Interdisciplinary Teamwork - The SMART Approach

Abstract

Health care professionals are obligated to review their current practice and seek areas for development and improvement that are in line with current health care reforms and public expectation. In the current climate, the focus is on cost effective care that is safe, efficient and does not compromise patient outcomes. An example of innovative practice that strives to provide comprehensive care within the existing resources available is the Surgical and Medical Assessment & Rehabilitation Team (SMART) based in Beaumont hospital, Dublin. It is an interdisciplinary team, comprising of Occupational therapists and Physiotherapists, who have enhanced their existing work practices in order to improve timeliness and quality of therapeutic interventions. These two services provide assessment and rehabilitation services to the medical and surgical patients who are admitted to a busy city hospital. It is a mixed patient population across all age ranges and a variety of diagnostic groups. Through improved communication, timely interventions, duplication avoidance and utilisation of joint working opportunities, this team has created a template for care that could be transferred to many acute settings optimising service provision. This system provides increased support for team members improving morale and job satisfaction. Pre-implementation planning began three months in advance. The development of an interdisciplinary common assessment tool (CAT) was key to this change in practice. The CAT reduced unnecessary duplication of various profession specific assessments and captured vital information relating to patients social situation, premorbid and current functional status. The team launched on October 1st 2016. Operationally, the team meets twice daily to discuss and divide referrals between both disciplines. Meetings allow for more face to face interaction with team members and improved communication regarding ongoing patient care. One team member, be it the physiotherapist or the Occupational therapist then completes a CAT, identifies the needs of the patient in relation to therapeutic input and communicates this with their OT/PT counterpart. From this, a multidisciplinary plan for intervention is formulated. Therapists from each discipline are co-located to a certain group of wards maximising dual working and communication. Overall, this improves inter-professional working. Patients identified by these teams as requiring longer-term, focussed rehabilitation are discussed within the interdisciplinary meetings and transferred to a SMART Rehabilitation stream if deemed appropriate. When working to its full potential, team members reported greater awareness of the rehab needs and discharge plans of patients. While team members have offered much positive feedback on the new structure we acknowledge it is only in its infancy. An improvement in inter-professional communication has been noted as the most positive aspect with it subjectively leading to a perception of improved patient care. Sustainability of the service was challenged during its infancy during a time with a high level of both scheduled and unscheduled leave, coinciding with increased activity level in the hospital. During this period, improved team communication led to improved patient safety as decisions regarding priorities were made based on knowledge of the patient’s performance and discharge plans. This service is constantly evolving to meet the changing needs of the patient population and as a result there have been a number of changes to our documentation, team and meeting structures during the initial months. Change at interdisciplinary level relies on trust between professions and openness to challenging the norm. Both disciplines need to continue working together, constantly reflecting to ensure the smooth running of the team, while monitoring the effects it has on our level of patient care. Review and enhancement of operational processes and team structures is ongoing.