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PubMed1984

Multidisciplinary or nondisciplinary: evaluation of staff functioning in a community mental health centre.

This paper describes the staffing aspects of an experimental community mental health centre (Melville Clinic). The different components of staff roles of members of a team consisting of different health professionals, crystallised during the three-year period with a shift from a 'nondisciplinary' to a 'multidisciplinary' approach, with preservation of 'generalised' and 'specialised', 'clinical' and 'community' roles of all staff members. The decision-making in the centre oscillated between group decisions by all staff members, and the acceptance of the leading role of the psychiatrist with the active multidisciplinary teamwork in community mental health centres.

Community Mental Health Centers↗

PubMed1996

Outcomes-based research in neurorehabilitation: the need for multidisciplinary team involvement.

There is a need for the evaluation of neurorehabilitation to reflect the integrated multidisciplinary input which is fundamental to the intervention process. The importance of multidisciplinary involvement in achieving this is discussed with particular reference to multiple sclerosis, which exemplifies the many problems inherent in chronic neurological disease that must be addressed in the evaluation of the rehabilitation programme. Some of the current difficulties of research in this specialty are raised, and suggestions made for the future.

Brain Diseases↗

PubMed1998

Effects of a multidisciplinary rehabilitation programme on health-related quality of life in patients with prolonged musculoskeletal disorders: a 6-month follow-up of a prospective controlled study.

PURPOSE: The aim of this prospective, controlled, follow-up study (6 months) was to examine the effects of a multidisciplinary rehabilitation programme on perceived health-related quality of life (HRQL) in patients with prolonged musculoskeletal disorders (PMSD). The programme focused on body awareness therapy and cognitive and relaxation treatment. METHOD: The rehabilitation group comprised 122 patients, and there were 114 patients in the matched control group (CG). Both groups of patients had access to primary health care. Baseline data were compared with 6-month follow-up data within and between the groups. The following measurements were employed: HRQL (Nottingham Health Profile), body awareness, postural control, pain (VAS), pain-related medicine consumption, isometric arm muscle endurance, aerobic capacity, psychosomatic symptoms, physical and psychosocial working environment and sick leave. RESULTS: Variables that improved significantly as compared with the CG were: HRQL, anxiety, pain related to movements, psychosomatic symptoms and need for pain-related medicines. CONCLUSIONS: The multidisciplinary rehabilitation programme used here improved HRQL in patients with PMSD to a greater extent than the standard treatment provided within primary heath care (p = 0.01) at least in the short term.

Adult↗

PubMed2006

[The role of a multidisciplinary approach in geriatric care and rehabilitation from the acute to the chronic stage].

A multidisciplinary team for bed sores consisted of 10 members including 3 dermatologists, 3 nurses, 1 physical therapist (PT), 1 pharmacist, 1 dietician, and 1 medical clerk. The incidence of new bed sores after admission was significantly decreased from 3.31% in 2003 to 1.04% in 2005 (P < 0.01). A total of 324 percutaneous endoscopic gastrostomy (PEG) procedures were performed from 2001 to January 2006. Among those, the survival of 172 elderly patient (aged 65 years or older at the time of PEG) was calculated by the Kaplan-Meier method. The 30-day mortality rates was 11%, and the 1-year, and 5-year survival rates were 61.2%, and 34.4% respectively. After discharge, 40 patients were followed up at the PEG clinic in our hospital whose staff consisted of 1 expert surgeon, 5 nurses and 1 dietician. When compared with 67 patients transferred to other hospitals or nursing homes, the patients in the PEG clinic showed a significantly longer survival (P < 0.01, 44 versus 29 months). A full-time integrated treatment (FIT) program for stroke rehabilitation was developed in the Nanakuri-Sanatorium of our university in 2000. Eighty-one stroke patients were on the FIT program during their hospital stay and achieved significantly higher activities of daily living (ADL) scores (P < 0.01) at discharge assessed by functional independence measure (FIM) compared to 41 patients on previous rehabilitation program. In addition, their ADL scores were maintained significantly higher (P < 0.05) even at 18 month after discharge, which might help them to stay home independently or with less care burden. These results suggest the important role of multidisciplinary approach for geriatric care and rehabilitation.

Activities of Daily Living↗

PubMed1994

The healing process for the multidisciplinary team: recovering post-inpatient suicide.

