Guide to Inter-Disciplinary Team Meeting (IDT)

 

Hospice Palliative medicine prides itself on working in inter-disciplinary teams (IDT). Inter-disciplinary teams see each member of the team (physician, nurse, social worker, health care aid, pharmacist, volunteer coordinator, administrator, others) as an equal, with important insights to contribute to the care of the patient and family. (In contrast to multi-disciplinary teams – which might have all the same players – but runs in more of a hierarchical ‘military’ ‘top-down’ mode … with the physician giving orders that then go down the chain of command and are carried out.)

 

Every Tuesday and Wednesday morning one of Hynes Hospice’s 4 Wichita area home care teams meets for its IDT meeting (each team meets every 2 weeks). There are RN’s, LPN’s, SW’s, Chaplains, Pharmacists, Administrators, Health Care Aids and often other students that sit in on these meetings. Each team has about 40 patients. Each RN cares for about 10 patients. There are ongoing ‘virtual’ IDT meetings (cell phone, text, notes in EMR, etc.) as well as this formal ‘sit-down’ IDT.

 

As you listen in on the meeting, please reflect on your own experience. Can you identify specific episodes when you have learned something about the medical aspect/condition of one of your patients from another member of the team? (similarly … can you identify a time when you ignored the input of another team member – to the patient’s detriment?)

 

The meeting usually begins at 8:30am with a review of the patients who have died – giving team members an opportunity to debrief and share about their interactions with patient and family. This is followed by the chaplain sharing a reflection and prayer. Beginning the meeting in this way emphasizes the importance of mindfulness in what we do.

 

We then ask each team member to identify a specific patient-family with active needs – those for whom we may not be meeting goals to the patient-family or our satisfaction. This is where the real ‘power’ of the IDT is brought to bear. I am always struck by other discipline’s assessment and ‘take’ on the clinical situation. A key role of the physician and/or team leader is to help the team take a step back and see the forest for the trees – it’s always easy for any of us to get lost in the ‘trees’ of our own discipline and not see the ‘forest’ of what is really going on with the patient-family. A key aspect of the IDT is that everyone needs to feel safe to step in to the other discipline’s turf.

 

Next is recertifications … an important technical aspect of hospice. (regardless of the discipline-field you go into, there is going to be someone looking over your shoulder making sure you dot all your I’s and cross all your t’s.) We need to prove that our patients (particularly those with 6 month or greater length of stay) are still ‘hospice appropriate’ i.e. that in our judgment they will die in 6 months. The core way this is done is by showing evidence of decline (weight loss, functional status, increasing disease process, increasing time to task completion). This can often involve very detailed and arcane discussion-documentation … but the patient-family’s ability to keep receiving the hospice benefit hinges on this.

 

The next item on the agenda is new patient review – going over those patients who have been admitted to the team since the last IDT. I am always struck by how many have already died.

 

A variety of other topics wrap up the meeting including double checking on patients who are on blood thinning medicine, miscellaneous announcements and quickly announcing the names of the other patients on the team who have not been discussed up to this point.

 

As the meeting closes, please note 1-2 things that strike you about the IDT meeting … this could be anything – clinical or nonclinical – ‘good’ or ‘bad’.