Multidisciplinary TeleMedicine Rounds

Perhaps my clearest memory of what exceptional quality patient care looks like in the hospital setting occurred during my Physician Assistant training in Baltimore, MD. Termed multidisciplinary team rounds, this integrated group approach incorporated a team of experts, including an Advanced Practice Practitioner (PA or ARNP), Physician (MD/DO), a Pharmacist, Laboratorian, RN, Case Manager, Social Worker, Physical Therapist and/or Occupational Therapist, and Nurse Assistant.  Once a day, this team rounded on all admitted patients, followed by a group consensus on the plan for each patient.

This collaborative rounding included:

1.      APP or Physician – patient history, presentation, findings, treatment plan

2.      Pharmacist – quality review for medicines prescribed, to include any noted antibiotic resistance, cross reaction(s) to medications, and dosing adjustments needed (age, weight, kidney function, liver function, etc.)

3.     Laboratorian – review of all lab test findings, redundancies, missed abnormal findings not previously addressed, and recommendation(s) for further testing

4.     RN – nursing concerns or questions (day and night shift) and patient concerns

5.     Case Manager/Social Worker – insurance, rehab or home health options, financial concerns for medication(s) prescribed

6.     Physical Therapist/Occupational Therapist – progress and/or recommendations 

7.     Nurse Assistant – issues seen and maybe not addressed

So now let’s consider the outpatient setting. As healthcare evolves and incorporates increasing use of a telehealth model, could a similar approach be considered in the non acute setting for complex patients? Is this already happening?

Would it be cost and time effective? Would it reduce errors and oversights, resulting in improved patient care/outcomes?  How would patients feel if everyone was available on one call to answer questions? Would this benefit both the patient and the clinical care team?

Just an idea. What are your thoughts?