Why does interprofessional collaboration matter The Triple Aim in Healthcare 3/7


Welcome to Segment 3, Why does Interprofessional
Healthcare Collaboration Matter? The Triple Aim in Healthcare. In this segment we’ll
discuss the the importance of interprofessional collaboration in
providing high quality, safe care. We’ll introduce the Triple Aim
in Healthcare and the role of interprofessional collaboration in
reaching the goals of the Triple Aim. And finally we’ll hear from an expert in
quality improvement and patient safety. Sheri VanOsdol, an assistant professor
in the school of pharmacy at UCSF. Let’s start with a patient case. This is Sylvia Johnson and
she’s a 35-year old woman who presented to the emergency department, due to
an exacerbation of her chronic asthma. She informed the physician taking care of
her in the emergency department that she was pregnant and this was confirmed
by urine pregnancy test that was documented in
the electronic medical record. She was admitted with
a diagnosis of pneumonia. During the handoff from the emergency
department to the floor, the patient’s pregnancy status was not mentioned by
either the nurse or the physician. And Levofloxacin, a drug that’s preferably
avoided in pregnancy, was ordered and administered to Sylvia. The lab result did not interact
with the drug database and the electronic medical records. So the pharmacist was unaware
of the patient’s pregnancy. Fortunately, there were no bad outcomes in
this case, but as you can see from this real case, there were communication errors
between providers at the time of a patient hand off, and a system’s issue that
resulted in a safety issue for a patient. In 2000, the Institute of Medicine
published To Err is Human, the first major public health report that
indicated that the US healthcare system, wasn’t as safe as was previously believed. In this report they estimated
that between, 44 and 98,000 American deaths where attributable
each year to medical errors. This is roughly equivalent, to three
747 jet planes crashing every two days. Failures of communication were identified
as a very common cause of medical errors. On the heels of to Err is Human, the Institute of Medicine published
Crossing the Quality Chasm. A new healthcare system for
the 21st century. This report presented,
several challenges for healthcare. With the goal of making care safe,
effective, patient-centered, timely, efficient and equitable. Really for these goals to be achievable,
the current system requires redesign. One of the main challenges identified for
the redesign of healthcare, was to develop highly functioning,
patient centered teams. And in conjunction with this challenge, to
think about better ways to prepare future health care professionals to work on
patient-centered, interprofessional teams. Following the Institute of Medicine
reports, there’s been a shift in thinking, regarding medical errors and
patient safety. National best practices recognize
that errors are usually the result of systems problems, rather than
low-performing individual providers. And there’s been a shift to focus on
educating and developing interprofessional teams, to improve the overall quality and
safety of the care that we provide. High-functioning teams have been
shown to decrease medical errors and improve patient safety. To enhance the quality of
the healthcare we provide. To lower cost of care, and
to improve patient satisfaction and quality of life [COUGH]. In line with the institute of medicine and
the importance of teamwork in healthcare, the Institute for Healthcare Improvement,
or the IHI, [COUGH]. Has developed three major goals
to help shape the future of healthcare in the United States. These are known as
the Triple Aim in Healthcare. To meet the goals set out by
the Crossing the Quality Chasm, IHI determined that sustainable
positive change would be required, in three different aspects of healthcare. To improve patient experiences of care and
that would include improving the quality of care,
as well as patient satisfaction with care. To focus on improving the health of
populations, not just individual patients. And then finally, to reduce
the per capita cost of healthcare. We know that in the United States, we spend a large portion of our gross
national product on healthcare. Yet what we receive is
not always high quality. Interprofessional communication and collaboration will be essential in order
to be able to achieve these goals. So lets go back to Sylvia’s case. A patient who received a medication that
generally should be avoided in pregnancy, because the admitting doctor and team weren’t aware that
the patient was pregnant. How might this error have been avoided? Well, one way to avoid these types of
errors is to use the structured handoff tool to facilitate communication, at the
time of transfer between the two services. Another way to avoid such an error would
be systems, a systems change, that would link the lab result with the drug
database in the electronic health record. Thus alerting the pharmacist to
the patients pregnancy status. In an upcoming module we’ll discuss
structured communication tools that could have been useful in this case. Now let’s hear from Sherry VanOsdol, who is an Assistant Professor in
the school of pharmacy here at UCSF. So we’ve been talking in this
segment about the importance of interprofessional collaboration, for
