This multi-institutional project demonstrated how a structured approach to interprofessional collaboration and patient engagement can mitigate preventable harm and improve patient experience for patients with a surgical airway (tracheostomy). Care of such patients is high stakes and fraught with risk. Harm occurs in hospital settings and in the community because poor communication and fragmented care are pervasive. Poor coordination of care contributes to anxiety, frustrations, and complications. Avoidable visits to emergency departments or injury are all too common. We applied an interprofessional approach involving patients, families, nurses, social workers, pharmacists, physicians, and other stakeholders to counteract these problems.
The interprofessional education and practice approach improved quality and safety of care through partnership with patients and families. The effort involved diverse health professionals and was conducted using mixed-methods interviews, focus groups, and assessments of anxiety and depression. Using appreciative inquiry, interviews, and Normalization Measure Development questionnaires, we showed improvements in staff engagement (1536 questionnaires from 1019 staff) across 2405 admissions in 20 hospitals. Furthermore, the median length of stay was reduced, as were complications and mortality. There were significant reductions in ICU and hospital days (P< 0.01). Time to speech and oral intake decreased by 7 days (n=733; P< 0.01). Anxiety decreased by 44%, from 35.9% to 20.0%, and depression decreased by 55%, from 38.7% to 18.3% (p< 0.01). Economic analysis demonstrated average savings of thousands of dollars per patient.
These data demonstrate that interprofessional collaboration can be applied at large scale when a purposeful approach is taken to engaging patients, committing to shared interprofessional education, and tracking patient-level data for iterative improvement in outcomes. Furthermore, because tracheostomy is associated with exceptionally high expenditure, reducing complications and length of stay dramatically improves value. Furthermore, focus interviews demonstrated improved morale for the care team, thereby realizing all goals of the quadruple aim.
In support of improving patient care, this activity is planned and implemented by The National Center for Interprofessional Practice and Education Office of Interprofessional Continuing Professional Development (OICPD). The OICPD is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
The National Center OICPD is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.
This activity was planned by and for the healthcare team, and learners will receive Interprofessional Continuing Education (IPCE) credit for learning and change.
Physicians: The National Center for Interprofessional Practice and Education designates this live activity for AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with their participation.
Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.
Nurses: Participants will be awarded contact hours of credit for attendance at this workshop.
Nurse Practitioners: The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
Pharmacists and Pharmacy Technicians: This activity is approved for contact hours.
Athletic Trainers: This program is eligible for Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.
Social Workers: As a Jointly Accredited Organization, the National Center is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The National Center maintains responsibility for this course. Social workers completing this course receive continuing education credits.
IPCE: This activity was planned by and for the healthcare team, and learners will receive Interprofessional Continuing Education (IPCE) credits for learning and change.