Centers of Excellence Primary Care Education
Transforming clinical education and preparing health professionals
Coordinating Center BLAST News Links May 16, 2013
The CoEPCE Coordinating Center BLAST is under re-construction! In an effort to bring you a valuable product we are rethinking the timing and delivery schedule of the BLAST. Your suggestions around document content and delivery are continually encouraged. Please submit your thoughts to Laurie Traylor
Boise VA Academic PACT Engages Ambulatory ICU with Trainees
Authors: Janet Willis, RN, BSN, William Weppner, MD, MPH, FACP,C. Scott Smith, MD, FACP Melanie Nash, MSN, NP-C, RNP, Jared Bernotski, BA
Collaborative, team-based care is a central component to the success of Patient Aligned Care Teams (PACT). Considerable evidence supports the importance of this approach in patients with multiple medical and behavioral health concerns. Despite this evidence, tracking progress and evaluating outcomes across the spectrum of care has been a missing link.
In response, a group of healthcare providers at the Boise (BVAMC) Center of Excellence in Primary Care Education (CoEPCE) have developed the EFECT model to strengthen collaboration and patient tracking across disciplines.
Using this mnemonic as part of the Boise CoEPCE/PACT Interprofessional Care Updates (ICU) has improved interdisciplinary providers' and trainees' ability to formulate a patient care plan that hinges on tracking changes and assessing progress.
Using this mnemonic as part of the Boise CoEPCE/PACT Interprofessional Care Updates (ICU) has improved interdisciplinary providers’ and trainees’ ability to formulate a patient care plan that hinges on tracking changes and assessing progress.
Each Thursday morning, an interdisciplinary group of healthcare trainees and supervising providers join to discuss treatment care plans for complex, high acuity patients assigned to CoEPCE trainees on the outpatient Silver Team. These care conferences, otherwise known as PACT ICU, bring together a multidisciplinary cohort that consists of primary care provider (PCP) trainees (both Nurse Practitioner and Physician), nurse care managers, pharmacy trainees, behavioral health trainees, social work, and a Chaplain. Facilitators are supervising providers from some of these disciplines. In addition to improving tracking and outcomes for individual patients, PACT ICU conferences have contributed to a more comprehensive approach to primary care through helping team members develop a better understanding of roles, responsibilities and important contributions of the various disciplines.
Patients for discussion in the PACT ICU are generally selected using the Care Assessment Needs (CAN) tool which provides information on patients with high morbidity and/or most likely to be admitted into the hospital in the next 30 days. The CAN report and other pertinent information is available on a secure internal wiki. Using a brief narrative, the PCP describes issues in the patient’s overall health status. Often, this leads to a more focused discussion that draws out each discipline’s sets of expertise. The vibe is generally informal, and participants are encouraged to contribute their thoughts using evidence-based processes derived from their specific field of study. Such an approach has improved ability to communicate as a team and marshal resources that more effectively and collaboratively address complex concerns.
Generally, two patients are selected and discussed in 30 minute blocks. The patient’s electronic medical record (EMR) is revealed on a large screen and the PCP begins by eliciting the narrative of the patient’s health history. This facilitates discussion among the team members and stimulates further review of the EMR. A gap analysis is conducted to determine which areas of care are likely to have the greatest impact on the patient. Collaboratively, a care management plan is formulated and tasks are given to individuals based on their role in caring for the patient. The primary care provider summarizes the plan in the patient’s EMR and includes interdisciplinary team members as additional signers to the note. Changes are tracked over time as the interventions are started.
While research on the EFECT framework in PACT ICU still awaits IRB approval, highly positive initial feedback from providers and improvements in outcomes from high-utilizing patients look promising. Therefore, the Boise CoE plans to evaluate and share more about lessons learned from the PACT ICU in future articles. Thank you Boise CoEPCE Team!
West Haven Center of Excellence Primary Care Education
1st Annual Research and Performance Improvement Day A Presentation of CoE Faculty and Trainee Scholarly WorkThursday May 16 Program Highlights:
Coordinating Center Staff