Collaboration, and the holistic care of the patient

The Joint Commission International (JCI) has a set of two criteria regarding collaboration between members of an interdisciplinary health care team in a hospital which uses an interdisciplinary approach seeking or already with JCI hospital accreditation status. The first criterion is by meeting compliance with JCI Standard AOP.4  that requires “Medical, nursing, and other individuals and services responsible for patient care collaborate to analyze and to integrate patient assessments.” The second criterion is by meeting the JCI Standard AOP.4.1 when “The most urgent or important care needs are identified.”

A patient may undergo many kinds of assessments outside the hospital which include the community and third-party payers (both public and private reimbursement organisations, for example an insurance company or for example in Malaysia – SOCSO, the abbreviation for Social Security Organisation, and it is commonly known in the Malay term as PERKESO or Pertubuhan Keselamatan Sosial, a social security organisation which provides social security protection by social insurance including medical and cash benefits, provision of artificial aids and rehabilitation to Malaysian employees to reduce the sufferings and to provide financial guarantees and protection to the family), and inside the hospital by many different departments and services which includes hospital staff such as a doctor, a nurse, a dietitian, a social worker, and a physiotherapist in the care delivery of a patient that these health care providers must meet.

A collaborative process takes place during an initial assessment. This is a process during which patients are screened by nurses to identify those at nutritional risk, and is one kind of assessment used to plan, to deliver, and to monitor nutrition therapy.These patients are referred to a nutritionist for further assessment. When it is determined that a patient is at nutrition risk, a plan for nutrition therapy is carried out. The patient’s progress is monitored and recorded in his or her medical record. Doctors, nurses, the dietetics service, and, when appropriate, the patient’s family are seen collaborating to plan and to provide that nutrition therapy.

Collaboration to plan and to provide nutrition therapy as in the above example, clearly benefits such a patient most on the basis of recommendations by an interdisciplinary health care team by examining another’s viewpoint when the staff responsible for the patient work together (collaborate) to gather data, plan, implement, evaluate, and gain objectivity from the patient’s medical record. During this process, the most urgent or important care needs are identified, for example the need for nutrition therapy for a patient at nutrition risk. When patient assessment data and information are analysed and integrated, the JCI Standard AOP.4, ME 1 requirement is clearly met.

From such kinds of interdepartmental collaboration, the patient’s needs have been identified, the order of their importance established, and care decisions made. Integration of findings at this point will facilitate the coordination of care provision that helps ensure an efficient care processes, more effective use of human and other resources, the likelihood a beneficial (cost-effective) outcome and enhances quality and the holistic care of the patient.

The team approach satisfies the JCI Standard AOP.4, ME 2 requirement which requires “those responsible for the patient’s care participate in the process”. This is when health care providers from all the relevant disciplines are involved in a multidisciplinary evaluation which mandates active involvement of all the care providers in the evaluation of quality care. This participatory process of evaluation facilitates options and services for meeting the patient’s health and helps promote a continuum of care for the patient, from the preadmission phase to discharge planning and follow-up care.

The goal of the interdisciplinary health team during acute hospitalisation and rehabilitation is to restore function, thus maximising the level of the patient’s independence.

At the same time, health care providers are challenged to work in greater collaboration to decrease the client’s length of stay in the hospital, increase satisfaction with the services, and prevent complications.

It can be said that the majority of clinical transactions in hospital settings are routine and straightforward enough to warrant no special attention or modification to their management (Kingsley & Sam, 2009). Being faced with a complicated clinical transaction, and having to decide whether and how to intervene, require a methodical approach. An example of a complicated a clinical transaction maybe a patient presenting with physical illness may precipitate the relapse of psychiatric illnesses such as manic-depressive psychosis or schizophrenia.

This kind of complicated clinical transactions requires a dynamic and systematic collaborative approach in providing and coordinating for example, using tools and techniques to better integrate and to coordinate care for their patients through formal treatment team meetings, team-delivered care, multidepartmental patient conferences and clinical rounds, combined care planning forms, integrated patient record, and case managers.

The patient, families of the patient and others who make decisions on the patient’s behalf are not neglected in the care process but are duly informed of the planned care and treatment and participate in the decisions about the priority needs to be met.

For patients and families to participate in care decisions, they need basic information about the medical conditions found during assessment, including any confirmed diagnosis when appropriate, and on the proposed care and treatment. Although some patients may not wish to personally know a confirmed diagnosis or to participate in the decisions regarding their care, they are given the opportunity and can choose to participate through a family member, friend, or a surrogate decision maker.

Collaboration includes encouragement  to participate in family support groups through a family member, friend, or a surrogate decision maker in problem-solving activities in the decision process involving treatment and aftercare plans to promote continuity of care when it is needed. Such collaborative encouragement meets the requirements of ME 2 and ME3 of the JCI Standard AOP.4.1.

These actions to promote collaboration with the patient and his or her family and others when the patient’s needs are prioritised based on assessment results,  will comply with the requirement of the JCI Standard AOP.4.1, ME 1 and when the patient and family members are fully aware of the treatment process and outcomes, then the requirements of both ME 2 and ME3 of the JCI Standard AOP.4.1 are also clearly met.

A Health Information Management (HIM) / Medical Records (MR) practitioner working in a hospital with JCI accreditation status or one that is seeking accreditation status, must know how the patient’s medical record facilitates and reflects the integration and coordination of care when each practitioner records observations and treatments in the patient’s medical record. Also, when any results or conclusions from collaborative patient care team meetings or similar patient discussions are written in the patient’s medical record.

With this post, I believe I have covered postings about medical documentation found in a typical medical record and their relationship to the relevant JCI standards.

In my next post about medical documentation found in a typical medical record, I shall summarise and tabulate the  relevant JCI standards and their respective requirements, and move on to posting on the remainder of the surgical documentation found in a typical medical record, and their relationship to the relevant JCI standards.

References :
Joint Commission International 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Kingsley, N & Sam, S 2009, Problems with patients, Cambridge University Press, NY, USA

Sue, CD & Patricia, KL 2011, Fundamentals of Nursing: Standards & Practice, 4th edn, Delmar, Cengage Learning, NY, USA