NUR 530 Module 4 Interprofessional Collaboration Paper Example

Nobody's Queue: Interprofessional Collaboration and the Timing of Discharge on a Medical Unit

[Student Name]

Southern New Hampshire University

NUR 530: Systems Leadership and Collaborative Practice

Interprofessional Collaboration Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Nobody's Queue: Interprofessional Collaboration and the Timing of Discharge on a Medical Unit

Every department that touches a discharge on 6 South has a queue of its own. The hospitalists have a list of patients to round on, the pharmacist a stack of orders to verify, the case managers a caseload of referrals, transport and housekeeping a line of requests from across the hospital. A discharge is the one piece of work that passes through all of them and belongs to none. Collaboration, in that setting, cannot mean asking everyone to try harder. This paper argues that an earlier discharge process will last only if each discipline's own measures and workload are part of the design, and it applies the IPEC core competencies to show how.

The Disciplines and Their Stakes

Table 1 summarizes, for each discipline, what it is judged on today, what moving discharge work earlier would ask of it and what it could gain. The entries come from conversations with members of each group on 6 South and are simplified for clarity.

Table 1

Stakes of an Earlier Discharge Process, by Discipline

Note. Composite summary for a 32-bed medical unit.

Two patterns in the table matter. First, the heaviest asks fall on the hospitalists and the pharmacist, who would do discharge work a day earlier while their current measures give them no credit for it. Second, most of the gains are indirect or delayed, while the costs arrive at once. A plan that ignores either pattern will look reasonable on paper and fade on the unit, as the earlier attempt to have hospitalists round on discharges first did.

Applying the IPEC Competencies

The current IPEC framework organizes collaborative practice into four competencies, covering values and ethics, then roles and responsibilities, then communication, and finally teams and teamwork (Interprofessional Education Collaborative [IPEC], 2023). Each one points to a feature of the discharge design.

Values and ethics. The shared value is the patient's safety and recovery, and the evidence on delayed discharge gives every discipline a reason to care: waiting in hospital is linked to infections, lost mobility and low mood, and the pressure to clear beds strains relationships among staff (Rojas-García et al., 2018). Framing an earlier discharge as protection for frail patients, not as bed management, gives the disciplines common ground.

Roles and responsibilities. Today, the discharge has steps but no owner. The design needs one role that tracks every likely discharge from the afternoon before to departure. On 6 South, the charge nurse already keeps an informal list and is the natural choice, provided the role comes with time protected for it.

Communication. Each department needs the same information at the same time. A short afternoon huddle, attended by the charge nurse, a hospitalist from each team, the pharmacist and a case manager, would name tomorrow's likely discharges and what each is still waiting for. The list would then be posted where transport and housekeeping can see it.

Teams and teamwork. A huddle only works if its members treat it as a shared commitment. That means reviewing the results together each week, celebrating improvements and hearing from any group whose workload grew.

What the Evidence Supports

The evidence for structured interdisciplinary work is encouraging but mixed, and an honest paper should say so. In a controlled trial on a medical teaching unit, structured interdisciplinary rounds cut the adjusted rate of adverse events almost in half, from 7.2 per 100 patient-days on a comparison unit to 3.9 (O'Leary et al., 2011). A Cochrane review of practice-based collaboration interventions, including interprofessional rounds, meetings and checklists, found only nine eligible studies and rated the evidence low to very low in certainty; rounds, checklists and facilitated team activities may slightly improve the use of healthcare resources, but the authors could not draw clear conclusions (Reeves et al., 2017). A systematic review of 30 studies of team interventions on general medical wards found that most did not shorten length of stay or reduce readmissions, though half of those that measured complications reduced them (Pannick et al., 2015).

For 6 South, the lesson is to expect collaboration to improve safety and the timing of discharge more readily than it shortens stays, and to measure accordingly. Promising a shorter length of stay would set the huddle up to be judged a failure.

Conditions for a Collaboration That Lasts

Three conditions follow from the analysis. First, each discipline must see something in return, so the hospitalist group should receive a report of how many of its own admissions reached a bed sooner, and the pharmacist's afternoon reconciliation should be counted in the department's productivity figures. Second, the huddle must be short and predictable, fifteen minutes at the same time each day, or busy clinicians will stop attending. Third, disagreements should be settled with the unit's own data. If transport times rise or readmissions creep up, the group should see it and adjust.

The nurse leader's role is to hold these conditions in place: to bring the disciplines together, to keep the data visible and to make sure no group carries the cost of the change alone.

Conclusion

A discharge on 6 South passes through six departments and belongs to none of them. Collaborating on it means designing a process in which each discipline's measures, workload and gains are visible, using the IPEC competencies to shape values, roles, communication and teamwork. The evidence suggests that structured interdisciplinary work improves safety more reliably than it shortens stays. The next project will analyze the causes of delay in detail so that the collaboration is aimed at the right targets.

References

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

O'Leary, K. J., Buck, R., Fligiel, H. M., Haviley, C., Slade, M. E., Landler, M. P., Kulkarni, N., Hinami, K., Lee, J., Cohen, S. E., Williams, M. V., & Wayne, D. B. (2011). Structured interdisciplinary rounds in a medical teaching unit: Improving patient safety. Archives of Internal Medicine, 171(7), 678-684. https://doi.org/10.1001/archinternmed.2011.128

Pannick, S., Davis, R., Ashrafian, H., Byrne, B. E., Beveridge, I., Athanasiou, T., Wachter, R. M., & Sevdalis, N. (2015). Effects of interdisciplinary team care interventions on general medical wards: A systematic review. JAMA Internal Medicine, 175(8), 1288-1298. https://doi.org/10.1001/jamainternmed.2015.2421

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2017(6), Article CD000072. https://doi.org/10.1002/14651858.CD000072.pub3

Rojas-García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J., & Raine, R. (2018). Impact and experiences of delayed discharge: A mixed-studies systematic review. Health Expectations, 21(1), 41-56. https://doi.org/10.1111/hex.12619