Collaborative Healthcare

Collaborative Healthcare

Hello everyone. My name is Annette. I am here to talk about collaborative healthcare based on a case scenario of a 2-year-old patient. In today’s healthcare system, the processes of delivery involve several patient handoffs and interfaces among different healthcare practitioners with diverse levels of occupational training and education. During a 4-day stay in a hospital, for example, a patient may interact with more than 40 different staff including nurses, physicians, specialists, and technicians, among others. For clinical practice to be effective, it requires that critical information is communicated accurately. Team members need to collaborate for effective patient care (Morley & Cashell, 2017). When there is ineffective communication between healthcare professionals, the patient’s safety is at risk for a number of reasons: information misinterpretation, lack of critical information, unclear orders made over a telephone call, and changes in patient status that are overlooked.

I will now share some information about the patient, Caitlyn Bergan.

Caitlyn Bergan is a 2-year-old pediatric patient who was brought to Valley City Regional Hospital with complications of pneumonia. It was the second time in six months that she had been brought in. The patient had decreased breath sounds at the right bases, and rhonchi were scattered in her upper lobes. Her temperature reading was 101, and respiration was recorded as 32. The respiratory therapist administered to the patient a nebulized aerosol, after which she had thick secretions. She also issued chest physiotherapy.

Caitlyn’s weight was 20.7 pounds and below the average weight. Her extremities had decreased subcutaneous tissue as well. A sweat chloride test gave results of 65 milliequivalents per liter. The patient’s mother, Janice, reported that when Caitlyn kissed her, she tasted salty. The patient was diagnosed with cystic fibrosis.

Caitlyn’s family lives in a small town, McHenry, which is an hour’s drive from Valley City Hospital. Her pediatrician, who is located in McHenry, does not have telemedicine access to Valley City. Although Caitlyn has insurance coverage from her father, Janice was not sure whether the insurance covered breathing complications and other treatments. The collaborative care for Caitlyn called for the respiratory nurse to educate Janice on how to care for Caitlyn, access Valley City via telemedicine, and coordinate with the pediatrician through phone calls and texts.

I will now talk about how evidence-based practice was used in developing a care plan for Caitlyn.

Telehealth, as defined by Tuckson et al. (2017), refers to health and health-related services’ delivery and facilitation and includes medical care, provider education, patient education, health information services, and self-care through digital communications and telecommunications. Examples of technologies used in telehealth include remote patient monitoring, ‘store and forward’ electronic transmission, mobile health apps, and live video conferencing.

In the case of Caitlyn, telehealth was used to ensure that she accessed the much-needed care to manage her cystic fibrosis. The physician at Valley City and the respiratory therapist contacted the patient’s pediatrician. They arranged that whenever the latter needed more information on treating cystic fibrosis in the patient, he would text Valley City. The team also agreed to set up phone call care whenever consultation was necessary. The social worker at Valley City also contacted the social worker at McHenry, and the two arranged that the latter would get information relating to the insurance coverage that was available to Caitlyn. The respiratory therapist also went ahead and educated Janice on how to perform percussions on Caitlyn to help clear phlegm in her lungs. Janice, at some point, made a video call to Valley City and consulted with the therapist on how to properly perform chest percussions on Caitlyn.

The John Hopkins model is a problem-solving approach that can be used in clinical decision-making. The model is accompanied by tools that guide an individual or group in using it. The model is designed to meet the practicing nurse’s needs and utilizes a 3-step process known as the PET (practice question, evidence, and translation of evidence to practice). The model aims at ensuring the best practices and latest research findings are appropriately and quickly incorporated into caring for patients (Hopkins Medicine, n.d)

In this case study, the Johns Hopkins model was ideal for caring for Caitlyn. The nurse practitioner and respiratory therapist looked at the challenges that Caitlyn faced regarding her health and access to care. The patient history was taken, and the subjective report from the mother, Janice, formed the basis for tests to be run. A diagnosis of cystic fibrosis, a long-term illness, was made. The next step was to start on patient treatment and education. The respiratory therapist educated Janice on how to help her daughter manage the illness. She was shown how to perform proper percussions on Caitlyn and the symptoms to look out for. The nurse practitioner and the therapist went a step further and contacted Caitlyn’s pediatrician to ensure that he was on standby whenever Caitlyn needed emergency care.

