The Webinar will begin at

12:00 p.m. CST

Workforce Redesign for InterprofessionalEducation and Collaborative Practice:

Using Simulation to Create Interprofessional Team across health care

settings

Monday, November 21

Moderator & Presenter

Sara Shrader, PharmD, FCCP, BCPS, CDEClinical Associate Professor,

University of Kansas School Of Pharmacy

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Presenters

Erika Erlandson MDAssistant Professor,

Physical Medicine and Rehabilitation,University of Kentucky

Director,Interprofessional Education,

College of Medicine,University of Kentucky

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Disclosure

The National Center for Interprofessional Practice and Education has a conflict of interest policy that requires disclosure of financial interests or affiliations with organizations with a direct substantial interest in the subject matter of their program.

Erika Erlandson, MD

Does not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this interprofessional continuing education activity, or any affiliation with an organization whose philosophy could potentially bias her presentation.

Workforce Redesign for Interprofessional Education and Collaborative Practice:

Using Simulation to Create Interprofessional Team across health care

settings

Erika Erlandson, MDJulia Blackburn,MSN RN

Lynne Jensen, PhD, APRN-BCJimmi Hatton-Kolpek, Pharm D

Objectives

• Describe the background and landscape of the state of Kentucky and Stroke

• Review the gaps in the current transition of care process

• Summarize the simulation experience

• Assess the effectiveness of simulation on collaboration

Background

• Stroke population in the state of Kentucky presents a unique cohort where the continuum of care coordination is essential to optimize outcomes

• 200 transitions of care for stroke patients in 2014 from acute care to acute rehabilitation

Background• Kentucky remains 10th nationwide for

mortality related to stroke1

• Stroke health outcomes are affected by efficient and effective care across the continuum 2

• Poor transitions of care ultimately influence the cost of healthcare, patient satisfaction, and health outcomes3

Phases of KCATS

Phase I: Baseline Transition of Care Process

Phase II: Simulation and Tool Development

Phase III: Implementation and Evaluation of KCATs tool

Phase I• Population: Chart review of 40 patients

transitioning from acute care to acute rehabilitation

• Reviewed data exchanged in current handoff process

• Comparison: Discharge summary from acute care and admission documentation to acute rehabilitation for accuracy, completeness, and congruence of data

• Outcomes: Contributing factors related to common complications post stroke

• Unable to run any statistical testing due to the large amount of missing information

Overall Risk of Complication

Aspiration PneumoniaRisk of Aspiration Pneumonia: Contributors include Modified Barium Results which did not cross the transition 80% of the time. The solid and liquid diet component was present 50% but revealed 17.5% non-congruence of information during transfer

Urinary Tract Infection

Risk of UTI: Contributors include bladder continence, bowel continence where more than 50% of the information did not make it across the transition. 100% of the information regarding toileting status was absent from the transfer.

Fall Risk

Summative Fall Risk: Transfer Status + Comprehension + Expression: 84% was lost in the transition of care

Phase I: Conclusions

• This chart review highlights the need for process improvement

• Creating an interprofessional care transition handoff tool may improve communication, effectiveness, and lower risk factors affecting health outcomes following stroke

Phases of KCATS

Phase I: Baseline Transition of Care Process

Phase II: Simulation and Tool Development

Phase III: Implementation and Evaluation of KCATs tool

Simulation

Simulation of CURRENT acute care to rehab transition

Focus group with interprofessional teams

KCATs tool development

Beta testing of KCATs tool

ICAR assessment

Refinement and Implementation

Simulation

• Prospective, non-randomized before and after investigation

• Interprofessional teams from different care facilities

• Participation in simulation re: transition of care for patient with stroke

• Develop a collaborative handoff tool • Identified interprofessional members

of the stroke care team in acute care and acute rehab

Simulation Participants

• Physical Therapy• Occupational Therapy • Speech and Language Pathology • Nursing• Pharmacy • Psychology • Dietary • Medicine• Case management• Social work

Methods

• The interprofessional teams simulated the current handoff process (Nursing phone call + Medical Documentation)

• Following, they implemented a model of enhanced communication, problem solving, and planning of care with the team to improve the handoff of patients with stroke by developing an interprofessional transition of care tool model.

Outcome Measures

• Pre and post simulation modified Interprofessional Collaborator Assessment Rubric1

• Pre and post simulation evaluation of beliefs on professions who should be part of the interprofessional team and evaluation of simulation as a learning tool.

1Curran, V., Hollett, A., Casimiro, L., McCarthy, P., Banfield, V., Hall, P., & Lackie, K. (2011). Development and validation of the interprofessional collaborator rubric. Journal of Interprofessional Care, 25, 339-344.

Simulation Results-Comments

0

6

9

0

0 1 2 3 4 5 6 7 8 9 10

Very Satisfied

Satisfied

Unsatisfied

Very Unsatisfied

How Satisfied are You with the Current Transition of Care Process?

3

12

Do You Think the Current Transition of Care Process for Patients with Stroke is Comprehensive?

Yes No

Modified ICAR

1

1.5

2

2.5

3

3.5

4

PRE SIM POST SIM 1 POST SIM 2

Share evidence-based or best practice discipline-specific knowlege with others?

Share best practice with others

*

**p<0.05

Next Steps

• The tool will be further modified using a Delphi method.

• The final version will then be piloted in the transition of care process and triple aim outcomes will be assessed for the stroke population

• Placed into the electronic medical record and integrated into workflow

References

1. Kentucky Heart Disease & Stroke Prevention. State Action Plan 2011-2016. http://chfs.ky.gov/NR/rdonlyres/90E41C2D-45EF-47EB-ABFD-60FBE326F59D/0/KYStatePlan_LowResFinalv6.pdf

2. Cameron, J.I., Tsoi, C., Marsella, A. (2008). Optimizing Stroke Systems of Care by Enhancing Transitions Across Care Environments. Stroke 2008;39;2637-2643; originally published online Jul 17, 2008; DOI: 10.1161/STROKEAHA.107.501064

3. Naylor, M., Keating, S. A. (2008). Transitional Care: Moving patients from one care setting to another. Am J Nurs. 2008 September ; 108 (9 Suppl): 58–63. doi:10.1097/01.NAJ.0000336420.34946.3

4. Curran, V., Hollett, A., Casimiro, L., McCarthy, P., Banfield, V., Hall, P., & Lackie, K. (2011). Development and validation of the interprofessional collaborator rubric. Journal of Interprofessional Care, 25, 339-344.

Questions?

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