1. With an inpatient suicide, the staff may experience grief for a variety of reasons. The staff member's perception of self as a competent mental health care provider may be destroyed. The caregiver may grieve the loss of an ideal. Some inpatient staff members mistakenly believe that suicide can always be prevented and that the multidisciplinary team can accurately assess all patients. 2. To successfully mourn a loss, Worden (1982) identified four tasks of grieving that must be completed: accept the reality of the loss; experience the pain of grief; adjust to an environment in which the deceased or lost object is missing; and withdraw emotional energy and reinvest it in another relationship. 3. Interventions to promote healing post-inpatient suicide must be aimed at individual caregivers and the multidisciplinary team. Individual caregivers will differ in their responses based on experiences, beliefs, values, and culture.

Attitude of Health Personnel↗

PubMed1998

Psychosocial rehabilitation nurses: taking our place on the multidisciplinary team.

Nurses have been working in the AMI/ABLE ISA for the past 6 years as part of a multidisciplinary team. The nursing contribution is important to the Team, not only because of nursing expertise in providing psychiatric mental health care, but also because nurses can provide services unique to nursing, such as health assessments and education, and medication support (Fur-long-Norman, Palmer-Erbs, & Jonikas, 1997). More than 80 people who are disabled by mental illnesses have been served by this innovative program since 1991, and members' hospitalization rates have been cut approximately in half by integrating services and reducing fragmentation, and by using aggressive outreach and a psychosocial rehabilitation approach. Psychosocial rehabilitation nursing has become a subspecialty that has expanded the profession. Experience in the AMI/ABLE program demonstrates that nurses, as fully integrated members of multidisciplinary teams, adapt to working in partnerships with clients and their families, in nontraditional settings.

California↗

PubMed2005

[Continuous positive airway pressure therapy in multidisciplinary treatment].

We studied the acceptability of nasal continuous positive airway pressure (CPAP) therapy in 74 patients with obstructive sleep apnea-hypopnea (OSAH). CPAP was conducted in multidisciplinary treatment, combined with surgery and oral appliances. OSAH was defined by an apnea-hypopnea index > 20/h. Follow-up was 3 to 21 months. Automated titration during full polysomnography was conducted in the hospital using auto-CPAP devices (Autoset T, RESMED Co, Australia). CPAP alone was done in 37 (50%); CPAP with conservative nasal treatment in 25 (34%); CPAP with nasal surgery, endoscopic nose and/or sinus surgery in 10 (14%); and CPAP with uvulopalatopharyngoplasty and endoscopic nose and sinus surgery in 1 patient (1%). CPAP with an oral appliance was done in 1 (1%) to provide lower therapeutic pressure to avoid electroencephalography arousal caused by CPAP. Consequently CPAP with conservative nasal treatment and/or endoscopic nose and sinus surgery were conducted in 36 (49%). It was very important to improve nasal resistance to continue CPAP therapy. No statistically significant differences were seen between compliant and noncompliant patients in severity of OSAH, improvement of daytime somnolence, mask trouble, or nasal resistance. At the latest follow-up, 71 of 74 were still using CPAP. CPAP compliance by Kaplan-Meier evaluation was 96%. Multidisciplinary treatment involving CPAP combined with surgery and oral appliances thus improved the acceptability of CPAP therapy.

Continuous Positive Airway Pressure↗

PubMed2006

The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department.

OBJECTIVE: To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED. DESIGN: Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 - 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial. SETTING: Inner urban tertiary hospital ED. PARTICIPANTS: Frequent ED attenders who received CM. MAIN OUTCOME MEASURES: ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement. RESULTS: 60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgroup was unaffected by CM (297 v 300, P = 0.8). Admissions for ED overnight observation increased as a result of CM (P = 0.025). CM increased scores for housing stability (P = 0.007), primary care linkage (P = 0.003), and community care engagement (P < 0.001) for the whole group and variously within subgroups. Drug and alcohol use was unaffected by CM. CONCLUSION: ED-initiated, multidisciplinary CM appears to increase ED utilisation and have a positive effect on some psychosocial factors for frequent attenders. A trend towards increased ED attendance and utilisation with CM may have implications for policies that seek to divert frequent attenders away from hospitals.

