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Challenge New, unexpected, or ambiguous occurrence
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– COVID-19 pandemic outbreak and containment guidelines preclude usual in-person interprofessional assessments and discussions for CACS patients and caregivers – Patients and caregivers unaccepting of deferral of CACS assessment and care – Several team members lack familiarity with remote care delivery options in health care and within their disciplines – Some care components may not have virtual care delivery options
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Goal
Reduce ambiguity and make sense of the issue and solution |
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– A modified shared TMM is derived to reflect the team’s new environment and commitment to establish the new what, who, and how for CACS virtual and home care provision, including supportive care, nutrition and physical rehabilitation evaluations and support – CACS screening and early referral criteria are reaffirmed
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Sharing unique perspectives
Each member draws from and shares their own knowledge and experience about the situation, resources, and ways to address |
– Team members share previous challenges with scheduling prolonged in person visits for weakened CACS patients – Each team member describes their current role and tasks, their experiences with virtual platforms, and the pros and cons of possible use of virtual assessments and care plan discussions in their discipline – Team members describe their knowledge of developing opportunities in the organization’s use of virtual visits in other programs and applicability to CACS care – Team members describe understanding of home-service options for some CACS care components
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Discussion
Team members converse to create shared understanding and representations |
– Nutrition and supportive care team members discuss how they can use virtual platforms to deliver rapid interprofessional sequential care for CACS and coordinate care among the members – Physical therapy team members discuss obstacles and home-based alternatives to in-person care
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Potential action
Shared representation allows development of potential action that can be implemented and understood by all participants |
– Agree on virtual mechanisms to provide interprofessional patient and family education regarding CACS presentation, staging, and outcomes; CACS comprehensive interprofessional assessments, including elicitation of the patient and caregiver priorities and goals – Agree on need to optimize patient convenience and coordinate care by continuing to provide new virtual assessments within a fixed time frame, while allowing for flexibility to optimize access to care
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– Supportive care and nutrition providers are trained in use of virtual visit platforms – Virtual visit scheduling mechanisms are adopted and appointments by the various CACS clinic providers occur sequentially on the same day whenever possible – Home PT assessments are arranged as part of the CACS ordering protocol – Templates to document timely virtual visit notes and patient agreements are created and made available for rapid implementation in the EHR – CACS specialists communicate with each other via video conferencing platforms, chat functions, and email – Education and discussion of care plans with patient/caregiver occur during each virtual visit and are immediately electronically documented for viewing by other team members – Group team members/patient/caregiver videoconferences are arranged as needed to discuss collaborative care plans – Patients and caregivers express satisfaction with the virtual CACS visits, discussions, and care plans.
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