Next, I will reflect on the most useful and relevant evidence when making decisions regarding Caitlyn’s care plan.

Some factors, including distance, professional expertise, and a lack of interconnectivity, drove the decision to engage in telehealth. Caitlyn’s parents decided that they wanted professional knowledge in their daughter’s treatment; thus, they consulted the doctor at Valley City Regional Hospital. The hospital, however, is an hour’s drive from McHenry, where they stay. For continued monitoring and faster consultation after discharge, the pediatrician at McHenry had to be involved in caring for Caitlyn. Communication between the pediatrician and Valley City Hospital had to be done via text and phone calls due to the lack of internet connectivity between the two.

Lastly, I will identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

Janice took the initiative to call Valley City Hospital when she noticed some red marks on her daughter’s ribs. During the call, she also said that she was always on the lookout for any symptoms. The respiratory therapist had educated Janice on how to perform percussions prior to discharge. The pediatrician was committed to learning more about cystic fibrosis and was also willing to communicate via phone regarding patient consultation and updates.

To mitigate any challenges that the interdisciplinary team may face, the care team will need to have authorized access to the patient’s electronic health record. Each team member will be required to update the paper immediately after seeing the patient. Doing so will ensure that all members are on the same page, and better decision-making will be made possible (Kruse et al., 2017).

In evaluating the positive benefits of the collaborative model and mitigating any challenges, the nurse practitioner can use a Collaborative Assessment Tool (CAT). The CAT will determine if all collective members have a clear understanding of the mission of care for Caitlyn; in this case, it is helping the patient manage the life-long illness by educating her mother on what to do. The CAT will also ensure that the team members are inspired and motivated; the pediatrician stated that he had limited knowledge of the management of cystic fibrosis; hence, the NP will need to ensure that the pediatrician doesn’t become demotivated in caring for Caitlyn. To do so, the NP will share any information on her findings from patient visits. Janice will also need to remain motivated and inspired; hence, the Valley City team suggested that she be linked to a grieving group for parents who have had challenges with their children. The CAT will also assess whether clear roles, procedures, and responsibilities are being followed and that all members are empowered to fulfill their roles. For instance, the pediatrician was encouraged to link to Valley City’s telehealth collaboration for easier access to patient care and communication with the rest of the team members.

In conclusion, telehealth, in this case scenario, has connected the patient to specialized medical services that were not available in her community. Telehealth will enable the patient to avoid wasting time associated with long-distance travel (Mechanic et al., 2017). Additionally, the patient will avoid extra visits, waiting periods, and scheduling when the specialists are available regularly via telehealth appointments.

References

Hopkins Medicine (n.d). Center for Evidence-Based Practice. https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html

Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ open, 7(8), e016242.

Mechanic, O. J., Persaud, Y., & Kimball, A. B. (2017). Telehealth systems.

Morley, L., & Cashell, A. (2017). Collaboration in health care. Journal of medical imaging and radiation sciences, 48(2), 207-216.

Tucson, R. V., Edmunds, M., & Hodgkins, M. L. (2017). Telehealth. New England Journal of Medicine, 377(16), 1585-1592.

ORDER A PLAGIARISM-FREE PAPER HERE

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Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in the Vila Health Remote Collaboration on Evidence-Based Care media scenario.

Discuss the ways in which an EBP model and relevant evidence helped you to develop and make a decision about the plan you proposed.

Wrap up by identifying the benefits of the remote collaboration in the scenario, as well as discussing strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaboration challenges you observed in the scenario.

Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform you. Make sure that you address the following grading criteria:

Propose an evidence-based care plan to improve the safety and outcomes for a patient based on the Vila Health Remote Collaboration on Evidence-Care media scenario.
Explain the ways in which an EBP model was used to help develop the care plan.
Reflect on which evidence was most relevant and useful when making decisions regarding the care plan.
Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.
Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in the current APA style.
The case that is to be in the paper is the following scenario.

