Multidisciplinary care in surgery: Are team-based interventions cost-effective?

Davis, Matthew J.; Luu, Bryan C.; Raj, Sarth; Abu‐Ghname, Amjed; Buchanan, Edward P.

doi:10.1016/j.surge.2020.02.005

Cited by 19 publications

(13 citation statements)

References 62 publications

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“…For other common surgical complications, protocols for mitigating each complication have been developed and implemented through interdisciplinary collaboration often through creation of care bundles [ 1 , 2 , 3 , 4 , 141 , 142 ]. One recent review noted that multidisciplinary surgical care often leads to better patient outcomes and improved provider knowledge as well as directly leading to cost savings, irrespective of surgical specialty, modality, or intervention [ 143 ]. As noted earlier, VTE prophylaxis standards have been embedded into order sets and monitoring plans [ 144 ], and surgery discharge plans have been designed and adopted [ 145 ].…”

Section: Resultsmentioning

confidence: 99%

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

Parrish

Bodenstab²,

Carneal

et al. 2022

JCM

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The influence of pharmacotherapy regimens on surgical patient outcomes is increasingly appreciated in the era of enhanced recovery protocols and institutional focus on reducing postoperative complications. Specifics related to medication selection, dosing, frequency of administration, and duration of therapy are evolving to optimize pharmacotherapeutic regimens for many enhanced recovery protocolized elements. This review provides a summary of recent pharmacotherapeutic strategies, including those configured within electronic health record (EHR) applications and functionalities, that are associated with the minimization of the frequency and severity of postoperative complications (POCs), shortened hospital length of stay (LOS), reduced readmission rates, and cost or revenue impacts. Further, it will highlight preventive pharmacotherapy regimens that are correlated with improved patient preparation, especially those related to surgical site infection (SSI), venous thromboembolism (VTE), nausea and vomiting (PONV), postoperative ileus (POI), and emergence delirium (PoD) as well as less commonly encountered POCs such as acute kidney injury (AKI) and atrial fibrillation (AF). The importance of interprofessional collaboration in all periprocedural phases, focusing on medication management through shared responsibilities for drug therapy outcomes, will be emphasized. Finally, examples of collaborative care through shared mental models of drug stewardship and non-medical practice agreements to improve operative throughput, reduce operative stress, and increase patient satisfaction are illustrated.

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Section: Resultsmentioning

confidence: 99%

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

Parrish

Bodenstab²,

Carneal

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…69 This was considered essential as the effectiveness of health care organizations relies on their workforce, which Sikka et al 69 describes as “an engaged and productive workforce.” The key to clinician engagement is finding joy and meaning in work and many studies have lamented the growing increase of clinician burnout, especially evident throughout the digital transformation of health care and throughout the COVID-19 pandemic. 70 71 72 73 Evidence shows that teamwork plays an important role in reducing clinician burnout and promoting clinician well-being, 65 71 74 75 76 in addition to achieving optimal patient outcomes, 6 77 78 79 patient satisfaction, 80 and efficiency 81 in line with the “quadruple aim” of health care. 69 As the use of EHRs becomes more ubiquitous in daily clinical practice, the link between teamwork and clinician satisfaction cannot be overlooked.…”

Section: Discussionmentioning

confidence: 99%

The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review

et al. 2022

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Background Interprofessional practice and teamwork are critical components to patient care in a complex hospital environment. The implementation of electronic health records (EHRs) in the hospital environment has brought major change to clinical practice for clinicians which could impact interprofessional practice. Objectives The aim of the study is to identify, describe, and evaluate studies on the effect of an EHR or modification/enhancement to an EHR on interprofessional practice in a hospital setting. Methods Seven databases were searched including PubMed, Scopus, Web of Science, CINAHL, Cochrane, EMBASE, and ACM Digital Library until November 2021. Subject heading and title/abstract searches were undertaken for three search concepts: “interprofessional” and “electronic health records” and “hospital, personnel.” No date limits were applied. The search generated 5,400 publications and after duplicates were removed, 3,255 remained for title/abstract screening. Seventeen studies met the inclusion criteria and were included in this review. Risk of bias was quantified using the Quality Assessment Tool for Studies with Diverse Designs. A narrative synthesis of the findings was completed based on type of intervention and outcome measures which included: communication, coordination, collaboration, and teamwork. Results The majority of publications were observational studies and of low research quality. Most studies reported on outcomes of communication and coordination, with few studies investigating collaboration or teamwork. Studies investigating the EHR demonstrated mostly negative or no effects on interprofessional practice (23/31 outcomes; 74%) in comparison to studies investigating EHR enhancements which showed more positive results (20/28 outcomes; 71%). Common concepts identified throughout the studies demonstrated mixed results: sharing of information, visibility of information, closed-loop feedback, decision support, and workflow disruption. Conclusion There were mixed effects of the EHR and EHR enhancements on all outcomes of interprofessional practice, however, EHR enhancements demonstrated more positive effects than the EHR alone. Few EHR studies investigated the effect on teamwork and collaboration.

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“…When two or more specialties offer treatments for the same condition, there can be a complex interplay between collaboration and competition [ 7 , 8 ]. Multidisciplinary collaboration has generally been shown to improve patient outcomes while being cost-effective [ 9 , 10 ]. Likewise, multidisciplinary fibroid clinics have been shown to deliver high patient satisfaction and increase use of less invasive treatment options [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The power of proximity: Effects of a multidisciplinary fibroid clinic on inter-specialty perceptions and practice patterns

et al. 2022

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Background Multidisciplinary collaboration has generally been shown to have positive effects on healthcare but can be difficult to facilitate. This study assessed the effects of a multidisciplinary fibroid clinic on practice patterns and clinician perceptions to better understand drivers of interspecialty collaboration. Materials and methods Annual rates of hysterectomies, myomectomies, and uterine fibroid embolizations (UFEs) performed in an urban healthcare system were collected from 2012–2019. Rates of each procedure were compared over time before and after launching a multidisciplinary fibroid clinic at the academic medical center. Referral rates were also compared. The gynecologists and interventional radiologists (IRs) involved in the clinic were interviewed 2 years prior to and after the clinic launch about their approaches to fibroids and perceptions of others who treat this condition. A phenomenological approach was used to identify and compare themes within the interviews by two researchers with excellent inter-rater agreement (κ = 0.80). Results and discussion Annual rates of fibroid procedures increased over time (p<0.01) but the relative number of UFEs decreased (p = 0.01). UFE referrals by the clinic gynecologists significantly increased as did the number of combined fibroid procedures (p<0.01). However, the rates of one fibroid procedure relative to others were not different between the clinic and rest of the healthcare system (p = 0.55). Specialty-specific perceptions of fibroid treatments and inter-specialty dynamics did not change. Despite this, clinicians unanimously perceived the clinic and post-clinic practice patterns as positive and distinct from their previous work and relationships between gynecology and IR elsewhere. Limitations of this study included its single clinic design and potential confounder of differences in advertising pre- versus post-clinic. Conclusion Creating the right practice environment may be more important for fostering inter-specialty collaboration and work satisfaction than shared mental models or procedural volumes in certain practice settings.

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Multidisciplinary care in surgery: Are team-based interventions cost-effective?

Cited by 19 publications

References 62 publications

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review

The power of proximity: Effects of a multidisciplinary fibroid clinic on inter-specialty perceptions and practice patterns

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