Teamwork in Healthcare: SIBR and preparing future providers for team based care

Teamwork in Healthcare: SIBR and preparing future providers for team based care

The delivery of medical care for centuries has been achieved on a provider-patient level with minimal thoughts about communication between physician, nurse, pharmacist and other providers. This tradition has been identified as problematic and recently began to change toward the dogma of team-based care. In fact, “failures in inter-professional teamwork and communication lead directly to compromised patient care, staff distress, tension, and inefficiency; make a substantial contribution to medical error; and are a contributory factor in 61% of sentinel events”[1]. Therefore, there is a need to train current and future providers in tackling healthcare as a team.

A diagram of SIBR rounds at EUH

A diagram of SIBR rounds at EUH

 

Emory University Hospital has adopted a method of patient rounding called “Structured Interdisciplinary Bedside Rounds” or “SIBR”. SIBR is a “team-based patient centered care model” and consists of all members of the healthcare team in the patients room discussing the patients care [2]. This includes medical interns, residents, attending physician, registered nurse, pharmacist, and social worker as well as the patient and their support system [2]. A diagram of what SIBR consists of can be seen below. By utilizing SIBR, EUH has seen a reduction of in-hospital mortality of 73% over a 12-month period, a reduction in the number of hypoglycemic episodes patients encounter, and a decrease in hospital acquired infection from 1/1000 patient days to 0.1/1000 patient days [2]. These are significant morbidity and mortality reductions that have come as a direct result of team-based healthcare delivery.

Hypoglycemia rates after SIBR implementationIn-Hospital Mortality after SIBR implementation

Yet, in order to achieve these results at the professional level, the skills need to be taught starting in professional school. Nursing, medical, PT/OT, and pharmacy students are often segregated into distinct buildings and classes with little overlap or interaction. In fact, Nadolski and colleagues concluded that “The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration” [3]. I would argue that this isolation, lack of understanding of the skills and strengths of the other professions, and limited opportunities to interact socially with members of the care team early in training contributes to the hostilities, prejudice, and hesitancy to work as an effective healthcare team later on. It is akin to racial tensions that existed more blatantly decades ago but are still present today. A lack of understanding between two or more groups, whether it is Caucasians and African-Americans, American citizens and foreigners, or doctors and nurses contributes to a mistrust and unwillingness to be a truly effective team. I would argue that the more understanding one person has of another, both professional and socially, that they develop a vested interest in that person – they have put a face to the title. Further, it is harder to disrespect or ignore a person if you have had meaningful interaction with them that is not just work-place related.

 

I believe that in order to build effective healthcare teams that can be instituted at any hospital, you need to train these professional together from the beginning and encourage social interaction between them. At Emory, we hold “inter-professional training days” in order to encourage communication and teamwork between the different professions. Although this is a great idea, they only occur once a year and for a few hours at a time. They do not provide real understand between the groups and do not yield lasting relationships. A more effective method would be to assign small groups consisting of members from each school with a mentor who could meet monthly and talk about issues in healthcare. This would facilitate discussion between professions, leading to respect between providers early in their education and a framework for which they could conduct meaningful team discussions as future professionals.

 

[1] Weller J, Boyd M, Cumin D. Postgrad Med J Published Online First: Jan 7th 2014, doi:10.1136/ postgradmedj-2012-131168

[2] http://www.lj.se/info_files/infosida35103/micro2012_a7_stein.pdf

[3] Gregory J Nadolski, Mary A Bell, Barbara B Brewer, Richard M Frankel, Herbert E Cushing, James J Brokaw

BMC Med Educ. 2006; 6: 23. Published online 2006 April 25. doi: 10.1186/1472-6920-6-23

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459856/pdf/1472-6920-6-23.pdf]

Featured Title image: http://web.jhu.edu/jhnmagazine/fall2009/departments/on_pulse.html