Background:
Despite efforts to improve the care of hospitalized patients, adverse events remain common. Care is siloed across disparate providers and patients are not engaged in their own care plans. In a collaborative care model, patients, families and providers partner to integrate high-quality care across disciplines to best meet patients’ needs. While support for delivering inter-professional, patient-centered care is growing, limited research exists examining the impact of delivering a collaborative care model, particularly with regard to learners’ experiences. Our objective was to evaluate the impact of delivering a collaborative care model on rounding patterns and student and resident learning experiences during an inpatient teaching service at a single academic medical center.
Methods:
We implemented a collaborative care model on a single inpatient team. The team included nurses/physicians/(attending, residents)/medical students/pharmacists/social worker/physical therapist. Each discipline’s workflow was adjusted to allow frequent interactions and bedside-rounding. Additionally, the team met daily for a 30 minute reflective session. Rounds were patient-centered and focused on patients’ stories and values surrounding care. Plans were scribed on a communication board and verbally summarized afterwards. A standardized safety checklist was utilized during every patient discussion.
Our mixed-methods approach to assessing the model’s impact included direct observation; provider and patient interviews; and administrative data analysis. Conventional inpatient teams served as comparators.
Results:
We engaged stakeholders to identify key elements for successful collaborative care implementation. Elements included workflow/observation/practice-simulation/geographic localization/daily goals of care/reflection/safety checklists/and patient/family engagement. Once implemented, mean time per patient discussion for traditional vs collaborative rounds was 16:57 vs 17:20 mins. Mean % of time spent with the patient during traditional vs collaborative rounds was 28% vs 99%. Patients/families contributed to discussions 2% of the time in the traditional care model vs 17% in the collaborative model. We interviewed 22 housestaff &16 medical students who worked on the collaborative team and coded interviews to identify themes related to learner’s interprofessional and educational experiences. Respondents generally saw the benefits of the collaborative model, citing improved interprofessional communication and more patient-centered care delivery. Concerns and negative responses were also identified, of which 40% related to perceived workload and “time required” for collaborative rounds. Other concerns related to less explicit teaching time and expressing uncertainty over care plans in front of patients and other providers.
Conclusions:
Implementing a collaborative care model on a medicine teaching service was feasible and did not substantially increase rounding time per patient. Improved patient and interprofessional communication was tempered with concerns over learners’ educational experiences. These concerns could be addressed through improved orientation and targeted curricular objectives and content. We will continue to assess this model’s impact on patients, learners, and providers to optimize its implementation in a teaching environment.