Nationwide Children’s Hospital inpatient teams are a great example of effective teamwork and communication. During rounds there is a pharmacist, discharge planner, nurses, residents, social work, medical students and attending who all work together to provide the best care for the patient. Having all these people on rounds allows everyone to be up to date on what each member of the team is doing and allows for opportunities to ask each other questions and for assistance. The pharmacist often can advise what drugs to use to prevent adverse events and at what dose. The social worker can provide insight as to what are some barriers the family has to care that may cause them to return to the hospital. The nurses can provide insight as to what has been going on with the patient and what their needs are. When the team is working together effectively, there is closed loop communication so that everyone knows what has been done and what needs to be done. This open communication can prevent mistakes and misunderstandings by having multiple people know the plan.
An example of when this multidisciplinary approach made an obvious difference was with a family whose newborn was admitted for fevers. The family kept creating new concerns for their infant and delaying his discharge. It was confusing to the team why there were all these new problems arising and why the family would not want to leave, which was discussed on rounds. The social worker understood this pattern of behavior and thought it would be best for her to have a discussion with them. She was able to illicit that they were homeless and had no transportation. She then set them up with a shelter and resources for food and infant supplies. It was really essential to have someone with that expertise to recognize the signs that the family needed help and to ensure that this child was going to be well cared for outside of the hospital.
Although this approach seems to work really effectively within a team, it can become complicated working with other teams. For example, a patient on the infectious disease team had a corneal ulcer that was being treated medically. The ophthalmology team visited the patient in the morning and decided the patient would need a corneal transplant, then proceeded to schedule him for surgery that day. The ophthalmology team did not communicate with the ID team that they changed his care plan. They called the family to let them know he would be having surgery, but did not explain what it was or why the care plan changed. The only way the team found out was through the medical record, where surgery was scheduled for that morning. This lack of communication led to a lot of confusion for the primary team and led to them having to scramble to make arrangements for post-operative care. The family was left worrying because they did not know what the surgery was or why it was being done.
For the most part, coordinating care between different services provides patients with the best care possible. The most important factors in allowing this system to work is having mutual respect for each other and open communication. My goal for intern year is to give the nurses daily updates on their patients either during rounds or call them right after rounds. After six months, I will assess how often I have been including the nurses and I will seek feedback from the nurses on how well I have been communicating with them.