Interprofessional Teamwork Is Key to Top-Notch Patient Care and Outcomes

When you ask Deborah Klein, MSN, APRN, ACNS-BC, CCRN, FAHA, FAAN who she teams with as a clinical nurse specialist in the coronary ICU, heart failure ICU and cardiac accelerated recovery/cardiac short-stay/post-anesthesia care at Cleveland Clinic’s main campus, her answer is simple – everyone.

“Although we are all here for the same purpose, we each bring a very specific skill set,” she says. “None of us can work in isolation in addressing all of the challenges related to patients, families and the hospital system.”

Two initiatives that depend on teamwork

Klein fosters teamwork among healthcare providers on her units in many ways, ranging from informal one-on-one collaboration to formal multidisciplinary initiatives sanctioned by the Cleveland Clinic healthcare system. The latter includes these two notable initiatives:

• Multidisciplinary Rounds– The coronary and heart failure ICUs began multidisciplinary rounds approximately 15 years ago to ensure that all caregivers understand the plan of care for patients. Klein coordinates the rounds, which occur each Wednesday at 2:30 p.m. and include the second-year cardiology fellow, case manager, social worker, spiritual care, physical therapist, occupational therapist, respiratory therapist, bioethics, nutrition services and any other appropriate staff member.

Prior to the meeting, Klein and clinical nurses identify long-term patients and patients whose plan of care may be unclear to the group. “As a team, we discuss where we are with those patients and where we are going,” says Klein. “It gets us all on the same page without having to decipher notes in the electronic medical record.” For example, if it looks like a patient is headed toward long-term acute care, the case manager and social worker are on hand and can start the process. If a patient requires alternative medical therapies, the team can sort through the options together, each lending their unique insight.

• The CCHS ICU Practice Council – Klein chairs the Cleveland Clinic health system ICU Practice Council, which has representatives from all adult ICUs in Northeast Ohio, as well as Cleveland Clinic Florida. Members include nurse managers, assistant nurse managers, clinical nurse specialists and directors of critical care. They meet monthly for an hour-and-a-half online call. “Together, we look at all of our nursing protocols and how we can standardize practice across all of our adult ICUs,” says Klein.

Since the council began in 2011, it has standardized care using the best evidence around central venous catheters, cardiac assist devices, mechanical ventilation, chest tubes, Foley catheters and more. “One of our greatest accomplishments is standardizing our end-of-life care,” says Klein. “Because there is trust and respect among council members, we can have tough conversations and make decisions based on the best evidence that benefit patients, families and the healthcare team.”

Strategies to foster interprofessional collaboration

The key to working well together, asserts Klein, is open communication. “Be open in your mind, your body language and the words you use,” she says. “It’s about mutual respect – being able to listen to different viewpoints and trying to understand that person’s frame of reference.”

Klein offers a handful of tips for fostering interprofessional collaboration:

• Set expectations early– “All of our nurses hear the word collaboration from the day they enter the doors of Cleveland Clinic,” says Klein. “As they go through orientation, year one, year two and so on, there is an expectation that we will all work together.”
• Cast a wide net for collaboration– “Ask yourself who you need at the table to provide the best care with the best outcomes,” says Klein. “One person cannot address everything. Our patients are more complex and living longer. All the psychosocial challenges they are dealing with in life outside the hospital are brought to the bedside.” Depending on the situation, your team may include a wide array of caregivers, from music therapists to infection preventionists.
• Decide on your purpose– “We all have to believe in the same purpose,” says Klein. Each team may have a different aim. For instance, the main goal of multidisciplinary rounds in the coronary and heart failure ICUs is moving patients through the continuum of care, ensuring the best quality of life and improving outcomes.
• Serve as a role model– “As a clinical nurse specialist, I role model collaboration,” says Klein. “People see me faced with difficult situations, working hand-in-hand with other healthcare providers.”

As the healthcare landscape continues to transform, interprofessional collaboration is more important than ever. Says Klein, “Be open to the process.”