[The art of communicating. Interdisciplinary communication].
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Effective interdisciplinary communication is at the heart of clinical decision-making in contemporary health-care environments. Efforts to enhance communication and work processes among nurses and doctors in an infants-and-toddler ward of a specialist paediatric hospital led to the establishment of Surgical Morning Meetings (SMMs). To evaluate the experiences of nursing and medical team members and their perceptions of the changes brought about by the SMM, qualitative evaluation of the SMM was undertaken through semistructured interviews. The analysis identified four major areas of impact: predictability: a nice way to start the day, which captured the ways in which the SMM led to better planning of the day's activities, knowledge and perspectives: learning from each other, which highlighted the way that ongoing discussions led to greater understanding and respect, relationships and support: getting to know you, which reflected the benefits derived from greater commitment, and desired outcomes: making a difference to staff, children and families. Overall, we believe that initiatives as simple as discussions among nurses and doctors can enhance personal and professional experience and lead to improved health outcomes for our patients.
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In 2005, the Healthcare Information and Management Systems Society's Nursing Informatics Task Force surveyed acute care providers across the United States to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. More than 1,700 healthcare professionals responded to the online survey and provided numerous insights into the impact that clinical information systems have in their daily communication and workflow patterns. This paper provides an overview of survey results from four large healthcare delivery systems with a focus on how the results will be employed to support an evidence-based approach to improving acute care IT systems across the following healthcare delivery systems: Partners and Lifespan Health Systems in the Northeast, Baptist Health South Florida in the Southeast, and Providence HealthSystem in the Northwest.A case study approach is employed to describe survey findings at the healthcare system level and then provide a set of recommendations to leverage findings to capitalize on the strengths of existing IT applications and tools, and work towards overcoming barriers to interdisciplinary communication or acute care workflows.
In 2000, an interdisciplinary surgical morning meeting (SMM) was introduced into the infants' and toddlers' ward of a major paediatric hospital to help overcome a number of communication and work process problems among the health professionals providing care to children/families. The objective of this study was to evaluate the impact of the SMM on a range of work practices. Comparative design including pre- and postintervention data collection was used. Data were collected on 100 patient records. Twenty children, from each of the five diagnostic-related groups most commonly admitted to the ward, were included. Demographic, medical review, documentation, critical incidents and complaint variables were obtained from three sources: the hospital clinical information system, the children's medical records and the hospital reporting systems for complaints and critical incidents. Children in the postintervention group were significantly more likely to be reviewed regularly by medical staff, to be reviewed in the morning, to have plans for discharge documented regularly throughout their admission and to have admission summary sheets completed at the time of discharge. The findings of the quantitative evaluation add some weight to the arguments for the purposely structured introduction of interdisciplinary teams into acute-care environments.
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The goal in breast-maintaining treatment of early mammary cancer means control of the tumor in a cosmetically acceptable breast worthy to be left in place. To this intent, a staged approach with agreement between therapists (surgeon, radiotherapist, oncologist) and pathologist should be used. Morphologic and histopathologic findings are relevant and are age-dependent indicators for risk of local recurrence. The cosmetic result as well as local tumor control depend on clinical findings and techniques of resection. The interdisciplinary communication weighs clinical and morphological criteria for counselling and selection of patients. In the presence of unfavourable prerequisites for cosmetically satisfactory results and increased probability of local recurrence (greater than 20%/5 years), breast-maintaining therapy should not be recommended; however, prognostic criteria do not depend on operative techniques.
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After an introduction clarifying the notion of interdisciplinarity, this chapter focuses on the importance of specific roles and mutual responsibilities within the interdisciplinary team, as well as basic rules of communication respecting the values of the concerned partners and professionals, as well as patient and family. Finally, the communication structure for efficient teamwork, and the importance of building a common vision, sharing leadership and learning to work together will be discussed.
The research problem investigated in this article emerged from a year-long ethnographic study of the interdisciplinary process of teams evaluating children for mental retardation/developmental disabilities. The researchers noticed that when a discipline was not present at team meetings, others attempted to speak for it. This article examines the team process and case consequences of such a "missing voice." Data collected through participant observation and videotaping were triangulated with transcripts, written and audiovisual records, and an interview with the missing team member. This process revealed a trail of ambiguous findings and uncertainty on the part of team members of disciplines related to that of the missing member. The "missing" member identified the knowledge, assessment skills, and theoretical perspective she could have contributed if consulted. The findings demonstrate that (a) team members bring differing knowledge and observational perspectives and (b) team deliberations appear to be a function of who is present and what is negotiated.
Multidisciplinary teams of nurses, physicians, and other professionals may have difficulty communicating because of inconsistent theoretical underpinnings. A theoretical base that spans both clinical outcomes and professional boundaries is needed. The web of causation is a theoretical framework that provides a platform of communication connecting issues related to infant mortality among various health-related professions. It includes professional, community, and institutional issues relevant to pregnant women and new mothers as infant caregivers. The article discusses how the web was used for interdisciplinary health care professional interaction and how it was used to develop a series of research protocols that will affect the care of mothers and infants in the District of Columbia.
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