Interprofessional Consultation Research Articles

249 Interprofessional Consultation to Reduce Unnecessary Transfers of Complicated Mild TBI to Tertiary Referral Centers

INTRODUCTION: The neurosurgical intervention rate for complicated mild traumatic brain injury (cmTBI) is less than 1%. However, the absence of transfer guidelines and fear of malpractice results in unnecessary transfers of cmTBI patients to tertiary referral centers. METHODS: Between April 2021 and March 2023, we implemented a Tele-TBI at three community hospitals for cmTBI patients seen in the emergency department (ED). An interprofessional telehealth-based consultation between emergency medicine and neurosurgery determined if a patient needed to be transferred to the Level-1Trauma Center or could be cared for at the community hospital. A retrospectively chart review was used to determine if transfers were unnecessary. Transfer rates were compared for patients from hospitals with and without the Tele-TBI protocol. RESULTS: Out of 822 cmTBI patients seen in our ED, 73% (n = 602) were transferred from other hospitals. The mean age of transferred patients was 67.5 (±19.9) and median GCS was 15. During this time, 128 Tele-TBI consultations were performed. The mean age was 75.7 (±16.2), and median GCS was 15. The overall transfer rate was decreased by 89% (n = 15/128) when Tele-TBI consultations were initiated. Tele-TBI-enabled hospitals had significantly fewer (p < 0.001) unindicated transfers (28.7%, n = 66 versus 71.3% n = 164) and led to fewer (p = 0.003) transferred patients discharged directly from the Level-1Trauma Center ED (28.6%, n = 66 versus 72.3%, n = 173). ICU admissions and frequency of neurosurgical intervention did not differ between hospitals with or without tele-TBI implementation. CONCLUSIONS: Interprofessional telehealth-based consultation can effectively triage patients with cmTBI presenting to community hospitals, leading to fewer unnecessary transfers with similar rates of ICU admissions and neurosurgical interventions.

How to Effectively Utilize Consultation Codes: 2023 Updates

Consultation codes can be utilized by dermatologists in both the inpatient and outpatient setting. Updates to the inpatient and outpatient consultation code families went into effect January 1, 2023. Similar to the outpatient evaluation and management (E/M) codes, level of service is now determined solely based on either time on the date of the encounter or medical decision-making. Additionally, interprofessional consultation codes are time-based codes that can be utilized when assisting in the diagnosis and/or management of a patient without face-to-face contact.

Interprofessional Consultations: 99446–99449 Versus 99451

This article reviews the following topics related to interprofessional consultation services: Differentiating interprofessional consultation services Instructions for when to report or not report interprofessional consultation services Examples of interprofessional consultation services Reporting the time spent by the requesting physician or other qualified health care professional (QHP)

Home care nurses’ perceptions about their role in interprofessional collaborative practice in clinical medication reviews

Regular clinical medication reviews (CMRs) are recommended for monitoring and addressing potential drug-related problems, especially in elderly people. Interprofessional collaborative practice (ICP) by general practitioners, community pharmacists, and nurses in a CMR is recommended and expected to produce more efficient CMRs. Involving home care nurses in ICP is not yet well implemented, and their perspectives are unclear. This study explores how they perceive their role in ICP in CMRs and the requirements to assume that role. Structured interviews were performed, using case-vignettes; data were analyzed with a thematic analysis approach. Twelve home care nurses were interviewed. Three themes regarding the nurses' role were identified: (1) observing, recognizing, and communicating information for a CMR to prescribers and community pharmacists (2); helping to provide patient information and education about implemented changes in the pharmaceutical care plan; and (3) the nurses’ level of involvement in ICP. Three themes regarding requirements were identified: (1) nursing competences, (2) periodic interprofessional consultation and ad hoc interprofessional communication, and (3) guidelines describing the role of nurses. Home care nurses could provide additional support in a CMR. Nursing competences, periodic interprofessional consultation and ad hoc interprofessional communication, and guidelines describing the role of home care nurses are required.

