Background: Research using the inpatient setting for interprofessional education (IPE) is sparse. At Duke Regional Hospital, the interprofessional team caring for general medicine teaching service patients includes residents, interns, medical students, physician assistant (PA) students, pharmacy students and residents, pharmacists, nurses, case managers and attending physicians.
Purpose: To determine the educational and operational measures needed to create a high yield inpatient IPE experience, improve patient progression, satisfaction and safety, and improve attitudes toward interprofessional collaboration (IPC).
Description: General medicine teaching teams’ patients were preferentially placed on the IPE unit by enhancing coordination between operational staff and the patient care team. Percent of teaching patients on the unit was tracked daily. Scripted interprofessional rounds (IPR) occurred weekdays with the interprofessional team. A standardized audit tool adapted from the ICU literature for IPR rounds assessed content and quality of interprofessional communication. Focus groups with nurses, interns, residents, and medical, pharmacy and, PA students examined the impact of the IPE unit and IPR. A new conference series presented by a variety of health professionals served as didactic teaching about IPC skills and learners evaluated it using short post conference evaluations. Attitudes toward IPE were measured using the Interprofessional Attitudes Scale (IPAS), a validated survey tool. Existing hospital metrics measured patient progression, patient safety and satisfaction.
Preferential placement of teaching service patients and IPR started September 1, 2016. Percent of teaching service patients on the unit ranged between 25-70%. 61 of 141 invitees completed the IPAS including nurses, interns, medicine residents, and PA, medical and pharmacy students. 58.5% had participated in IPR prior to this experience but most had not participated in an IPE initiative(53.8%) or had training in IPC(63.1%). On the initial IPAS most respondents reported positive attitudes towards IPE. Post experience IPAS surveys are in progress. Focus groups revealed a number of themes including: effective communication, collaboration with other health professions, team building, experiential learning, efficiency and feedback. Interprofessional conference attendees series rated the content and speakers highly. Data collection on patient safety, satisfaction and patient progression is ongoing.
Conclusions: We successfully created an IPE unit which we used as the basis for additional IPE innovations. Challenges included competing operational priorities for patient flow, unit staffing and the logistics of managing the disparate schedules of the interprofessional team. Despite this, all stakeholder groups considered IPR a valuable addition to the patient care. Future directions include faculty development on evaluating IPC skills, IPR QI initiatives, inclusion of additional health professions, and further study on direct patient impacts.