One Saturday as patient A was at the hospital for her non stress test she was found to have elevated blood pressure and proteinuria. Dr. A, an obstetrician (OB), who was on call for the weekend decided to send the patient home on bed rest and to follow up with her primary OB physician, Dr. B on Monday. At her follow up appointment with her primary OB, she was found to still have elevated blood pressures, blood sugars in 200's, 2+ protein in her urine and had some elevated blood work. Primary OB decided Patient A needed to be induced due to patient A’s unstable condition.
Primary OB is not on call this particular Monday and asked Dr. C to induce her patient. Dr. C was not happy about inducing her because of her high risk status but agreed to do so. Dr. D, a laborist and pediatrician, wanted the patient transferred to a higher level of care facility because he felt due to patient A’s history best care for the newborn would be at another facility. Dr. D and Dr. C argued about patient A’s care and disposition at the nurses’ station which was in close proximity to patient A’s room. The nurses who were without a manager at the time were unable to control the altercation between Dr.
C and Dr. D. Patient A who overheard the discussion eventually asked to be transfer to another hospital to seek care elsewhere. This paper highlights the importance of effective interprofessional collaboration that is missing in this case. As well, potential plans of action and potential outcomes are discussed. Plan to Address Conflict The major conflict in this situation was a lack of communication between providers regarding the best plan of care of the patient. In addition to the obstetrician, members of the interprofessional team should include the pediatrician, a nurse leader, and the patient.
Legare et al (2011) describes a stepwise approach to interprofessional collaboration and the shared decision-making process. The members of the interprofessional team must start by exchanging information and options available related to the care of the patient. Next, the values of both the patient and the healthcare providers should be clarified and addressed. The feasibility of each option should be weighed. Often, certain options are not feasible based on resources or time. In this case, the skills and comfort of the healthcare team members needed to be considered.
Once a decision is made, the information needs to be disseminated, including the plan of care and rationales for the decision made. SBAR (Situation, Background, Assessment, and Recommendation) is a useful tool in succinct and structured communication. (Boaro, Fancott, Baken, Velji, & Andreoli, 2010) To prevent future situations similar to this one, Standard Operating Procedures, or SOPs, should be developed and followed. These SOPs should address staff competency, scope of practice, role clarification, and the resources and limitations of the facility.
The interprofessional team should develop these SOPs together to ensure they reflect the values of the involved disciplines. (Gardner, 2010) Additionally, resources are available to aid hospitals in developing a structure for interprofessional collaboration. A national interprofessional competency framework detailed by the Canadian Interprofessional Health Collaborative (CIHC) provides an integrative approach to describe competencies required for the interprofessional collaboration to be effective.
They are as follows:
patient/family centered care role clarification
Interprofessional conflict resolution. (CIHC, 2010) CIHC suggests that having a competency framework because it helps the team make sense of the learning practice, it will differentiate matters by relevance, give the team members a chance to apply the learning to practical situations and then associate the learning elements by integrating them. CIHC, 2010) When this patient arrived to the unit, if the team had used the six suggested competencies providing best care for this mom and baby could have been achieved easier. Discussion of Outcomes The intent of interprofessional collaboration is one that will foster the safe practice of all health care professionals, and enables the achievement of better outcomes. Some outcomes needed for this particular situation would be as followed:
Shared decision making between all providers involved. What is the best practice that can be provided for a safe outcome for mom and baby? Inducing the mom because it was best practice was made by the OB, but she didn't factor in safe practice for the pediatric doctor in this situation.
Demonstrate professional conduct during inter professional collaboration. Make sure if there are any discussions with team members, disagreements with the care that is being provided that it is not done where the patient can hear it.
That the interprofessional team can acknowledge the various skill levels of everyone involved.
The pediatric hospitalist is this situation felt that the patient’s diagnosis of Type 1 diabetes, uncontrolled throughout the pregnancy put the baby at risk for having glucose controlled problems and felt that a higher level of care was needed because it was beyond his skills set. Interprofessional collaboration was necessary in this situation. No one discipline has all of the knowledge needed to provided complete patient-centered care. True interdisciplinary patient-centered care includes a partnership between health care professionals as well as the patient.
This collaborative and coordinated approach improves patient outcomes and quality of care (Orchard, Curran, & Kabene, 2005). In this case, the interprofessional team failed to communicate effectively. This lack of communication and professional conduct led to a failure to recognize the skill levels of the team members, and prevented the team from making a shared decision that would benefit the patient. Conclusion In order for patient A to achieve a positive outcome several factors related to interprofessional collaboration needed to be addressed in this case.
First, to improve collaboration and understanding, clear team roles of the health care providers should be defined. Scopes of practice as defined by standard operation procedures and discussions of available resources should be taken into account. In addition, distribution a consistent communication tool such as SBAR could be used. Had the healthcare providers involved with this case practiced as a team, positive outcomes such as: open communication, trust, professionalism and improved patient outcomes and experiences would have been achieved.
Boaro, N., Fancott, C., Baker, R., Velji, K., & Andreoli, A. (2010). Using SBAR to improve communication in interprofessional rehabilitation teams. Journal of Interprofessional Care, 24(1), 111-114.
Gardner, D. (2010). Expanding scope of practice: Inter-professional collaboration or conflict? Nursing Economics 28(4), 264-266.
Legare, F., Stacey, D., Pouliot, S., Gauvin, F. P., Desroches, S., Kryworuchko, J., …Graham, I. D. (2011). Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model. Journal of Interprofessional Care 25, 18-25.
Orchard, C.A., Curran, V., & Kabene, S. (2005). Creating a culture of interdisciplinary collaborative professional practice. Medical Education Online. Retrieved from http://med-ed-online.net/index.php/meo/article/viewArticle/4387. Canadian Interprofessional Health Collaborative. ( 2010). A National Interprofessional Competency Framework. Retrieved from http://www.chic.ca/files/CIHC_IPCompetencies_Feb1210.pdf