Defining the Role of the Physical Therapist in Addressing Vaping and Smoking Cessation

The use of electronic or e-cigarettes, commonly referred to as vaping, has markedly increased in recent years. Vaping devices were initially introduced to promote smoking cessation in the chronic adult smoker as a less harmful substitute for combustible cigarettes. However, they have significantly expanded in popularity with youth, creating a global health crisis. Broadly, 2 populations of individuals are noted to vape: the chronic smoker attempting to quit and young teenagers who are lured into using these devices. Recent evidence indicates an outbreak of vaping-associated lung injury and other physiological disturbances that may be particularly harmful to patients and clients. Many physical therapists are currently unaware of the physiological effects of e-cigarettes and lack the knowledge and confidence needed to provide cessation recommendations at the individual and community levels. This lack of awareness also hampers the assessment of physiological responses, appropriate modifications to the plan of care, and referral for interprofessional consultation when indicated. The purpose of this perspective article is to provide recent updates to educate physical therapists and physical therapist assistants about e-cigarettes and relevant implications for patient care. The article reports the growing prevalence of e-cigarette use as a public health crisis, the pathophysiological impact of vaping on various body systems, and the unique role physical therapists and physical therapist assistants can play in successfully engaging in e-cigarette cessation interventions. The authors suggest a targeted 5-step Verify, Assess, Plan, Educate, and Refer approach that can be utilized by physical therapists in addressing vaping and smoking cessation. Finally, the article discusses opportunities for incorporating these strategies into physical therapist education and offers avenues for future research and practice.

Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study

Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines.Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases.Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31–60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0–14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely “type of question,” “cases in relation to current clinical guidelines,” “case complexity” and “the doctor being pressured.” Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients.Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.

Interprofessional Consultations (eConsults) in Urology.

An interprofessional consultation (eConsult) is an asynchronous form of telehealth whereby a primary care provider requests electronic consultation with a specialist in place of an in-person consultation. While eConsults have been successfully implemented in many medical specialties, their use in the practice of urology is relatively unknown. We included data from four academic institutions: University of Michigan, University of California -San Francisco, University of Washington, and Montefiore Medical Center. We included every urological eConsult performed at each institution from the launch of their respective programs through August 2019. We considered an eConsult "converted" when the participating urologist recommended a full in-person evaluation. We report eConsult conversion rate, response time, completion time, and diagnosis categories. A total of 462 urological eConsults were requested. Of these, 36% were converted to a traditional in-person visit. Among resolved eConsults, with data on provider response time available (n=119),53.8% of eConsults were addressed in less than 1 day; 28.6% in 1 day; 8.4% in 2 days; 3.4% in 3 days; 3.4% in 4 days; 1.7% in 5 days; and 0.8% in ≥6 days. Among resolved eConsults, with data on provider completion time available (n=283), 50.2% were completed in 1-10 minutes; 46.7% in 11-20 minutes; 2.8% in 21-30 minutes; and less than 1% in ≥31 minutes. Our study suggests that eConsults are an effective avenue for urologists to provide recommendations for many common non-surgical urological conditions and thus avoid a traditional in-person for low-complexity situations. Further investigation into the impact of eConsults on healthcare costs and access to urological care are necessary.

Integrated Care Committee Provides Guides to Interprofessional Consultation Codes

Integrated Care Committee Provides Guides to Interprofessional Consultation Codes

Tele-Neuro-Ophthalmology During the Age of COVID-19.

Tele-Neuro-Ophthalmology During the Age of COVID-19.

Barriers and facilitators to ask for lower urinary tract symptoms in people with low back pain and pelvic girdle pain. A qualitative study

BackgroundLower urinary tract symptoms (LUTS) may be a relevant comorbidity when managing people with low back or pelvic girdle pain. It is unknown how often physiotherapists inquire about LUTS, and what the potential barriers and facilitators are to inquire about LUTS in this patient population. ObjectiveTo explore the frequency of inquiring about LUTS, and to identify the barriers and facilitators among physiotherapists with and without additional pelvic health training to ask for LUTS in people with low back or pelvic girdle pain. DesignA qualitative study using thematic analysis. MethodsThrough purposeful sampling, 29 primary care physiotherapists were interviewed (16 physiotherapists and 13 physiotherapists with additional pelvic health training). Thematic analysis was performed to identify themes regarding facilitators and barriers. FindingsThe frequency of inquiring about LUTS was: ‘never’: 10%, ‘sometimes’: 38%, and ‘always’: 52%. Four barriers were identified: (1) lack of knowledge of the physiotherapist, (2) a standardised assessment approach which did not include LUTS, (3) patient expectations assumed by the physiotherapist, and (4) social, cultural and personal barriers. Three facilitators were identified: (1) communication skills and experience of the physiotherapist, (2) education and knowledge, and (3) interprofessional consultation and referral. ConclusionThe majority of physiotherapists surveyed in this study regularly asked for LUTS in people with low back or pelvic pain. For when not asked, the identified barriers seem modifiable with adequate training, knowledge and skill acquisition, and sound clinical reasoning.

Health Psychology Consultation in the Inpatient Medical Setting

Health Psychology Consultation in the Inpatient Medical Setting is suitable and recommended for any collection that focuses on clinical psychology or interprofessional consultation.

Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study.

Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings. This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes. There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings. Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine

Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada. We assessed feasibility of the TIP model from the number of referrals from PCPs and emergency departments in Toronto, Canada; the intervention cost; and the satisfaction of patients, PCPs, and team members with the new model. One patient and PCP story highlights the model's impact. We also performed thematic analysis of written feedback. A total of 76 patients were referred from 53 PCPs and 4 emergency departments, and 65 PCPs participated in TIP. All 74 patient survey respondents indicated TIP improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use TIP again, and 90% reported improved confidence in managing their patient's care. Of 87 team member survey respondents, 97% rated TIP as effective. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088). TIP is a feasible intervention in multiple primary care settings that gives patients an active role in their health management, supported by their team. The model effectively addresses the needs of the most complex patients and their PCPs.

Interprofessional Assessment and Management 2019: Reporting Referring and Consulting Services

Codes for interprofessional telephone and Internet consultation are changed in Current Procedural Terminology (CPT®) 2019 to include communication via EHR but still include verbal and written reports from the consultant to the referring provider. Get all the details here.

Development and validation of a questionnaire to self-assess the quality of interprofessional team meetings in primary and community healthcare

ABSTRACTIn the context of a quality assurance policy, a regional network initiated a project to measure the quality of interprofessional consultation meetings. A questionnaire was evaluated on content validity by 48 stakeholders: healthcare professionals, representatives from healthcare organizations, interprofessional consultation meeting coordinators, and representatives from patient organizations. A revision resulted in two subscales (each consisting of 16 items) for assessing process and outcome aspects of interprofessional consultation meetings. After validating the instrument, it was used in a hands-on test by individuals and in a pilot series of team-based self-assessments. Responses were used to analyse reliability and consistency of the subscales and the items, and to reveal first indications of relative weaknesses and strengths in interprofessional consultation meetings. Results point out that the subscales, now part of the Interprofessional Practice and Education Quality Scales (IPEQS), can be useful for self-assessment of the quality of such meetings in primary and community healthcare, but maybe also in other areas of interprofessional collaboration.

Teleconsultation for integrated palliative care at home: A qualitative study

Background: Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual teleconsultations could be a method for integrating palliative care services. Aim: This study aims to describe (1) whether and how teleconsultation supports the integration of primary care, specialist palliative care, and patient perspectives and services and (2) how patients and (in)formal caregivers experience collaboration in a teleconsultation approach. Design: This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews. Setting/participants: A total of 18 home-based palliative care patients (16 with cancer, 2 with chronic obstructive pulmonary disease; age range 24–85 years old), 12 hospital-based specialist palliative care team clinicians, and 17 primary care physicians. Results: Analysis showed that the introduction of specialist palliative care team-patient teleconsultation led to collaboration between primary care physicians and specialist palliative care team clinicians in all 18 cases. In 17/18 cases, interprofessional contact was restricted to backstage work after teleconsultation. In one deviant case, both the patient and the professionals were simultaneously connected through teleconsultation. Two themes characterized integrated palliative care at home as a consequence of teleconsultation: (1) professionals defining responsibility and (2) building interprofessional rapport. Conclusion: Specialist palliative care team teleconsultation with home-based patients leads to collaboration between primary care physicians and hospital-based palliative care specialists. Due to cultural reasons, most collaboration was of a multidisciplinary character, strongly relying on organized backstage work. Interdisciplinary teleconsultations with real-time contact between patient and both professionals were less common but stimulated patient-centered care dialogues.

