Interprofessional Team Members Research Articles

Impact of Collaborative Leadership, Workplace Social Capital, and Interprofessional Collaboration Practice on Patient Safety Climate.

Patient safety climate is an important factor in promoting patient safety for healthcare organizations. This study investigated the relationship between collaborative leadership and patient safety climate, the mediation effect of workplace social capital, or interprofessional collaboration practice. A web-based cross-sectional questionnaire survey was administered between May 2021 and May 2022, to employees of three acute care hospitals in Japan. The relationship between variables was verified by structural equation modeling. A total of 1,276 staff members participated in the study. Collaborative leadership affected the workplace social capital (β = .734) and interprofessional collaboration (β = .561), which were positively associated with patient safety climate (β = .403 and .405, respectively), verifying the mediating relationship of workplace social capital and interprofessional collaboration between collaborative leadership and patient safety climate. Collaborative leadership enhances the reciprocity and interprofessional practices of the healthcare team. The interaction among interprofessional team members fosters a patient safety climate. The results of this survey suggest that the development of collaborative leadership, which encourages interprofessional collaboration and fosters workplace social capital, is inherently crucial for cultivating a patient safety climate.

Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach.

Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.

Bias in team decision-making for advanced heart failure therapies: model application

ABSTRACT Bias in advanced heart failure therapy allocation results in inequitable outcomes for minoritized populations. The purpose of this study was to examine how bias is introduced during group decision-making with an interprofessional team using Breathett’s Model of Heart Failure Decision-Making. This was a secondary qualitative descriptive analysis from a study focused on bias in advanced heart failure therapy allocation. Team meetings were recorded and transcribed from four heart failure centers. Breathett’s Model was applied both deductively and inductively to transcripts (n = 12). Bias was identified during discussions about patient characteristics, clinical fragility, and prior clinical decision-making. Some patients were labeled as “good citizens” or as adherent/non-adherent while others benefited from strong advocacy from interprofessional team members. Social determinants of health also impacted therapy allocation. Interprofessional collaboration with advanced heart failure therapy allocation may be enhanced with the inclusion of patient advocates and limit of clinical decision-making using subjective data.

Behavioral Health Access and Workforce Competence for Integrated Care: Highlighting Interprofessional Initiatives from Two North Carolina Social Work Programs

Effective team-based care is necessary for implementation of the integrated care models recommended to improve behavioral health access. Many models rely on social work­ers who are trained to deliver behavioral health care as an interprofessional team member. In this article, we highlight two social work programs utilizing interprofessional educa­tion to enhance team-based care competence.

Fostering Psychological Safety: Building Team-Based Care Communication Skills

As health systems continue to advance integrated models of care, communication remains a central facet of how interprofessional team members can concurrently address physical health, behavioral health, and social needs.

An Analysis of Workplace-Based Assessments for Core Entrustable Professional Activities for Entering Residency: Does Type of Clinical Assessor Influence Level of Supervision Ratings?

The authors describe use of the workplace-based assessment (WBA) coactivity scale according to entrustable professional activities (EPAs) and assessor type to examine how diverse assessors rate medical students using WBAs. A WBA data collection system was launched at Oregon Health and Science University to visualize learner competency in various clinical settings to foster EPA assessment. WBA data from January 14 to June 18, 2021, for medical students (all years) were analyzed. The outcome variable was level of supervisor involvement in each EPA, and the independent variable was assessor type. A total of 7,809 WBAs were included. Most fourth-, third-, and second-year students were assessed by residents or fellows (755 [49.5%], 1,686 [48.5%], and 918 [49.9%], respectively) and first-year students by attending physicians (803 [83.0%]; P < .001). Attendings were least likely to use the highest rating of 4 (1 was available just in case; 2,148 [56.7%] vs 2,368 [67.7%] for residents; P < .001). Learners more commonly sought WBAs from attendings for EPA 2 (prioritize differential diagnosis), EPA 5 (document clinical encounter), EPA 6 (provide oral presentation), EPA 7 (form clinical questions and retrieve evidence-based medicine), and EPA 12 (perform general procedures of a physician). Residents and fellows were more likely to assess students on EPA 3 (recommend and interpret diagnostic and screening tests), EPA 4 (enter and discuss orders and prescriptions), EPA 8 (give and receive patient handover for transitions in care), EPA 9 (collaborate as member of interprofessional team), EPA 10 (recognize and manage patient in need of urgent care), and EPA 11 (obtain informed consent). Learners preferentially sought resident vs attending supervisors for different EPA assessments. Future research should investigate why learners seek different assessors more frequently for various EPAs and if assessor type variability in WBA levels holds true across institutions.