patient safety and for quality of care. We’re fortunate to have
an expert on patient safety and quality improvement, Sheri VanOsdol,
from the School of Pharmacy at UCSF. Sherry can you tell me a little
bit about yourself and your role as a pharmacist in quality and
safety at UCSF?>>Absolutely, so as, as you mentioned
Maria, I am a member of the school of pharmacy, and I work in a group
called the Medication Outcome Center. And what we do is we really work closely
with the medical center to evaluate our use of medications to make sure
we’re using them as safely and effectively as possible. And of course to hopefully improve
patient outcomes as we do so.>>Great. Terrific. So what’s the relationship between
a team-based approach to patient care and quality and safety, for patients?>>Well, I think a really large
component about team-based care that we’ve been discussing is
the importance of communication. And so within team-based care, there is
a very strong communication structure. And to improve quality and
patient safety, communication is key. So all members of the team really need
to be able to, discuss care plans, talk to the patients, assess the scenario
so that we’re all on the same page.>>Terrific. And so, why is involving the entire
team in patient safety important? Why is that so critical to safety?>>Well, as I mentioned, communication is key, and so there’s
actually data from the joint commission. Which is an accreditation body for
hospitals in the United States, and what they have is, they look at sentinel
events, which are serious safety events.>>Mm-hm.
>>And over a two year period, they had noticed
that, over 60% of sentinel events. Had the root cause of
communication errors. So, communication is very important. It’s also important as different
members of the team, so different professionals,
we all have different perspectives. So, as a pharmacist,
looking at a potential safety vent, I’ll have a very different perspective
than you would as a physician, or a nurse on the team, or
even a hospital administrator.>>Hm, terrific.>>And, so how do we teach our teams
to communicate more effectively to avoid errors, what are some of
the strategies that you’ve used?>>So some things that are very
important is to really remove barriers to communication. So there are things like
hierarchical structure. That has been very common in the history
of medicine and hospital based care. And so there’s a large move in
the safety literature and really, safety communities across the country,
to say let’s remove this hierarchy and say, everybody on the team
has an equal voice. And so, in the past perhaps in
a stereotypical situation there would be a surgeon or an attending physician. Who really didn’t want the nurse, or say, a student to speak up about some
kind of a concern or issue. However, the way that we’re moving in
the future is to say, everybody has an equal voice and everybody is allowed
to speak up to voice their concerns, so that we make sure that
we don’t miss anything.>>And so what are some of
the trends in patient quality and safety that you see on the horizon for us.>>Well something that I,
I think is going to be happening, and it’s really happening
in a lot of places now, is involving the patient
as a member of the team. And to truly embracing the concept
of patient centered care. And so when a patient or their,
their designee or care provider. Is, involved in all decisions and
discussion about that patient’s care. It’s really informative for the team. It really helps the patient. Or their, their patient’s care provider,
say a parent or designee understand what is going on with their
health and the decision making process. And then they can actually start to
provide some continuity of care, as they move throughout the healthcare
system to really improve communication and understanding of, all the different
healthcare providers who are involved, but are also of that person itself,
the patient itself. Something else that I think is a large
movement that’s really occurred since the Institute of Medicine report in 2000,
is improved transparency. And so, if an error does occur,
as inevitably some kind of a safety at a error will what institutions
are really starting to embrace, is talking about the errors, to make sure
that we learn from those mistakes, and make sure that we don’t make
that same mistake again.>>Thanks so much for talking to me
today it’s been really informative. I think for the students to
kind of hear your perspective.>>Absolutely, thank you.>>Great. So what are the key learning points for
this segment? Communication and systems failures
are common causes of medical errors. Evidence is accumulating that
interprofessional teams positively impact patient outcomes,
including patient safety. Effective interprofessional collaboration
and team-based care are essential to meet the goals of the Triple Aim set out by
the Institute for Healthcare Improvement. And finally quality and safety initiatives
require participation by all members of the team, in order to be effective. Let’s check your understanding. Which of the following is not
a goal of the Triple Aim? To improve the patient experience of care. To re, reform the reimbursement system. To improve the health of populations. Or to reduce the costs of care. That’s right, B is the answer. Reforming a reimbursement system
is not a goal of the Triple Aim.

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