Mark Twain St.

Joseph's has added physician's assistants to their emergency room staff; these physician's assistants are tasked with treating non-acute injuries and illnesses" (Mazzarreo, 2011). Even just having physician's assistants around allow a higher level of service to be provided to patients so that results are delivered in a more timely fashion. Strategy to Enhance Collaboration within Interdisciplinary Teams Interdisciplinary teams won't necessarily work together in effortless, flawless manners right off the bat. Sometimes there need to be structures in place to help empower them.

One means of enhancing collaboration between teams or between experts from different fields in the health care profession is simply by exposing them to one another, and allowing them time to just get comfortable. "Creating opportunities for different groups to just get together is a highly effective strategy for enhancing collaboration and communication. These group interactions can be either formal or informal.

Encouraging open dialogue, collaborative rounds, implementing preop and postop team briefings, and creating interdisciplinary committees or task forces that discuss problem areas frequently provides an upfront solution that reduces the likelihood of disruptive events" (O'Daniel & Rosenstein, 2013). This allows all these different professionals to get used to communicating with one another in situations that aren't high-stress or extremely fast-paced or serious. It also allows them to work at establishing some sort of rapport before they do begin to do the serious work of professional healthcare.

It also allows them to engage in some trouble-shooting before the real work begins. Interdisciplinary teams can develop codes for when someone needs a time-out or for when some of the team members need to step out and have a talk. It's so important to have strategies in place so that interdisciplinary teams are able to thrive and to work with one another harmoniously, because such teams have been found to benefit the healthcare industry in the most lasting and tremendous way. One study found that "compared with.