Operationalization of the Transition to Comfort Measures Only in the Neurocritical Care Unit: A Quality Improvement Project

Introduction: Transition to comfort measures only (CMO) is common in the neurocritical care unit, and close communication between interdisciplinary health-care teams is vital to a smooth transition. We developed and implemented a CMO huddle in an effort to reduce inconsistencies during the process of CMO transition. Methods: The CMO huddle was a multiphase quality improvement project in a neurocritical care unit of a level-1 trauma and comprehensive stroke center. Interdisciplinary critical care clinicians engaged in a huddle during CMO processes and participated in a pre- and postimplementation survey to examine the impact of CMO huddle on communication, missed opportunities, and improvement in knowledge. Results: Since the CMO implementation, a total of 131 patients underwent CMO transitions. After implementation of an interdisciplinary CMO huddle, 64.3% of neurocritical care nurses reported that they felt included and involved in CMO process compared to 28% before implementation ( P = .003); 87.9% of all neurocritical care clinicians reported that they felt comfortable participating in CMO discussions compared to 69.8% before ( P < .001); 57.4% of all neurocritical care clinicians reported that the CMO huddle improved communication among neurocritical care clinicians, 51.9% reported reduction in missed opportunities during CMO process, and 21.7% reported witnessing less-than-ideal CMO process compared to 80% before ( P < .001). Conclusions: Implementation of a multidisciplinary huddle in the neuro–intensive care unit before transition to CMO may improve clinician’s experience of the end-of-life process through enhanced nursing inclusion and involvement and organized communication with the neurocritical care team.

Influences on Interdisciplinary Collaboration among Social Work and Health Sciences Students

Interdisciplinary collaboration is an effective and satisfying way to provide health care services and learning across professions. This study aimed to explore interdisciplinary collaboration experiences amongst social work and allied health sciences graduate students and examined factors that contributed to their interdisciplinary collaboration. An interdisciplinary survey was conducted in a Mid-Atlantic public university. Analysis was conducted using hierarchical regressions from 112 health sciences and social work students. Students with positive attitudes toward interdisciplinary health care teams and part-time students compared to full-time students presented higher flexibility of interdisciplinary collaboration. Students with positive experiences of interdisciplinary collaboration demonstrated higher levels of interdependence, compared to those with no and negative experiences of interdisciplinary collaboration. Students in medicine were less likely to show interdependence, compared to those in social work. Professional disciplines and educators should put efforts in offering opportunities for interdisciplinary collaboration practice and building curricula to promote positive attitudes toward interdisciplinary teamwork.

Referral Criteria for Assessment and Treatment: In an Ambulatory Dysphagia Clinic

Dysphagia is highly prevalent in patients with chronic neurological disorders and can increase the risk for comorbidities such as aspiration pneumonia and malnutrition. Treatment includes timely access to interdisciplinary health care teams with specialized skills in dysphagia management. A retrospective chart review (n=99 of 125 charts screened) was conducted to evaluate the effectiveness of referral criteria to identify and triage patients with suspected dysphagia to an ambulatory dysphagia clinic. Variables collected included demographic information (age), anthropometric information (body mass index [BMI], each patient’s sex), reason for referral, primary medical diagnosis, symptomatology (e.g., pneumonia, chest congestion), nutrition and swallowing interventions, clinic wait times, missed/cancelled appointments, and referring health care professional. The mean age and mean BMI ± standard deviation of patients reviewed were 68.7 years ± 18.4 years and 25.2 kg/m2 ± 6.7 kg/m2, respectively. Average clinic wait times were 158 days (13 to 368 days) for routine and 52 days (0 to 344 days) for urgent assessments (p<0.001). The most common reason(s) for referral was/were related to dysphagia (n=83), surgery (n=50), and/or gastrointestinal symptomatology (n=28); 80% to 90% of patients received varying diagnostic and treatment services for dysphagia. Development of effective referral criteria is critical to ensure that clients with dysphagia receive timely diagnostic, treatment, and nutrition interventions by interdisciplinary health care teams specializing in dysphagia.

Interdisciplinary Teamwork: Student Differences and Teaching Implications

Teamwork with individuals from multiple disciplines is recognized as a significant skill necessary for professional employment. While a variety of teaching methods for students in health care professions have been investigated and found to be generally effective in improving interdisciplinary team skills, one field - health administration - has not been included in these studies. The research presented here used two standardized instruments (with seven distinct subscales) to compare perceptions of health care administration students and clinical students regarding interdisciplinary teamwork. Three attitudes toward interdisciplinary health care teams were similar among all students - shared leadership, perceived need for cooperation, and understanding others’ values. Significant differences between administration and clinical students were found in four areas. Health administration students exhibited lower scores for: 1) believing in the value of teamwork, 2) recognizing teamwork efficiency, 3) believing their profession was perceived as competent by other health care professionals, and 4) recognizing their own lack of cooperation in teamwork. These findings reveal the diverse cultures among health care professionals and invite educators to consider the diversity of their students when implementing interdisciplinary team-teaching techniques and methods.