Adult↗

PubMed1996

Nurses' perceptions of roles in multidisciplinary teams.

The move towards multidisciplinary approaches to health care has been encouraged by a number of government reports (DoH 1986, 1989) in order to support the increase in community care and improve the quality of the service. Such approaches to care are dependent on a high level of co-operation between members of different professions within the multidisciplinary team. Inherent in the concept of such a team is the assumption that each team member has a clear understanding of the role of all other members. This project set out to test this assumption by examining the knowledge and perception of nurses and podiatrists with regard to each other's role.

Education, Nursing↗

PubMedDate not supplied

Developing multidisciplinary profiles in a day hospital.

The Ferguson Day Hospital provides a patient-centred, multidisciplinary service for patient assessment and rehabilitation. The authors describe the development of a patient profile that has centralised documentation and reflects the multidisciplinary nature of the services provided.

Communication↗

PubMed2005

Promoting multidisciplinary relationships: a pragmatic framework for helping service providers to work collaboratively.

Multidisciplinary teamwork is increasingly considered the ideal way to provide mental health services. This is especially the case when working with children or families. However, there is little easy-to-use information available to help practicing professionals recognize and overcome barriers to working in multidisciplinary settings. There are even fewer resources intended for use across disiplines. This paper offers a practical approach to help mental health professionals identify barriers to teamwork and create solutions to those barriers.

Canada↗

PubMed1999

Limb salvage experience in a multidisciplinary diabetic foot unit.

OBJECTIVE: To assess the results of the strategy used in avoiding major amputations in patients admitted to a vascular surgical department with a new multidisciplinary diabetic foot unit. RESEARCH DESIGN AND METHODS: The study was retrospective. A total of 162 patients (172 limbs) were classified into three groups. Group A1 had limb-threatening ischemia and were undergoing revascularization (85 patients, 91 legs). Group A2 had limb-threatening ischemia, but revascularization was not feasible for them (23 patients). Group B had foot ulcers due to peripheral neuropathy and did not require arterial reconstruction (54 patients, 58 legs). RESULTS: In group A1 there were 115 revascularizations; 42 conduits had outflow to crural arteries and 14 to pedal arteries. Resection of gangrene was required in 43% of the limbs. The chances of preserved limb at 1 and at 24 months were 95 and 85%, respectively, and the chances of patient survival were 89 and 64%. In group A2, the chances of preserved limb at 1 and at 24 months were only 35 and 17%, respectively, and the chances of patient survival were only 64 and 16%. In group B, 51 of 58 limbs suffered invasive infection; debridement of the ulcers required resection of toes or part of the foot in 64% of cases. The chances of preserved limb at 1 and at 24 months was 98 and 86%; the chances of patient survival were 98 and 68%. Ankle and toe systolic pressures were less suitable than repeated clinical examinations in deciding the need for revascularization. CONCLUSIONS: Major amputation can be avoided in about 80% of patients with limb-threatening ischemia and in about 95% with foot ulceration complicated with infection. Multifactorial treatment of the complex foot lesions by a multidisciplinary foot care team is considered mandatory to obtain satisfactory limb salvage.

Amputation, Surgical↗

PubMed1991

The use of a decision analysis model in multidisciplinary decision making.

This paper describes a conceptual decision analysis model for use in multidisciplinary decision making. Decision analysis was used to structure a decision process that ensured the best choice through consensus building among hospital decision makers. The four basic steps of the decision analysis model included: (1) identifying and establishing boundaries of the decision problem; (2) structuring the decision problem; (3) characterizing information needed to fill in the structure; and (4) choosing a preferred course of action. The selection of the best intermittent intravenous drug delivery system for Presbyterian Hospital illustrates the application of the conceptual model. This type of decision analysis model becomes a useful consensus building and communication device for the administrative pharmacist who is involved in multidisciplinary decision-making processes.

Decision Making, Organizational↗

PubMed1992

Do we measure up? The development of a multidisciplinary quality assurance and audit system in a psychiatric rehabilitation setting.

The purpose of this paper is to describe a simple system of multidisciplinary team quality assurance and audit, and to consider its use in a rehabilitation unit. The Merton rehabilitation team at Springfield University Hospital, Tooting, developed this system, and this paper also outlines some of the problems encountered during the system's development. The system not only offers criteria by which to assess performance in a long-term and rehabilitation setting, but also provides a method for evaluating the multidisciplinary team's performance.

