Transdisciplinary care in the emergency department: A qualitative analysis
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).
Section snippets
Background
A transdisciplinary care coordination team consisting of emergency nurses, physiotherapists, social workers, and occupational therapists was introduced in the ED of a large outer metropolitan hospital in Melbourne, Australia in 2001. Each transdisciplinary team member completed 20 competencies to increase their educational preparedness to extend the services and care they could provide, effectively enabling them to provide health services which may typically reside within a different discipline
Method
A qualitative approach was used in this exploratory descriptive study, which utilised focus groups and interviews to gather data (Taylor and Francis, 2013). The setting for the study was the ED of a large tertiary hospital in Melbourne, Australia. Interviews were conducted with patients and carers who had received transdisciplinary team services. Carers included relatives or friends who supported the patient during their ED visit. Focus groups were conducted with ED and transdisciplinary team
Results
Analysis of the interviews and focus groups revealed four themes in relation to the transdisciplinary team: (i) transdisciplinary care model; (ii) time constraints; (iii) care in the ED; and (iv) enabling patients to return home. These findings will be presented in the following section.
Discussion
This study has identified several important factors which contribute to the success of the transdisciplinary team in ED. These factors include the transdisciplinary model itself, time management – including making time to communicate, and the provision of a safety net to enable patients to return home.
Enabling patients to return home
The patient-centred approach provided by the transdisciplinary team ensured that the needs of the patient were assessed and considered when planning care. The transdisciplinary team were reported to coordinate services and resources to enable patients to return home. The coordination of discharge services is often a barrier for patients, carers and ED staff who may not have the time or ability to identify and coordinate multiple services to affect a safe discharge. It has been reported that
Limitations
The results of this study should be considered in light of the two study limitations. The self-selection of interview and focus group participants may have resulted in sample bias. The relatives, carers and emergency nurses who participated in the study demonstrated firm views in relation to their experience of the transdisciplinary team in ED. Further, no quantitative data were reported to demonstrate improved patient flow through the ED or improved patient outcomes. In spite of these
Conclusion
This study has shown that the transdisciplinary model of care was an essential service for patients requiring complex care. The patients, carers, transdisciplinary team members and emergency nurses were unanimous in their support of this initiative in response to the increasing demand on ED services. The transdisciplinary team was well-integrated into the ED team, facilitating cross-disciplinary learning and sharing of information. Such integration ensured that the transdisciplinary team was
Conflict of interest
None declared.
Acknowledgement
The research team gratefully acknowledges the support of the ED patients and staff who participated in this study.
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