Interprofessional Collaboration

Interprofessional Collaboration

Interprofessional communication and collaboration are a significant part of ensuring safe and effective patient outcomes. In the case detailed below the health care team failed to communicate and collaborate care of patient A, ultimately leading to a negative outcome.

Patient A is a female white 38 year old G1P0 with Type I diabetes since the age of 9. Due to her high risk pregnancy and history of non compliance with medical therapy she had been coming in since 28 weeks gestation for twice weekly non stress tests. 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 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+ proteins 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.

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)

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