Steps for establishing effective meetings
The devil is in the details when it comes to convening a successful interdisciplinary meeting.
Multiple questions such as who should be the executive sponsor, where and when to meet, whom to include, and how to communicate with patients/families need to be considered. There is not one right answer to these questions. Each hospital must determine what is right for them and the patients they serve.
1. Secure executive support and physician champions.
Before embarking on implementing interdisciplinary meetings, identify an executive who will be the sponsor of this initiative. Ideally, this is someone with a clinical background such as a chief nursing or medical officer. However, an operational executive such as the chief operating or executive officer can also be effective in this role.
Prepare by understanding the goals and vision of your organization and potential sponsor so that you can clearly point out how interdisciplinary meetings support the direction in which he/she wants to move. For example, a CEO might be interested in improving patient satisfaction scores. Connecting the dots between that outcome and the improved involvement of the patient and family in the care planning that results from interdisciplinary meetings will be helpful in gaining support.
Identifying physician champions is also important. The participation of attending physicians, or someone who can make decisions and write orders on behalf of the medical team in the interdisciplinary meetings, is extremely important. The involvement of nurse practitioners, physician assistants, and residents can be an effective way to ensure the medical viewpoint is present and orders are written in real time to advance care. If a supportive physician or medical service can be identified, it might be a successful strategy to pilot interdisciplinary meetings with this group to show others what can be accomplished.
2. Determine: Should interdisciplinary meetings be unit or service based?
Unfortunately, there is no perfect answer to this question. The reason is because if you select a unit-based interdisciplinary meeting, any caregiver who is not assigned by unit might have to attend more than one meeting. Even though the target length of the meetings is only 30 minutes, this amount of time still can be a significant commitment from someone who has to attend multiple meetings.
Often the case management and social work staff is assigned by geographic unit or group of beds. If this is the case, a unit-based meeting may work best. The group that is typically not unit-based is the physicians. A schedule must be arranged that allows physicians to efficiently rotate into the meeting to participate in discussions about their patients.
3. Determine: Where and when will interdisciplinary meetings be held?
Ideally, the interdisciplinary meeting will be held on the unit that is caring for the patients being discussed. By meeting there, many of the participants already are present, and any hard copy documentation that is needed can be accessed. The further away from the care area the meeting is held, the less likely there will be consistent participation from unit-based staff.
Consider whether the meetings will be stationary or if the team will walk through the unit. There is no question that the patient and family need to be involved in the plan of care, and communication must flow to them. So many teams want to conduct their interdisciplinary meeting while walking from room to room. The main disadvantage of this approach is that the meeting becomes rounding and might take too long, which makes it impractical for everyone to participate the entire time. One option is to have the interdisciplinary team meet quickly in one spot and then plan necessary follow up and communication with patients and families through other methods. Being in one place also supports the completion of activity such as documentation and order writing in real time.
The timing of the meeting is also important for success. Not all meetings need to occur at the same time or in the morning. The main point is to obtain consistent involvement from as many disciplines as possible that are key to the care of the patients being discussed.
4. Identify interdisciplinary team members.
All interdisciplinary meetings should include a physician or physician representative, bedside nursing, case management, and social work.
Additional care team members should be determined based on the needs of the patient population being discussed. For example, for pediatric patients, consider including child life therapy. For oncology patients, palliative care and chaplaincy could be a good addition to the team. For neurology patients, the involvement of physical, speech, and/or occupational therapy perspectives will be important to advancing patient care.
5. Identify a facilitator.
All interdisciplinary meetings need a strong facilitator to keep the discussion focused, ask probing questions, and ensure follow up is completed. Ideally the facilitator should have a deep knowledge of the patient population being discussed, as well as a strong relationship with the physicians providing care to these patients.
Even though case management staff might have the skill set to fulfill the facilitator role, this role is best filled by nursing leadership. The reason is that nursing is involved in detail with all patients and plays a role in every discharge. Nursing staff also is present 24/7 and have a role in the progression and transitions of all patients. Having a nursing leader such as a unit manager, charge nurse, or clinical nurse specialist consistently facilitate the interdisciplinary meetings is ideal.
6. Predict/communicate discharge and transition dates.
Within 24 hours of admission, the team should predict a target discharge date for each patient based on available benchmarks such as Medicare geometric mean length of stay (LOS), historical LOS for similar patients at their hospital, and characteristics of each individual patient.
The purpose of this initial discharge date prediction is to get the care team to discuss factors that might contribute to a given patient having a shorter or longer LOS than the norm. In addition, the team should understand what goals the patient must reach before being able to safely transition from the current level of care.
As the patient's plan of care is carried out, the discharge date prediction should be updated, and whenever possible, a time of discharge should be assigned. Communication of the anticipated discharge date and time to the patient/family is crucial so they can prepare for and understand their role in what must be done prior to transition. Allowing the patient and care team to be proactive in their planning helps education, transportation, physical therapy assessments, and other necessary activity to be completed in a timely manner so that discharge can occur when the patient is medically ready.