Not so long ago, a resident of the old-fashioned “nursing home” might receive only palliative care from a nurse’s aide, RN and a general practitioner. A doctor would make rounds occasionally, prescribing treatments to ease the aging process. Nurses took care of patients on a healthcare island, separate from medical and public health communities.
A nurse’s aide would notice something with the patient and ask an RN or LPN for guidance. If the nurse could not resolve the problem, she would telephone the doctor’s office and wait for the physician to return her call – a process that arrests workflow for both busy environments. The nurse would describe the problem verbally. If the problem described seemed serious enough, staff members would trundle the frail resident off to the hospital where specialists could surround her bedside and collaborate about her condition. A family member was asked to leave work to accompany the patient and staff. Then, all together, they waited.
Residents in a skilled nursing facility are typically not robust, facing increased risk any time they are away from the facility. Elderly patients often become confused in the hospital, and they suffer an increased risk for falls and infections. Residents of skilled nursing facilities can introduce MRSA into hospital settings and vice versa. Collaboration would keep these individuals in their own beds, where the highly qualified CNAs and RNs they already know can deliver advanced skilled nursing techniques under the guidance of their trusted physician specialists.
Collaboration in today’s technically advanced skilled nursing facility
Today’s skilled nursing facility provides more than end-of-life care. Nurses and caretakers at these facilities provide special treatments, including enteral nutrition and intravenous injections.
The modern patient, especially one sick enough for placement at a skilled nursing facility, requires a team of specialists. Skilled nursing facilities now only provide palliative care. While a facility can grant privileges to multiple specialists, it is not feasible for all these physicians to maintain onsite offices or make rounds at the facility.
Caring for today’s skilled nursing facility resident requires a new approach to collaboration between everyone on the healthcare team, from the CNA to the oncologist. Collaboration provides feedback to the doctor regarding efficacy of treatment, and reassures the nurse’s aide that the physician was cognizant of her concerns regarding the patient’s health.
Medical collaboration is the communication and exchange of ideas between doctors, nurses, and other caregivers. Medical collaboration is an information superhighway connecting caretakers of all levels, from nurse’s aide to anesthesiologist.
The Association of American Medical Colleges says there are more than 200 types of physician specialists in the United States. Medical collaboration improves the likelihood a resident in a skilled nursing facility struggling with a specific condition will connect with a leading professional in that field. Before the advent of care coordination, chances of getting a nursing home patient into the hands of the right specialist were nearly infinitesimal.
Technology has driven medical collaboration. In 2010, the Apple iPhone led the way with the expanded adoption of smartphone apps. Today, clinicians use hybrid store and forward. This technology allows doctors to add personal health information for each patient at an intermediate, safe location and then send it to others on the collaborative team.
Collaboration keeps all caregivers in the loop without jostling the patient from office to office. A hospital radiology department can upload a chest x-ray, for example, to save the patient from repeating it for a consulting physician. A nurse’s aide can update pictures of a resident’s decubitis, or rash, or edema, frequently to the team of physicians and reduce the need for office visits.
Benefits of Medical Collaboration
Along with convenience, medical collaboration has many benefits to the patient and her healthcare team.
Benefits to the resident include:
· Improved healthcare
· Increased access to specialists without travel
· Reduced risk for hospital-acquired problems like infection
· Coordinated healthcare
· Family stays at work and at home instead of going on office visits
Benefits to doctors and other caregivers:
· Fewer errors
· Less redundancy
· Greater efficiency and productivity
· More appropriate use of expertise and medications
· More confidence that comes with support
Everyone benefits from medical collaboration; care coordination fully utilizes advancing technology to share patient information safely and effectively. This new approach to care brings together caregivers of all levels to provide superior care to patients in skilled nursing facilities. Nothing is needed except an iPhone, iPad or camera and computer.