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A Team Approach to Patient Care – Joint Appointments

Featured image: Clinician Teamwork

On Wednesday, September 11, 2019, members of VCSQI’s quality team had the opportunity to tour UVA’s Interventional Cardiology and Cardiac Surgical programs.

As we entered the halls of the facility, it was important to take in the sense of pride felt from all members of the organizations, as it resembled Cheers…a place where everyone knows your name.  This sense was proven true as we later learned about various engagement opportunities throughout the organization with efforts of getting to personally know employees.  For instance, to promote wellness and relationships, leaders are paired up with an employee and take a few lapses around the skywalk (1 mile) while engaging in meaningful conversations.

To learn more about the cardiology and surgical programs, Robbin Shifflett, RN, Cardiac Surgery Nurse Navigator, introduced us to their system-side dashboard that captured resource utilization information and so much more.  The system served as a tool to promote and sustain quality.  For example,  patients who were readmitted, triggered Robbin to begin an investigation with the patient and all current medical providers to explore cause for the readmission with efforts to prevent reoccurrences and improve quality of care.  We were later given a tour of inpatient and outpatient units of both programs.  It was important to note the location of the cardiology and cardiac surgery departments as their close proximity appeared to have helped to foster the dynamic partnership between both teams.

The tour also consisted of us observing the hospital wide huddle in the “situation room”.  It was a powerful experience to see over 70 leaders fill the room to discussion items going on in their respective departments that could potentially effect patient care if gone unknown.  This meeting served as a forum to create strategies to counter potential obstacles.  The format of the meeting, lead by UVA’s Chief Nursing Officer, was quick and to the point, allowing only emergent situations to be verbally announced.  However, each respective department’s voice was captured visually on the wall for all to be aware, (see image 1) as this was updated as participants entered the room.  Like many health care facilities, more focused huddles take place to report out information shared during the hospital-wide huddle as well as to create a department specific game plan to carry out quality patient care.

Image 1: Wall in Situation Room that captures delays and other pertinent information relevant to patient care.

 

Image 2: Joint Appointment Huddles

 

 

With efforts to capitalize on their transparent communication strategies, neighboring  service locations, and collaborative environment, UVA has implemented joint appointments as a method for expediting procedure workups for severe cardiac conditions.    With joint appointments, a multidisciplinary team of providers assess a patient during a single visit.

To learn more about UVA’s trial phase of joint appointments, I met with Marissa Donatelle, Program Coordinator – Advanced Cardiac Valve Center, who developed the model (image 2).  With a collaborative approach to care, cardiologists, surgeons, anesthesiologists, and other medical professionals all work together to design the ideal treatment and recovery plan for each patient.

Patients are scheduled for images and tests the same day as their joint appointment, prior to coming to seeing the team. Once in clinic they are checked in and roomed just like any other appointment.  Following rooming, the RN care coordinator begins the appointment by reviewing medications and symptoms.  While she is at work, the team (APP, Cardiology, Cardiac Surgeon) review images and test results to determine a preliminary plan.  The RN care coordinator then gives her report to the team.  After which, they all then go in to meet the patient and collaborate on the next best approach for that patient.

The duration of the joint appointment is 90 minutes and has shown promising outcomes as it is improving patient throughput and expedites the procedural work up process.

Patients are now being worked up on average, from referral to ready for procedure, in 5 weeks.  As a result, UVA is now at capacity for procedures and will open up another day starting in late January. The team has also started rolling the model out to additional surgeons and cardiologist.

Kudos to the UVA team for their extraordinary contributions to patient care.

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