Case Management Insider

Interdisciplinary meetings play critical role in inpatient setting

Case managers can make a positive change with daily meetings

By Ann Kirby, MSN, MPA
Managing Director
Huron Healthcare
Huron Consulting Group
Lake Oswego, OR

It is expected that metrics will be available so that the contributions of case management are quantified, as outlined by Toni Cesta, PhD, RN, FAAN, senior vice president, Lutheran Medical Center, Brooklyn, NY, in her April 2011 Case Management Insider article "You're only as good as yesterday's discharges — Strategies to demonstrate case management's value." In May 2011, Cesta provided examples of specific metrics that case management departments can use to demonstrate their effectiveness.

We are being asked not only to do more with less, but we are being asked to do better with less. Doing better with less is not possible without making changes in how we communicate and collaborate to serve patients. The necessary processes and tools must be in place to support consistent behaviors that will facilitate the desired levels of performance on metrics ranging from quality of care to patient satisfaction.

Today's case managers must assist with decreasing readmissions and lengths of stay, better predicting discharge dates, and reducing delays in care; while also improving a myriad of other metrics. How can they more effectively do these things? The answer is to move upstream from these metrics, become more proactive, leverage the expertise of the broader care team, and create the time needed to prepare the patient to transition to the next care setting.

Establishing effective daily interdisciplinary meetings is one way that hospital-based case managers can participate in a concrete change that will improve performance on many metrics that will help demonstrate their value to the hospitals in which they work. Effective interdisciplinary meetings allow the care team, including the case manager, to be proactive in their planning, communication, and interventions with patients and families. Through 30-minute daily interdisciplinary meetings where each patient's goal for the day and for the hospital stay are reviewed, the care providers share their varied expertise and perspectives so that they can accomplish what is needed for the patient and learn from one another. Barriers are identified and resolved so that care is provided in a timely manner.

Once the care team is on the same page, communication with the patient and family is consistent. Involving the patient in her/his plan of care while in the hospital promotes high care quality and satisfaction with the care experience.

At first caregivers will understandably feel that they can't possibly participate in a daily meeting since they already are busy. Once the meetings get up and running, participants realize that the discussions save them time. The entire team is together, plans of care are coordinated, and time spent locating colleagues via phone or pager is greatly diminished.

The overall goal of convening interdisciplinary meetings is to improve the team's ability to consistently deliver high quality care. Achieving the goal of better quality care must be supported by several other outcomes and can help to accomplish other goals. (See examples, below.)

Outcomes for Interdisciplinary Meetings

  • Improve communication between the physician, nurse, case manager and other team members involved in the patient's care (e.g., speech, physical and occupational therapy; chaplaincy; pharmacy).
  • Enhance communication and coordination with the patient and family, which improves their satisfaction with their care experience.
  • Provide a forum in which house staff can learn and demonstrate Accreditation Council for Graduate Medical Education (ACGME) competencies (e.g., developing and carrying out patient management plans, working within a team, and knowledge of practice and delivery systems).
  • Enhance staff satisfaction and retention.
  • Establish a common understanding of the next steps to advance the plan of care each day.
  • Identify barriers to care and accountability for timely follow-up.
  • Identify and work toward an appropriate discharge/transfer goal date for each patient.
  • Improve communication of bed availability to support overall house management and placement of patients on units where caregiver expertise matches the patient's needs.
  • Reduction in length of stay creating capacity to serve additional patients.

Interdisciplinary meeting principles

A set of "guiding principles" should be established for the interdisciplinary meetings. Within these guidelines, each interdisciplinary team can determine how their meeting will be conducted. The following principles should be consistent among all interdisciplinary meetings:

  • Physician involvement/input is required.
  • There is a rapid format that respects and recognizes other caregivers' time commitments and schedules. In an academic medical setting, the caregiving time commitments must be balanced/integrated with research and teaching activity.
  • Through effective collaboration, people come prepared to contribute and know what to expect of others. Replacements are sent to cover absences.
  • The unit director is ultimately responsible for meeting facilitation by nursing and for ensuring follow-up.
  • Meeting should be daily, including weekends. Service or unit-based discussions are held at a predictable time.
  • Participants will anticipate discharge dates/times and discuss these with the patient/family.
  • Patients and families will be involved in, and receive communication about, their plan of care.
  • Accomplish as much as possible during the rounds (e.g., write orders, enter delay data, update documentation).
  • Establish and monitor metrics that reflect the functioning of the meetings.
  • Implement a quality review process so that the interdisciplinary meetings remain productive over time.

Establishing effective interdisciplinary meetings that can lead to improved performance metrics is not easy. Do not underestimate the time it takes to hardwire new behavior, and assist all team members to be effective participants. Plan carefully to secure executive support, provide needed training for a sustained period, identify a time and place that is conducive to active participation, and create ongoing measurement.

The effort involved in setting up interdisciplinary meetings is well worth it so that patients are better served by a care team that is collaborating to share their knowledge and communicating well with one another. In addition, interdisciplinary meetings provide a dynamic forum in which CM expertise can be leveraged and proactive transition planning can occur. This basic, yet often lacking approach to interdisciplinary collaboration can help caregivers to improve performance metrics and do better with less in an extremely challenging healthcare environment.

Resources

For more information about recommended processes to improve discharge outcomes, see: