Geisinger Health System in Danville, Pa., a leader in developing the patient-centered medical-home model and team-based care, provides IPE training to students and practicing professionals. “Medicine is truly a team sport, but we haven't treated it like a team sport,” said Dr. Douglas Kupas, Geisinger's associate chief academic officer for simulation and medical education.
Along with training its own staff, Geisinger offers IPE to students from Temple University School of Medicine in Philadelphia, the Philadelphia College of Osteopathic Medicine and Bloomsburg (Pa.) University's department of nursing.
Geisinger's program has medical, nursing and pharmacy students working on quality improvement projects, practicing in different scenarios and rounding together. The goal, Kupas said, is to build “situational awareness” so all members of the team know what they should be doing and how to complement each other's work.
Two-hospital health system Christiana Care in Wilmington, Del., has also received recognition for its IPE training program. It recently earned the 2014 Leape Ahead Award—recognizing excellence in patient safety among medical schools and teaching hospitals—from the American College of Physician Executives, for its team-based care and training program.
Dr. Virginia Collier, Christiana Care's chairwoman of medicine, said the system's teams of physicians and physician assistants in intensive care had been working so well together that there actually was tension when new resident physicians arrived for their ICU rotations and had to join the well-oiled teams. This issue was resolved by clarifying the roles and responsibilities assigned to the residents and PAs.
At Christiana Care, team-based care is emphasized for the department of medicine's training of its 65 residents. Simulation is used to build teamwork in scenarios involving attending physicians, nurses, case managers and others. Physician assistants are used extensively in intensive care, and nurse practitioners are heavily involved in the system's Acute Care for the Elderly unit. “We've heard our hospitalists call case managers the glue that holds everything together,” said Mike Eppehimer, vice president of Christiana Care's department of medicine.
Interprofessional teams also do rounds together, which leads to better communication between staff, patients and their families. “It's important that the entire team knows the care plan and speaks with one voice,” Collier said. “Studies show it gives patients and their families confidence and correlates to patient satisfaction.”
At North Shore-Long Island Jewish Health System in Great Neck, N.Y., the emergency department was the first hospital area to participate in team training. Now the system has 47,000 employees undergoing regular team-based simulation training, with as many as 20 simultaneous sessions, involving up to 300 people a day, said Kathleen Gallo, senior vice president and chief learning officer at the system. Simulations use high-tech mannequins with systems that mimic the human body as well actors with whom clinicians rehearse how to tell a patient or a family member bad news. It's mandatory “for anybody who touches our patients, whether it's the new residents or our chair of anesthesia,” Gallo said.
While team-based care is well established in operating rooms and EDs, the biggest new focus is primary care, given the growth of the patient-centered medical-home model. At Oregon Health & Science University, Dr. John Saultz, chairman of the department of family medicine, said team-based care is improving care quality. But the most lasting impact may be enhanced staff satisfaction.
Saultz is overseeing the participation of three OHSU clinics in the CMS Comprehensive Primary Care Initiative, in which insurers pay providers a per-member, per-month fee to support multidisciplinary care coordination. Saultz said the team-based nature of the medical home will attract new doctors to primary care. “I like going (to work) more than I have in my 30 years as a family physician,” Saultz said.
Follow Andis Robeznieks on Twitter: @MHARobeznieks