Transdisciplinary care in the emergency department: A qualitative analysis

Highlights

• The transdisciplinary team consists of nurses and allied health staff.

• Staff in the transdisciplinary team autonomously assess and manage diverse patient presentations.

• The transdisciplinary team is a novel approach to expedite ED patient flow.

• ED staff, patients and carers favoured the transdisciplinary care model.

Abstract

In response to increasing demands some emergency departments have introduced transdisciplinary care coordination teams. Such teams comprise staff from multiple disciplines who are trained to perform roles outside their usual scope of practice. This study aimed to critically evaluate the patient, carer and ED staff perceptions of the transdisciplinary model of care in an emergency department in a Melbourne metropolitan hospital.

The evaluation of the transdisciplinary team involved interviews with patients and carers who have received the transdisciplinary team services, and focus groups with emergency nursing and transdisciplinary team staff.

Analysis of the data revealed that the transdisciplinary model provided an essential service, where staff members were capable of delivering care across all disciplines. The ability to perform comprehensive patient assessments ensured safe discharge, with follow-up services in place. The existence of this team was seen to free up time for the emergency nursing staff, enabling them to see other patients, and improving department efficiency while providing quality care and increasing staff satisfaction.

This study identified several important factors which contributed to the success of the transdisciplinary team, which was well integrated into the larger emergency department team.

Introduction

Health care systems and administrators have been required to respond to mounting demands on emergency departments (EDs). The increasing number of patient presentations, access block and limited resources has resulted in overcrowding and decreasing patient satisfaction (Forero et al., 2011). Several initiatives have been implemented to address these issues, including waiting room nurses (Innes et al., 2015), streaming, rapid assessment teams, short stay units and care coordination programmes (Crawford et al., 2014). Care coordination teams are typically multidisciplinary, and aim to decrease admissions (Peter et al., 2011), waiting times, and access block in the emergency department (ED), by preventing unnecessary admissions and readmissions, and providing safe and effective discharge (Corbett et al, 2005, Moss et al, 2002).

Transdisciplinary teams are a unique way of drawing together the skills of different disciplines. In a multidisciplinary team, individuals from varied disciplines work in parallel to perform discipline-specific assessment, planning and delivery of care to address common goals (Rosenfield, 1992, Smart, Smith, 2013). Within the multidisciplinary model, discipline boundaries are evident, with each member adhering to the roles and responsibilities of their discipline (Stepans et al., 2002). Multidisciplinary teams are common in EDs. Interdisciplinary teams also work together to address common goals, sharing communication, but still working from a disciplinary-specific basis (Dyer, 2003, Rosenfield, 1992). By comparison, transdisciplinary teams cross the boundaries of disciplines (Rosenfield, 1992). “Members of the team share knowledge, skills and responsibilities” (Dyer, 2003, p. 187), completing training in other disciplines, and thereby increasing each team member's scope of practice (Batorowicz, Shepherd, 2008, Cartmill et al, 2011, Dyer, 2003, Stepans et al, 2002) and flexibility in workload (Dyer, 2003). The transdisciplinary skills of team members allow them to provide whichever services and skills are required at any given time. This is an important advantage of the transdisciplinary team model, as it avoids the delays associated with waiting for multiple specialised assessments (King et al., 2009).