England↗

PubMed1995

Impact of the development of a multidisciplinary adverse drug reaction committee.

A multidisciplinary Adverse Drug Reaction (ADR) committee consisting of pharmacists, nurses, and physician was formed. The committee developed an ADR Reporting Form and a 24-hour ADR Reporting Hotline to simplify ADR Reporting throughout the hospital. An ADR Newsletter and an extensive inservice education program was also implemented. Suspected ADRs are investigated by a pharmacist and presented to committee. A formal report is then forwarded to the Pharmacy and Therapeutics Committee, as well as the clinical departments within the hospital. The establishment of a formalized multidisciplinary ADR committee was successful in generating 2.1 ADR reports per 100 hospital admissions. These ADRs were reported from a variety of healthcare professionals.

Adverse Drug Reaction Reporting Systems↗

PubMedDate not supplied

Multidisciplinary patient management by means of a high social risk screening tool.

OBJECTIVE: The long-term goal in this study was for the Memorial Hospital of Salem County, Inc (MHSC), to create a seamless system of continuity of care for patients. This continuity of care begins before patients require acute admission through the hospital course and extends beyond discharge and into the post-hospital setting or alternate care situation. DESIGN: In a retrospective study in 1993, through the first 6 months of 1994, it was discovered that MHSC patients experienced a longer-than-average Medicare length of stay than was seen in other hospitals. MHSC embarked on a program to reduce discharge planning request time to the social work and home care departments by using a patient screening system that began at the time of admission. The nursing, social work, and home care departments collaboratively designed a system that allowed for immediate transfer of vital discharge planning information to the social work and home care departments at the time of the patient's admission. A tool was jointly developed called the multidisciplinary patient management record. RESULTS: The benefits of this process far exceeded the cost of implementing the tool. The average skilled nursing facility length of stay decreased below the national average by almost one full day. Patients experienced earlier access to social service intervention: discharge planning needs were identified more accurately; and the social services and home care departments' productivity rose because they could anticipate problems before a crisis arose. CONCLUSIONS: Critical to the success of this overall effort was not designing the new tool, but integrating the tool into a reengineered multidisciplinary patient management process.

Continuity of Patient Care↗

PubMedDate not supplied

Multidisciplinary management--an opportunity for service integration.

The management team of the future will enter an environment requiring facilitation, participation, clinical, and empowerment skills. Those individuals who possess a clinical orientation as well as business expertise will be sought to manage multidisciplinary units. The rapid changes in the health-care environment have forced organizations to restructure their operations. To achieve quality care, customer satisfaction, cost-effectiveness, and efficiency, service integration across the organization will be required. As we approach the 21st century, this standard will evolve until "all levels are managing patient care." Some of the restructuring trends occurring in the health-care industry have been collaboration service integration, management consolidation, and job elimination. The emphasis for the multidisciplinary manager of the future will include integrating the professional and clinical services, managing information, building community partnerships, promoting physician collaboration, and managing the change process. A model organization in the next century will move toward a people-oriented system with inclusion and empowerment initiatives. Service integration will affect all organizations, but the disciplines within the Clinical Support System will be the most affected. Future opportunities of leadership will exist for pathologists, nurses, or medical technologists as the professional silos of managers and clinicians continue to crumble.

Ancillary Services, Hospital↗

PubMed1999

Multidisciplinary team dynamics in the production of problem-based-learning cases in issues related to older adults.

Two important goals in allied health education are to prepare future allied health professionals to function as members of interdisciplinary teams and to increase their awareness of issues related to the growing older adult population. The responsibility for achieving these goals rests on the faculty and administrators of allied health education programs, who may not themselves be proficient in either of these domains. A multidisciplinary team of health educators and administrators was brought together to produce six problem-based learning (PBL) cases related to older adults. Members of the team represented a variety of disciplines in health care, diverse philosophies of educational development, a variety of roles in allied health education, and differing levels of knowledge of issues related to older adults--parameters similar to those found in the members of an interdisciplinary healthcare team. The methods by which this multidisciplinary group functioned and the dynamics in attaining the goals of the project are presented.

Aged↗