Patient Education Practices and Preferences of Radiation Oncologists and Interprofessional Radiation Therapy Care Teams: A Mixed-Methods Study Exploring Strategies for Effective Patient Education Delivery

Purpose/ObjectivesPatients’ understanding of radiotherapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. Materials/MethodsAn anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group (ROECSG) members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. Results113 ROECSG members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices amongst radiation oncologists differed according to RT clinical workflow timing (consultation vs simulation vs first RT, respectively): one-on-one teaching: 88.5% vs 49.4% vs 56.3%, p<0.01 and paper handouts: 69.0% vs 28.7% vs 16.1%, p<0.01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. ConclusionsRadiation oncologists and interprofessional RO team members engage in PE, with most utilizing institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery.

Codesign of health technology interventions to support best-practice perioperative care and surgical waitlist management

ObjectivesThis project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery.MethodsAn exploratory codesign process used personas and journey mapping in three interprofessional workshops...

Wound Bed Preparation 2024: Delphi Consensus on Foot Ulcer Management in Resource-Limited Settings.

To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds.

Virtual 3D Simulation Technology for Interprofessional Team Training

Background In the hospital, interprofessional team members must work collaboratively. That creates a gap in medical practice, particularly in a hectic emergency that may lead to medical errors, with associated ethical, legal, and financial consequences. Mannequin-based simulation can be a solution to bridge this gap in team training. While mannequin-based simulations are effective as a synchronous method, they are expensive, time and space-bound, use hospital resources, and require the whole team to be present. Objective To develop a prototype of a 3D virtual simulation emergency room (ER) environment for interprofessional team training. And to assess the usability of the prototype in a simulation environment for team training using a clinical scenario. Methods Tools and technologies used for this prototype included the Unity platform, C# programming language, and Photon Voice 2. With 3DS Max, we modified and created 3d assets in the ER simulation room. Adobe XD was used to create interactive prototype iterations. Clinical cases were developed with simple algorithms to prove the concepts. We used complex algorithms with Artificial Intelligence and Machine Learning capabilities for the final product. We conducted two usability tests (n = 10, n = 9) using a think-aloud method, a semi-structured follow-up interview, and a survey. Results A prototype was built to achieve asynchronous team training with easy user access from anywhere in the world. The prototype, which includes voice communication and control of the avatars by players from a distance, supported the usability of the technology for asynchronous team training in health education. Conclusions CyberPatientER can be used as an additional tool to support team training and communication skills in the health education and healthcare environment.

Perceived trauma nursing core competency, interprofessional collaborative competency, and associated barriers among regional trauma center nurses

IntroductionAs key members of interprofessional teams working in complex settings, nurses in trauma centers require trauma nursing core competency. PurposeThis study sought to determine the levels and relationships of the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers among Korean regional trauma center nurses. MethodsThis cross-sectional, descriptive, and correlational survey involved a convenience sample of 190 Korean trauma center nurses. Data were collected using a web-based self-reporting questionnaire about the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers. Data were analyzed using descriptive statistics, Pearson’s correlation, and multiple regression (Enter method) analyses. ResultsThe perceived performance and importance of interprofessional collaborative competency, the perceived importance of trauma nursing core competency, and the perceived barriers to resources, training, competency, and interest significantly affected trauma nursing core competency performance, accounting for 64.5 % of the variance. ConclusionsTraining programs are needed to improve the core and interprofessional collaborative competencies of trauma nurses. Individual, team, and organizational approaches are essential to addressing the perceived barriers. The effects of training programs on the core competency of trauma nurses should be validated.

The Value and Success of Live Plus Online Enduring CME/CE on Hematology/Oncology Specialists' Ability to Care for Patients with Hematologic Disorders

Background: As translational and clinical research across the continuum of classical and malignant hematology continues to accelerate at an unprecedented pace, hematologist/oncologists (hem/oncs) may find it challenging to stay up to date on new discoveries and constantly evolving standards of care. The ASH Annual Meeting offers an unparalleled opportunity to present live continuing medical education (CME/CE) activities to a broad cross-section of this clinician population. The reach of these programs is multiplied by converting recordings into accredited online CME activities available to interprofessional clinician audiences for on-demand learning. The objective of this study was to assess the impact of 9 live plus enduring symposia at ASH 2022 on hem/oncs' knowledge, competence, and confidence in providing comprehensive care for patients with hematologic disorders. Methods: The Medscape Education/Medscape Oncology educational portfolio at the 64 th ASH Annual Meeting consisted of nine 90-minute CME-accredited Friday Satellite Symposia presented live on December 9, 2022, and posted online within 3 weeks as CME-accredited enduring activities consisting of multimedia recordings with synchronized slides. Four of the enduring programs also offered nursing and/or pharmacy continuing education credit. Symposium topics included 2 programs on classical hematologic disorders, 3 on lymphoid malignancies, 3 on myeloid malignancies, and 1 addressing health equity across all hematologic malignancies developed in collaboration with the Leukemia &amp; Lymphoma Society. Educational impact was measured with pre-/post-education assessments including multiple-choice knowledge/competence questions and 5-point Likert scale confidence questions. Data from all hem/onc learners who completed pre- and/or post-education assessments were aggregated across activities and stratified by learning themes. Relative changes in the percentage of correct responses and clinicians who were confident (value of 4 or 5) were used to measure improvement in knowledge, competence, and confidence. A McNemar test assessed significant levels of changes reported, with P values &amp;lt; .05 considered statistically significant. Data were collected through July 31, 2023. Results: The educational portfolio demonstrated a profound reach to 76,647 learners at the time of data cutoff (3361 live learners plus 73,286 enduring learners). Among them, 6821 were hem/onc learners, with other learners comprising additional physician specialties and interprofessional team members (eg, nurses, nurse practitioners, and pharmacists). In each learning theme, statistically significant improvements were observed in hem/oncs' knowledge, competence, and confidence after education (N = 161 to 640). Conclusions: Participation in live or recorded CME/CE-accredited activities presented at the ASH Annual Meeting resulted in statistically significant improvements in hem/onc learners' knowledge, competence, and confidence related to the comprehensive care of patients with a variety of hematologic disorders. These results have the ability to translate to real-world improvements in clinical care and to enhance patient outcomes and experiences. Despite these achievements, continued educational activities are needed to address residual gaps and further increase clinicians' ability in this dynamic clinical setting.

Critical Care and Occupational Therapy Practice Across the Lifespan.

This AOTA Position Statement defines the distinct role and value of occupational therapy practitioners in critical care settings across the lifespan. Occupational therapy practitioners are essential interprofessional team members who address the needs of critically ill individuals by implementing evidence-based critical care guidelines that aim to improve the quality of survivorship.

The Development and Implementation of a School-Based Dental Sealant Program for Hawaii Public Schools.

School-based dental sealant programs are noted to increase sealant uptake among children, especially those from low-income families and those living in rural and underserved areas. However, nationally school-based dental sealant programs are substantially underutilized. This paper describes a partnership approach to a school-based dental sealant program for Title 1 public schools in Hawaii. The Hawaii Keiki: Healthy and Ready to Learn program partnered with the Hawaii Dental Service to develop and implement an interprofessional, school-based sealant program (SBSP). This article describes the development of key factors, such as partnerships, an interprofessional team, team roles, policies, and marketing tools to optimize program success. The SBSP has completed over 3 academic years of implementation in Hawaii public schools. In its initial year (school year [SY] 2019-2020), which presented challenges due to the COVID-19 pandemic, it served 6 schools (106 students screened) on 1 island. It expanded to 14 schools on 1 island (193 students screened) in its second year (SY 2020-2021), 28 schools on 3 islands (653 students screened) in its third year (SY 2021-2022), and during the Fall of the fourth year, the program reached 50 schools on 3 islands (1821 students screened) and is projected to reach over 70 schools by the end of SY 2022-2023. Taking advantage of strategic partnerships and key interprofessional team members, a school-based dental sealant program can help to improve the oral health of children in public schools by helping to decrease barriers to care.

Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

Interprofessional Team Members' Knowledge and Perceptions of Physical Therapist Education and Practice

Introduction. High-quality patient care requires that providers understand and optimize each health care team member's roles and responsibilities. Review of Literature. The purpose of this paper was to examine the contemporary knowledge and perceptions of physical therapist (PT) practice and education held by advanced practice interprofessional (IP) team members, including physicians, physician assistants (PAs), and advanced practice registered nurses (APRNs). Subjects. Physicians, PAs, and APRNs licensed in the state of Minnesota. Methods. Eligible individuals were invited to participate in an online survey assessing understanding of PT practice and education. Descriptive and nonparametric statistical analyses were used to evaluate respondent demographics, practice characteristics, and perceptions and knowledge of PT education and practice. Results. Survey responses were analyzed from 442 respondents including 210 APRNs, 182 physicians, 48 PAs, and 2 clinicians of unknown profession. Results demonstrated that most referring providers did not learn about physical therapy during their academic or posttraining education. Those who interacted with PTs more frequently perceived greater benefit for their patients, tended to refer to PTs more often, and demonstrated greater knowledge of PT practice. Poorly understood areas of PT practice and education included PT practice settings, specialties, salary, level of education, and the ability to see patients through direct access. Discussion and Conclusion. Multiple areas of poor provider knowledge regarding PT education and practice were identified; many unchanged from the literature in the 1980s. Three main areas of growth were identified from which actionable recommendations are made: increase IP interactions with PTs, address areas of poor understanding of PT education and scope, and maximize shifting perceptions of PTs through education and advocacy. This paper illustrates that PT education and practice are not well understood by referring providers, posing a threat to IP collaboration. A lack of collaboration may hinder patient and system outcomes because of suboptimal provider utilization.

Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit.

Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU). This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically. One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were >80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs (p < 0.001 for both). Qualitative themes including clear communication, adequate planning and preparation prior to procedure initiation, and clear definition of roles emerged among both affirmative and constructive comments. Exploration of provider perceptions and emergence of constructive themes expose opportunities for teamwork improvement strategies involving intubations in the PICU. The use of a preintubation checklist may improve organization and communication amongst team members, increase provider morale, decrease team stress levels, and, ultimately, may improve patient outcomes during this high stakes, coordinated event.

PB0721 Continuing Education Enhances Interprofessional Team Members' Ability to Care for Patients with Paroxysmal Nocturnal Hemoglobinuria

PB0721 Continuing Education Enhances Interprofessional Team Members' Ability to Care for Patients with Paroxysmal Nocturnal Hemoglobinuria

Promoting interprofessional education in surgery: development and evaluation of a clinical curriculum

PurposeInterprofessional collaboration is essential in surgery, but health professions students have limited opportunities for interprofessional education (IPE) during training in authentic patient-care settings. This report describes the development and evaluation of a clinical interprofessional elective in otolaryngology for medical (MD) and nurse practitioner (NP) students.MethodsMD and NP students were paired together on an inpatient otolaryngology consult service for one- or two-week rotations designed to promote interprofessional learning objectives. Students worked with different professions essential to the care of patients with voice, airway, and swallowing conditions, including surgeons, advanced practice providers, speech-language pathologists, nurses, and respiratory therapists. Students completed written daily reflections about their experiences and pre- and post-rotation surveys to assess comfort with course learning objectives. Paired t-tests and Cohen’s d effect sizes were used to compare pre/post responses, and thematic analysis was used to analyze all narrative data.ResultsFourteen students (8 MD, 6 NP) students completed the rotation. All participants reported significant improvements on all learning objectives (p < 0.05) with large effect sizes (Cohen’s d range: 1.2–2.9), including their understanding of the responsibilities of each interprofessional team member. Participants described three overarching themes that characterized their learning experiences and supported the learning objectives: appreciation for interprofessional patient care, benefits of learning with an interprofessional peer, and clinician role modeling of effective interprofessional communication.ConclusionsIPE can be successfully integrated into a clinical surgical rotation and enhance students’ understanding of the benefits of and strategies for effective interprofessional collaboration. The elective can serve as a model for IPE rotations in other surgical subspecialties and be extended to include students across the continuum of health professions education.

Healthcare educational debt in the united states: unequal economic impact within interprofessional team members

BackgroundAdvancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy.MethodsThe study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime “economic power” for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers.ResultsHigh salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10–30% more debt than their non-minoritized peers.ConclusionsGraduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy.