Department of Interdisciplinary Practice and Training

Additional Info

• Audio File:uab/ua066.mp3
• Doctors:Flood, Kellie
• Featured Speaker:Kellie Flood, MD
• CME Series:Quality and Outcomes
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=4619
• Guest Bio:Kellie L. Flood, MD practices Geriatric Medicine in Birmingham, AL. Dr. Flood graduated from University of Texas Southwestern Medical Center Southwestern Medical School in 1996 and has been in practice for 21 years.
  
  Learn more about Kellie Flood, MD
  
  
  Release Date: April 25, 2018
  Reissue Date: March 8, 2021
  Expiration Date: March 8, 2024
  
  Disclosure Information:
  
  Planners:
  Ronan O’Beirne, EdD, MBA
  Director, UAB Continuing Medical Education
  
  Katelyn Hiden
  Physician Marketing Manager, UAB Health System
  
  The planners have no commercial affiliations to disclose.
  
  Faculty:
  Kellie Flood, MD
  Associate Professor in Hospice and Palliative Care, Geriatric Medicine, Internal Medicine
  
  Dr. Flood has no financial relationships related to the content of this activity to disclose.
  
  There is no commercial support for this activity.
• Transcription:Melanie Cole: Our topic today is interdisciplinary practice and training. My guest is Dr. Kellie Flood. She's a geriatric quality officer and the assistant chief medical office for care transition at UAB Medicine. What is interdisciplinary training and how does it differ from a multidisciplinary approach to training?
  
  Kellie Flood, MD: Thank you. In the hospital setting, in traditional models of care, you have multiple disciplines who all work on a hospital unit, but they tend to function primarily in their silo. For example, you have physicians, nurses, pharmacists, dietitians, case managers and social workers, but in traditional models, you don't have all of those folks around the table every single day all working as one connected team to develop the plan for that individual treatment. In an interdisciplinary or interprofessional model, you have all of those subspecialists and disciplines coming together every single day in a very structured team meeting where everybody can communicate their observations regarding the patient, so we all can be on the same page for the right plan for that patient not only for that hospital day but for their care transition as well.
  
  Melanie: What are some of the goals of interdisciplinary training or interdisciplinary education initiatives?
  
  Dr. Flood: We know from the geriatric literature that if patients, especially older patients, come into the hospital with certain vulnerabilities, then they're at an increased risk of adverse events during their hospitalization, so they may be vulnerable in terms of functional decline or dementia or they may be at increased risk of experiencing a side effect from a medication or developing delirium. The goal of an inter-professional team is to very proactively assess for present vulnerabilities such as declines in function and cognition or risk for developing a complication, and that way, we can put plans in place to prevent complications while the patient is receiving the medical care they need for the acute issue that brought them into the hospital in the first place.  
  
  Melanie: As those are some of the goals, what are some of the challenges of this type of training?
  
  Dr. Flood: It’s very interesting because we all know that it works best for providers as well as for patients and families. In the current hospital workflow, everyone who works in the hospital is very busy, so it really takes dedication at the organizational leadership level to say it’s going to be a priority that we provide structures and processes for training our workforce to work in teams, that we can develop a curriculum and that we create a way to have these daily team meetings on our hospital units. What really needs to become an expectation at the organizational level that if we can restructure how we work together, we actually save ourselves time in the long run while we also improve the quality of care, and studies have shown that this actually reduces cost as well. Functioning and practicing medicine in teams is really a way to achieve the triple aim. We provide better care for vulnerable patient populations with higher quality and at a reduced cost.
  
  Melanie: Such an important point. Discuss the newly formed department of interdisciplinary practice and training and how you provide a broader and more diverse experience.
  
  Dr. Flood: At UAB Hospital, we initially started these efforts around geriatric care on our one geriatric acute care for elders unit. Our organization quickly realized this is just better care and right care for all vulnerable patients in our hospital, so we needed an infrastructure to be able to provide this care delivery redesign and education throughout our hospital setting. The department was formed about two years ago and this is our home base from which we develop and disseminate inter-professional team training targeting geriatric syndromes, such as function and cognition, but we also recognize that these syndromes apply to younger patients as well. When we deliver our training, we’re really targeting not specifically just a patient age, but patient vulnerabilities. We’re able to train all of our disciplines all together in the same program, so we have nurses, pharmacists, physical, occupational, speech and respiratory therapists, case managers, social workers – every single discipline that works at UAB Hospital is touched by this training and we really specifically don’t train them in their siloes but bring them together and train them as a team.
  
  Melanie: How does it specifically relate to the Geriatric Scholar Program? Speak about some of the evidence-based practice that you're using.
  
  Dr. Flood: The Geriatric Scholar Program is probably one of the most impactful programs that we have within our department of inter-professional practice and training. This is a two-year professional development program for staff from all disciplines as I mentioned. In year one, we deliver 40 hours of geriatric knowledge and skills content. This is where we're laying the foundation for all of our staff to not only understand why we need to change the way we deliver geriatric care but we give them the tools or the skills to be able to do that within their own unit or department. We provide content, but it's also very experiential curriculum, so we provide avenues for hands-on training. Our scholars go on clinical rotations. They practice the skills we teach in simulation training. We have a lot of case debates and application homework assignments. In year one, they not only have knowledge but they now have their newly equipped geriatric skills. They are also tasked with teaching the same skills to their colleagues on their units and we track and measure who they're teaching and what content they're teaching. In year two of the program, we mentor them through process improvement projects where they know help us hardwire in the hospital workflow the mechanisms for actually delivering geriatric based evidence care. For example, if we're teaching a bunch of nurses about delirium prevention, then we also have to hardwire the processes into their workflow for them to be able to deliver this care. Our geriatric nurse scholars have rolled out a project related to how we now screen for delirium at UAB Hospital, we now have delirium prevention toolkits on every unit that's stemmed from Geriatric Scholar Programs, and now we teach all the units how to utilize the screening tool and toolkits to prevent and manage delirium. Our scholars are really our army of change agents that not only teach their colleagues but also drive the process improvement that will allow us to delivery evidence-based geriatric case.
  
  Melanie: Speak about HELP and Virtual ACE.
  
  Dr. Flood: HELP and Virtual ACE are now another layer of dissemination of evidence-based geriatric care. A stands for Acute Care for Elders, which is an evidence-based team model of care that’s been shown to preserve functional status and improve outcomes for hospitalized older adults. A traditional ACE unit is one designated geographically distinct unit in a hospital. We needed to extend that type of care to all of our hospital units because we have 52 units at our hospital, so we drill down all of the geriatric care into three primary themes; pain management, especially non-pharmacological pain management, maintaining safe mobility and preventing and managing delirium. In essence, we’re drilling down a full-fledged ACE unit into its three primary initiatives around pain, mobility, and delirium, and we now disseminate that teaching and care processes to all of our other units in the hospital. We've done those for about eight of our other units and we're seeing the same benefits in those units, in our virtual ACE units that we see from our geographically distinct based unit. The Hospital Elder Life Program was developed by Dr. Inouye over two decades ago and it's essentially another means of disseminating evidence-based delirium prevention, so in the HELP program, we have a nurse coordinator who trains volunteers to provide interventions that are known to prevent delirium. Now our volunteers can help us with feeding assistance and cognitive stimulation and early mobility. In essence, we’re adding on layers of additional team care for vulnerable patients through an entire organization.
  
  Melanie: How are you evaluating the impact of such programs on outcomes?
  
  Dr. Flood: We really have educational outcomes for our staff that we're training, their own professional development outcomes, we measure their performance of skills and simulation training, and ultimately all this is to be able to improve patient outcomes. We measure our scholars pre- and post-testing and we see their knowledge improve. We allow them to give us feedback in their own self-rated competencies of caring for geriatric patients, we measure their skills through simulation, and finally, as we're rolling out these programs, we measure the impact of these initiatives on patient mobility and delirium. What we are seeing is after we apply these principles and really hardwire these care processes on units, we see that more patients are mobilized and we see that delirium prevalence reduced. We do think we've established a means of disseminating geriatric care throughout an entire hospital.
  
  Melanie: That’s wonderful. In summary, tell other physicians what you'd like them to know about the department of interdisciplinary practice and training and UAB Medicine and when to refer.
  
  Dr. Flood: We would be delighted to help other hospitals actually develop similar departments, it’s not a full-fledged department, to develop these similar programs, so we’re working with the hospital system in Wisconsin who has now launched their own Geriatric Scholar Program. We’re working with the American College of Surgeons right now to help disseminate these virtual ACE techniques and processes, targeting surgical patients eventually nationwide, so we would love to be of assistance to other hospitals who would like to develop similar programs targeting geriatric patients, but really patients of any age who have geriatric like syndromes, such as functional or cognitive impairment. We would be happy to assist those hospitals in developing their own program.
  
  Melanie: Tell us about your team. Why is UAB so great to work with?
  
  Dr. Flood: When I came to UAB, what attracted me to move here to Alabama and join UAB is really just the collaboration and collegial culture with the focus on one thing and that’s to do the right thing. We’re really focused right now on the right care in the right place at the right time for all of our patients. Working in teams is really just one strategy to accomplish that goal, so our team in this work, I get to work with physicians, nurses, therapists, social workers, case managers, and pharmacists. It means that I learn from my fellow team members every single day, they help me to be a better physician and a better team member, and ultimately again, our goal is that every patient family receives the same care we all want for our loved ones. You really see a team that is driven by that goal and it just makes the workplace not only so much more effective and efficient but fun as well.
  
  Melanie: Thank you so much for being with us today. A community physician can refer a patient to UAB Medicine by calling the Mist Line at 1-800-UAB-MIST. That’s 1-800-822-6478. You're listening to UAB Medcast. For more information on resources available at UAB Medicine, you can go to uabmedicine.org/physician. That’s uabmedicine.org/physician. This is Melanie Cole. Thanks so much for listening.
  
  
  
• Hosts:Melanie Cole, MS