Introduction Evidence-based care can be a challenge in any medical situation, but particular difficulties present themselves when care is being provided remotely. In order to provide quality care to patients who live in rural settings or have trouble with transportation to a care site, healthcare professionals must sometimes collaborate with other professionals in different ZIP codes or even time zones.

In this activity, you will observe how healthcare professionals collaborate remotely and virtually to provide care for a patient in Valley City, North Dakota.

The Patient Presents

Dr. Erica Copeland and Virginia Anderson, a pediatric nurse, discuss Caitlynn, who came into the ER last night and has now been admitted to the pediatric unit.

Dr. Copeland starts the conversation.
Dr. Copeland: Nurse, can you give me an update on Caitlynn? I know she’s two years old, and she’s been admitted for pneumonia. Does she have any history of breathing problems?

Virginia Anderson: Yes, this is her second admission for pneumonia in the last six months. She had a meconium ileus at birth.

Dr. Copeland: All right. Is she presenting with any other symptoms?

Virginia Anderson: She has decreased breath sounds at the right bases and rhonchi scattered in the upper lobes. Respirations are 32 and shallow with a temp of 101.

Dr. Copeland: What have we done for her so far?

Virginia Anderson: The respiratory therapist administered nebulized aerosol and chest physiotherapy. After the aerosol, she had thick secretions.

Dr. Copeland: I see her weight is 20.7 pounds, and there’s been some decreased subcutaneous tissue observed in her extremities.

Virginia Anderson: Correct. I noticed this, too, so that she might have some malabsorption of nutrients.

Dr. Copeland: Have we done a sweat chloride test yet?

Virginia Anderson: Yes, and the results were 65 milliequivalents per liter. Also, the mother reports that when she kisses her, she tastes salty.

Dr. Copeland: All right. Well, I think it’s fair to say we might be dealing with cystic fibrosis here. Let’s get her started on an IV with piperacillin and keep an eye on her temperature.

Collaboration Begins
Later, the diagnosis is confirmed: Caitlynn has cystic fibrosis. Dr. Copeland, Virginia Anderson, and Rebecca Helgo, the hospital’s respiratory therapist, have a short consult, where they realize that Caitlynn’s care will not be easy.

Dr. Copeland starts the conversation.
Dr. Copeland: Let’s talk about Caitlynn Bergan. Her mother, uh, [checks notes] Janice, has been informed of her diagnosis. I didn’t realize this when she first came in, but she doesn’t live in Valley City; she’s in McHenry.

Rebecca Helgo: That’s a tough drive during winter. They’re over an hour away, aren’t they?

Dr. Copeland: That’s right. It was a toss-up between coming here or going to Jamestown, but I guess the father — Doug — thought Valley City was the better choice. Anyway, I’ve put her on Ppancreasenzymes, and we’ll be recommending a high-protein, extra-calorie diet along with the fat-soluble vitamins — A, D, E, and K. I’ll update her pediatrician on her condition and order dornase alfa. Let’s see how she does with the breathing treatments. How are those going?

Rebecca Helgo: Quite well, actually. She’s too young to get her to do the huff breaths, but we’re keeping the secretions thin and manageable with the aerosol treatments. I am concerned about her day-to-day treatment, though. She’ll be back here with pneumonia if the parents can’t stay on top of that. She’s at risk for impaired gas exchange and respiratory distress, which will cause her anxiety and more pain, and that’s not going to help her stay well.

Dr. Copeland: How well do you think the parents will be able to handle the treatment?

Virginia Anderson: That might get tricky. I gather that the mother and father are still married but separated. We’ll need to make sure that at least one of them gets the education they need. But they both work, and trips here aren’t the easiest choice. We should get a social services consult to coordinate services and identify some assistance for the family in McHenry.

Rebecca Helgo: I can do some education here and then do a Skype consult with one or both of them once she’s been discharged and is back home.

