Working with Working with multidisciplinary teamsmultidisciplinary teams

Josanne K. Pagel MPAS, PA-C, Josanne K. Pagel MPAS, PA-C, Karuna RMTKaruna RMT®®

ObjectivesObjectives

Identify the different healthcare individuals Identify the different healthcare individuals involved with patient careinvolved with patient care

Discuss how a PA interacts with each Discuss how a PA interacts with each healthcare workerhealthcare worker

Discuss challenges, opportunities, with Discuss challenges, opportunities, with working with multidisciplinary teamsworking with multidisciplinary teams

The Ripple effectThe Ripple effect

Everything we say, touch and do, has an effect on everyone around Everything we say, touch and do, has an effect on everyone around us.us.

Drop a pebble in the water, and the ripples will spread out for what Drop a pebble in the water, and the ripples will spread out for what seems like an eternity. Yet, the ripples may have other effects. It seems like an eternity. Yet, the ripples may have other effects. It may frighten a duck, causing it to fly away, or bounce off a rock, may frighten a duck, causing it to fly away, or bounce off a rock, scaring a school of fish. The simple act of casting a pebble into the scaring a school of fish. The simple act of casting a pebble into the pond causes changes to all around.pond causes changes to all around.

What you do today, may affect many tomorrowWhat you do today, may affect many tomorrow..

Who’s part of the health care team?Who’s part of the health care team?

PhysiciansPhysicians NursesNurses FellowsFellows ResidentsResidents PAsPAs Unit assistantsUnit assistants PTPT OTOT Case ManagersCase Managers Pastoral carePastoral care LabLab EVSEVS DietaryDietary Who else?Who else?

What role do they all play?What role do they all play? Physician: Team leaderPhysician: Team leader Nurses: Nurses: PAs:PAs: Fellows and Residents:Fellows and Residents: Unit Assistants:Unit Assistants: PT & OT:PT & OT: Case Managers:Case Managers: Pastoral care:Pastoral care: Lab:Lab: EVS:EVS: Dietary:Dietary: Who else?Who else?

InitiativesInitiatives HCAHPS: HCAHPS: Hospital Consumer Assessment of

Healthcare Providers and Systems) ; (pt ; (pt satisfaction; medication communication, satisfaction; medication communication, infections, etc)infections, etc)

Joint Commission; standards of care; pt Joint Commission; standards of care; pt involvement, educationinvolvement, education

CMS; one complaint will bring them to youCMS; one complaint will bring them to you Press Ganey; patient satisfaction with carePress Ganey; patient satisfaction with care Gallop; employee engagementGallop; employee engagement Other regulating/monitoring bodiesOther regulating/monitoring bodies All initiatives are geared towards outcomesAll initiatives are geared towards outcomes

LOS initiativeLOS initiative

You are tasked with decreasing the length You are tasked with decreasing the length of stay of your patientsof stay of your patients

You are tasked with making sure all You are tasked with making sure all discharges are written by 10am on DODdischarges are written by 10am on DOD

You are tasked with decreasing You are tasked with decreasing opportunity daysopportunity days

You are tasked with making sure your You are tasked with making sure your patients are not re-admitted to the hospitalpatients are not re-admitted to the hospital

How It Started – Mid Level Provider Initiative

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LOS Team Initiates Mid-Level Provider Initiative

Mid-Level Directors Choose

CORS as Beta Site

CORS Team Created to

Spearhead the trial

CORS Admin Supports the CORS Team

Med Ops and PSI Support the CORS

Team

Other Services involved as

needed

Case Example:Case Example: Arrives to office @ 6:45amArrives to office @ 6:45am Reviews inpatient records, nursing notes, night fellow notes, emailsReviews inpatient records, nursing notes, night fellow notes, emails Rounds autonomously on all her patientsRounds autonomously on all her patients Meets with Fellow, short discussions Meets with Fellow, short discussions Staff arrives on floorStaff arrives on floor Fellow, PA and Staff roundFellow, PA and Staff round 10:45am to 11:45am: Residents huddle; staff, fellow and PA10:45am to 11:45am: Residents huddle; staff, fellow and PA Quick lunchQuick lunch Meet with fellow; discuss patient managementMeet with fellow; discuss patient management Afternoon is completing discharges, patient orders, managementAfternoon is completing discharges, patient orders, management Sign out to night FellowSign out to night Fellow 4:30: office: finish emails, documents4:30: office: finish emails, documents 5pm: Residents presentations (DDI)5pm: Residents presentations (DDI)

What’s missing, if anything???What’s missing, if anything???

Better communication:Better communication: Arrives to office @ 6:45amArrives to office @ 6:45am Reviews inpatient records, nursing notes, night fellow notes, emailsReviews inpatient records, nursing notes, night fellow notes, emails Gets hand off from night FellowGets hand off from night Fellow Rounds autonomously on all her patientsRounds autonomously on all her patients Meets with Meets with dayday Fellow, short discussionsFellow, short discussions Meets with NM, ANM for report on nursing support, update on pts.Meets with NM, ANM for report on nursing support, update on pts. Meets with case management for Discharge planningMeets with case management for Discharge planning Staff arrives on floorStaff arrives on floor Fellow, PA and Staff roundFellow, PA and Staff round 10:45am to 11:45am: Residents huddle; staff, fellow and PA10:45am to 11:45am: Residents huddle; staff, fellow and PA Quick lunchQuick lunch Meet with fellow; discuss patient managementMeet with fellow; discuss patient management Huddle with nursing for update on any changes.Huddle with nursing for update on any changes. Huddle with case managementHuddle with case management Afternoon is completing discharges, patient orders, managementAfternoon is completing discharges, patient orders, management Sign out to night FellowSign out to night Fellow 4:30: office: finish emails, documents4:30: office: finish emails, documents 5pm: Residents presentations (DDI)5pm: Residents presentations (DDI)

CORS - Mid-Level Provider Model - Information Flow

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7:00 Report to PA

7:30 a.m. Report to Nurse Manager

Morning Report to Case Manager –

by 8:30 a.m.

Directions for Patient Care – by

8:00 a.m.

Makes arrangements for

post discharge care

Provides daily care based on

instructions

Morning Report Secretary – by

8:30 a.m.

Enters orders for consults, services,

etc.

Office setting is no differentOffice setting is no different

Who’s involved?:Who’s involved?: PhysicianPhysician NursesNurses Office managerOffice manager PAsPAs Coders and billersCoders and billers Outside office personnelOutside office personnel Hospital personnel (for referrals)Hospital personnel (for referrals)

SummarySummary

What is the value of the multidisciplinary What is the value of the multidisciplinary team?team?

Who’s in-charge of the team?Who’s in-charge of the team? What personal characteristics should you What personal characteristics should you

possess to assure success with working possess to assure success with working with multidisciplinary teams?with multidisciplinary teams?

Questions?Questions?