The bedside, interprofessionally

IPE_Brashers
Dr. Tina Brashers works with nursing and med students during an interprofessional training exercise.
photo by Coe Sweet

Team-based health care, formerly the province of nursing and medical schools, is making its way to the bedside at the U.Va. Medical Center – and it’s making a difference for patients.

Interprofessional education – a formal way that team-based care is taught to nurses- and physicians-to-be – once was the sole domain of students in the classroom.

Now, thanks to the work of a core group of University of Virginia faculty and clinicians as well as U.Va.’s Center for ASPIRE, team-based health care training is making its way to the hospital unit and patient bedside.

The logic behind U.Va.’s interprofessional focus, said Dr. Tina Brashers, is this: Clinicians adept at working as part of health care teams cause fewer medical errors. Hospitals where collaborative practice is the norm experience fewer errors and adverse events. Health care professionals who work as part of highly functional care teams are less stressed, more compassionate, more resilient caregivers. And patients treated by those with a strong ability to collaborate receive safer, more empathic, higher-quality care.

In 21st-century medicine and nursing, it’s not enough to be an expert clinician, said Brashers, a professor of nursing, attending physician in internal medicine and founder of the Center for ASPIRE, or Academic Strategic Partnership for Interprofessional Research and Education. One must also be an exceptional team player. That’s what interprofessional education is all about.

“Time was when interprofessional education was a concept that no one fully understood,” she said. “But today, we know that we’re onto something because so many medical and nursing schools have followed U.Va.’s lead in the area.”

Several new efforts in the Medical Center reveal its burgeoning interprofessional emphasis, including:

·     The new Pediatric Intensive Care Unit “Room of Errors.” This hospital room offers students, clinicians, residents and staff the chance to hone their ability to identify potential safety hazards. Participants are given a fictitious patient case, and then try their hand at identifying a variety of physical and medical hazards – everything from too-high bed rails and inappropriately sounding alarms to medication mismatches problems – first independently and then as a team. Creators Dr. Julie Haizlip and Sandy Neumayr, a PICU nurse manager, said they believe interprofessional teams will be more likely to identify multiple errors than individuals. And that, Haizlip said, means that boosting hospital staff’s interprofessional skills will likely lead to fewer errors overall (nationwide, there are between 1.8 and 2.9 errors per 100 pediatric patients). 

·     A new interprofessional process for screening geriatric pre-operative patients. Twenty nursing and 20 medical students will watch a video of a collaborative R.N.-M.D.-geriatrician assessment with a patient, then engage in interprofessional education training that focuses on communication, shared problem-solving, decision-making and conflict resolution. The 40 students then conduct mock assessments with simulated geriatric patients (actors), both on their own and then with nurse and physician pairs, before working with actual patients under the guidance of seasoned clinic staff. The goal, explained project leader Beth Turrentine, a U.Va. surgical nurse, is to develop the independent and interprofessional collaborative assessment skills of students working with geriatric pre-operative patients as well as to streamline the Medical Center’s approach in dealing with older, vulnerable patients.

·     A third ASPIRE-funded initiative involving the Health System’s Department of Medicine, acute care units and Medical Intensive Care Unit aims to measure the differences between resident physicians who’ve had training in interprofessional education collaboration and communication and those who have not by examining their work in recognizing and managing patients in certain critical care events. Nurse and physician participants will score and discuss their abilities to collaborate with their colleagues to address the needs of a simulated patient. The hypothesis, said MICU nurse Allie Tran, is that those who’ve participated in interprofessional exercises and focused debriefings will demonstrate better collaborative behaviors and better communication than those who have not (Support was also received from the UVA Medical Center and the School of Medicine for this initiative).

“These are very real ways to emphasize and measure the value and effect of interprofessional collaboration,” said Haizlip, ASPIRE’s co-director. “It is a way to really reinforce that we are more powerful, safer, better caregivers when we work together. Collaboration has a definiteimpact on patient safety and quality care. That is already a huge focus here – and one that’s growing as we transition to being an Accountable Care Organization (ACO).”

UVA Health System is one of 123 American hospitals recently certified by the Department of Health and Human Services as an ACO, a designation that will allow clinicians within the network to pool information by bypassing certain privacy laws for Medicare patients. Such coordination of care – which is more patient-centered and cost-effective because it eliminates the need for duplicate procedures and tests – aims to buoy outcomes in particular for chronic illness.

These initiatives are either funded and/or intellectually supported by the Center for ASPIRE, which serves as a central repository for research, methods information and support for interprofessional activities and initiatives. The Center for ASPIRE is directed by Brashers and Haizlip, and co-led by John Owen, EdD, MSC, and project managers Sophie Schorling, MSN, RN, and Linda Hanson.

In addition, a newly formed steering committee – comprised of professionals across the health care spectrum – aims to move beyond classroom scenarios and workshops to forge a direct impact on patient safety and quality in the hospital. A wide variety of nonacademics, including practicing physicians, nurses, pharmacists and therapists, among others, will work collaboratively with faculty, research centers and with students to integrate interprofessional education even further across alllearning levels, measuring their success as they go.

The ASPIRE steering committee is already systematically reviewing ways to weave interprofessional collaboration into everyday practice at the hospital – and well beyond the confines of the classroom. Brashers and her team offer measurement models to assess collaborative competencies and their changes over time, logistical and intellectual support and provide a framework for clinicians and others to bring interprofessional ethos to their units.

“There is not one of us who can’t use some skill-sharpening in the area of teamwork,” said Brashers, among the core leaders of the initiative to practice interdisciplinary collaboration in medicine and nursing. “Our efforts are moving beyond the classroom to engage practicing clinicians as well, and our ability to test how we’re doing through novel protocols we’ve developed will indicate whether we’re on the right road to success – or if our methods need tweaking.”

U.Va.’s interprofessional education efforts began in 2009, and culminated in the establishment of the Center for ASPIRE in early 2013. More than 25 interprofessional learning opportunities are now available for nursing and medical students, while a wide variety of research on their effects, measurability and long-term efficacy is also being studied.

By engaging a wider variety of clinicians in the effort, Brashers said, “our ability to work together, and work well, will have a very powerful, very meaningful impact on patient quality and care. And that’s really why we’re all here.”

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