Dr. Copeland: It sounded like both parents work long hours. Are you going to be able to schedule times that work?

Rebecca Helgo: I may have to do some after-hours appointments. We’ll have to sort that out.

Virginia Anderson: She’s had one bowel obstruction already, so I think we need to help them monitor for DIOS, too. Does the pediatrician’s office have a telemedicine relationship with us? That might be helpful in preventing unnecessary trips here.

Dr. Copeland: Let’s find out a bit more and see what our options are.

Consulting With the Pediatrician
Later that day, Dr. Copeland and Virginia Anderson talk to Dr. Benjamin, Caitlynn’s pediatrician, about how his office can coordinate with the hospital on Caitlynn’s care.

Dr. Copeland greets Dr. Benjamin.
Dr. Copeland: Hello, Dr. Benjamin. I’m sorry to be meeting under such circumstances; I hope we can work with you to help the Bergans handle Caitlynn’s care. On the line with me is Virginia Anderson, the nurse assigned to Caitlynn while she’s here.

Dr. Benjamin: Hello to both of you. Yes, it’s unfortunate. This is the first case I’ve seen among my patients.

Dr. Copeland: Are you familiar with the CF protocol?

Dr. Benjamin: I am, but I’d love to get any more details that relate to Caitlynn. She’s done with most of her immunizations, but she still needs her HAV and influenza, of course. I’m also not sure where to order some of the pancreatic enzymes and medications you listed.

Virginia Anderson: We can help with all that. Do you have telemedicine access to Valley City?

Dr. Benjamin: No, but we do have it with Cooperstown Medical Center. We have to be in a town of less than 100 people.

Dr. Copeland: We may be able to use Skype on a more informal basis for consults between us, but it might be good to get connected with Valley City on your telemedicine equipment. If the parents bring Caitlynn to you with symptoms, and you’re not sure whether the hour-long trip is necessary, we can make a telemedicine appointment and make sure.

Dr. Benjamin: All right. It sounds like we might see them often initially, and I understand that bowel obstructions and pneumonia are two possible complications. We can handle some of those issues here, but assuming they have trouble during working hours, I think we can reach you by phone.

Dr. Copeland: You or your staff can send me a text. If we need to talk further, we can set up a call, but if not, text is the quickest way to get my attention and the easiest way for me to respond between things.

Virginia Anderson: And I’m available via text as well if you’re having trouble reaching Dr. Copeland or if it’s a question I can field.

The Care Plan Continues
To address some of the questions that came up during the consult, Virginia met with Madeline Becker, the social worker at the clinic in McHenry.

Virginia starts the conversation.
Virginia Anderson: Hi, Madeline; this is Virginia Anderson at Valley City Regional Hospital. I’m on the line with Marta Simmons, our social worker here at the hospital.

Madeline Becker: Hi, both of you.

Marta Simmons: Madeline, we’re calling because Virginia is working on a care plan for a child from McHenry, Caitlynn Bergan. He’s here after a about of pneumonia, and she’s been diagnosed with cystic fibrosis. I wanted to talk to you about resources there for some of the issues the Bergans are going to be dealing with.

Madeline Becker: Of course. I got the documentation you emailed earlier. Fortunately, the Bergans are both employed and have good insurance through Doug’s new job. Ut, as you may have heard, he was unemployed for some time, so money is tighter than it might seem.

Virginia Anderson: We’ve talked to Janice, and she isn’t sure what her insurance covers as related to the breathing and other treatments Caitlynn is likely to need.

Madeline Becker: I can do some initial work on that. I’ll need a release from Janice to get detailed information, but I should be able to get general coverage information. What other resources might they need? McHenry is pretty small, as I’m sure you’re aware.

Marta Simmons: The main issue is going to be the stress of caring for a child with a chronic illness. Ven a group that helps members deal with grief would be helpful. Children with CF live much longer than they used to, but it’s still a difficult condition.

Madeline Becker: There isn’t a group like that here, but there is one in Sheyenne. Mean, it’s more for parents in grief already, parents who have lost a child, but it’s a sizable group. I’m sure there will be some parents who understand what it’s like to have a child with a difficult condition.

Virginia Anderson: All right, that helps. Ow, we’re going to provide as much education as we can before Janice takes Caitlynn home, but what kind of resources are there in McHenry? If she doesn’t have home Internet access, does the library offer it? Is there a library?

Madeline Becker: No, the closest library is in Cooperstown.

Marta Simmons: Well, we’ll talk to the Bergans’ pediatrician and see if they might be able to help if they need materials and can’t get them easily at home. His is progressive and lifelong, and they’re going to need some support as they learn to deal with it.

Respiratory Therapist Consult on Skype
A few days after Janice and Caitlynn go back to McHenry, Janice calls to talk to someone about whether she’s doing Caitlynn’s chest physiotherapy correctly. Virginia and Rebecca, the respiratory therapist, called her back on Skype to answer her questions.

Virginia Anderson starts the conversation.
Virginia Anderson: Hi, Janice; thanks for contacting us! We’re getting back to you about Caitlynn. Ith me on the line is Rebecca Helgo, the respiratory therapist who helped you out when you were here.

Rebecca Helgo: Hi, Janice.

Janice: [sounding stressed] Hi.

Virginia Anderson: Janice, how is it going with Caitlynn?

Janice: Well, that’s why I called, actually. It’s Not so good. Mean, not bad, but I guess I do not remember everything you told me when we practiced the physiotherapy, the chest physiotherapy.

Virginia Anderson: That’s okay, Janice. I know this feels overwhelming. Caitlyn’s condition is an extensive one, and we’re here to help you manage it. I’ll continue to be here as you’re figuring this out, okay?

Rebecca Helgo: That’s right, Janice. I know you’ll get the hang of it, but in the meantime, there’s a lot to learn. Do you have some questions about chest physiotherapy? What’s going on?

Janice: Okay, if you can see on the camera, Caitlynn has these red marks on her ribs here. Is that a symptom of something?

Rebecca Helgo: Can you get the camera just a bit closer?

Janice: How’s that?

Rebecca Helgo: Okay, very good. Es, those look like marks from the percussion. Are those over her last two ribs?

Janice: I think so.

Rebecca Helgo: That’s one thing you’ll have to remember: You don’t want to do the percussion on her last two ribs on either side, her backbone, or her breastbone. And when you do it anywhere else, you don’t want to leave red marks. If you see those, that’s a hint that you’re doing the percussion just a bit too hard.

Virginia Anderson: Don’t worry, you haven’t hurt her that I can see. Plus, you’re obviously really staying on top of things, and you’re following the recommended treatment procedures for Caitlynn, and I really want to praise you for that. o, is she acting like that area is hurting her? r can you tell?

Janice: No, it doesn’t seem like it’s hurting her at all.

Rebecca Helgo: She should be fine, then.

Virginia Anderson: And remember, Janice, if you continue to have trouble with this, we’ve got other options. Here’s a vest that vibrates the child if percussion isn’t getting the job done. And you won’t have to do exactly this forever. s she gets older and can learn how to do huff coughs, you’ll be doing less work, and she’ll be doing more.

Janice: Okay. Hank, you; that makes me feel better. I couldn’t get hold of my pediatrician, and I was getting worried.

Rebecca Helgo: Good, that’s what we’re here for.

Virginia Anderson: Janice, should we review the signs and symptoms of respiratory distress? We’re happy to go over anything you need to feel more confident about monitoring Caitlynn.

Janice: I think I remember those. I feel like I check for them every hour.

Rebecca Helgo: [chuckles] That’s understandable. Remember to check with Dr. Benjamin or me or Virginia if you need to.

Conclusion

As you saw in this activity, coordinating care can be a challenge when the patient lives far from her provider or when multiple providers are distant from each other. Any technologies may be necessary in order to provide quality evidence-based care to patients when care teams and patients are not in the same location. Nurses and other health care professionals must find creative solutions when problems arise so that care planning for remote patients is just as comprehensive and outcome-based as that for patients nearby or on-site.