Hospitals of the Future

I am always amazed at how many hospitals call their new facilities hospital of the Just hearing the term inspires expectations of innovation, creativity, and a building that is beyond anything we know today. I can just imagine that the facility will be amazingly designed with all of the attributes of a healing environment with abundant natural light, indoor/outdoor relationships, and an efficient layout that supports patient care processes. These hospitals of the future likely ensure patient safety by using existing evidence published in HERD and other journals that we know prevents medication errors, cross contamination, and employee injuries. Surely the facility will be rich with technology, spaces for interprofessional consultation and dialogue, and a clean, bright aesthetic appearance. Certainly, the hospital of the future will operationalize the concept of flexibility and adaptability with modular plug-and-play spaces, patient room headwalls and footwalls, and wall-mounted cabinetry that can be readily adapted when there are changes in patient acuity or services. What an opportunity to test innovative design features that address some of the current issues faced by clinicians who resort to workarounds and make-do in their existing facilities.How does a hospital of the future get planned or designed? Some health care leaders have engaged futurists, business leaders, pilots, motivational speakers, attorneys, hospitality leaders, physicians, community leaders, politicians, signature designers, and other professionals to help them in the visioning and planning their new hospital of the future. Of course, all of these diverse opinion leaders know firsthand what is needed in a new hospital to provide care or to receive care as a patient or family member (a bit of skepticism and sarcasm here). Few engage clinical nurses at the early stages, although some nurse leaders might be involved in the early processes. It is true that there is magic at the intersection when diverse thought leaders come together to collaboratively discuss what services the hospital of the future should include, how it should be designed, and its exterior image in the community. Unfortunately, when you rely too heavily on the opinions of those who do not have context-specific knowledge for the delivery of health care, significant problems can occur that ultimately affect the patient experience, the work processes of care providers, and even the bottom line.[Image omitted: See PDF.]Recently, I have been engaged in the care of family members in two different states in these so-called hospitals of the future--newly constructed hospitals. Of course, I always ask the nurses, physicians, and other caregivers what it is like working in the new hospital. Anticipating a positive and excited answer, I am always a bit surprised when I hear some of their responses!No one asked us for input. We have these little workstations outside of the patient rooms, but they are too small to be usable ... the observation windows are too high to see the patient when we are seated.The supplies are kept far away from where we need to access them, so we spend all day trying to find the supplies we need. So we fixed the problem and hoard them in our work carts.The hand washing sink in the patient room is a joke. It is camp size, and you can't get your hands under the faucet to wash. The soap dispenser is way out of reach.The bathroom--shower design has caused more patient falls than before and it was supposed to reduce the falls! Not only that, there is water everywhere so nurses fall too. Best yet, a ton of linen is used to try to create dams to keep the water from running out into the patient rooms.You have got to be kidding me--hospital of the future! How can you design a hospital of the future with open bays in the emergency department with patients separated by a curtain! Maybe that should be called back to the future? …

When Physicians Report Having Used Medical Drugs to Deliberately End a Patient's Life: Findings of the “End-of-Life in France” Survey

ContextThe debate on the decriminalization of active assistance in dying is still a topical issue in many countries where it is regarded as homicide. Despite the prohibition, some physicians say they have used drugs to intentionally end a patient's life. ObjectivesTo provide some empirical grounding for the ongoing debate. MethodsUsing data from the End-of-Life in France survey (a representative sample of 15,000 deaths that occurred in December 2009, questionnaires completed anonymously by the physicians who had certified the deaths), we selected all the cases where the physician had used one or more drugs to intentionally end a patient's life and compared the decisions and decision-making process with the conditions imposed by the French law for decisions to withhold or withdraw life-supporting treatments and by the Belgian law on euthanasia. ResultsOf the 36 cases analyzed, four situations seemed to be deliberate acts after explicit requests from the patients, and only two seemed to fulfill the eligibility and due care conditions of the Belgian euthanasia law. Decisions made without any discussion with patients were quite common, and we observed inadequate labeling, frequent signs of ambivalence (artificial feeding and hydration not withdrawn, types of drug used), and little interprofessional consultation. Where the patient had requested euthanasia, the emotional burden on the physician was heavy. ConclusionThese findings underscore the pressing need for a clarification of the concepts involved among health professionals, patients, and society at large, and better training and support for physicians.

Healthcare students’ perceptions of a simulated interprofessional consultation in an outpatient clinic

Newly graduated healthcare workers should appreciate the importance of teamwork and each profession’s unique role in a multi-disciplinary team. At Medunsa, an institution for higher education of healthcare professionals, each profession’s teaching occurs independently. This study explores the perceptions of healthcare students and their facilitators of a simulated interprofessional consultation. Eighty-two senior medical, occupational therapy and physiotherapy students participated in a simulated event over three separate sessions. A multi-disciplinary team comprising one representative per profession conducted the consultation, while the other students observed. Facilitators initiated reflection at the end of each session. Participants gained an understanding of the multi-disciplinary team’s functioning, the importance of professional skills and behaviour. The facilitators learnt how to improve on the simulation scenario and their facilitation skills. The introduction of interprofessional education events, where important skills and role clarification can be experienced in a non-threatening way, can benefit students and facilitators alike.

Innovative model of interprofessional geriatric consultation: specialized seniors clinics.

As the Canadian population ages, healthcare systems have become increasingly interested in exploring new ways to deliver services to frail older adults, and in particular older adults with dementia. The Specialized Seniors Clinics (SSCs) are an innovative integrated network of six outpatient clinics in BC's Fraser Health Authority that utilize interprofessional teams to provide comprehensive geriatric assessments and care planning for frail older adults. The SSCs provided approximately 19,000 appointments in the past fiscal year, and clients and primary care physicians are highly satisfied with the model. This article describes the SSC model and provides reflection on the model development, implementation and standardization processes.