Complex case calls for interprofessional care

The patient, Sally, was a 12-year-old female who had surgery to treat Legg-Calve-Perthes disease, a childhood condition that occurs when blood supply to the femoral head of the hip joint is disrupted and the bone begins to die. The surgery had gone well, but it left Sally in casts that immobilized her legs into the shape of the letter “A.” Now it was time for her caregivers to devise a discharge plan – all while considering these facts:

  • Sally’s mother died in a motor vehicle accident four years earlier. Because Sally’s parents had never married, she was placed in foster care.
  • Her father was incarcerated just over three years ago after he committed theft to support his addiction to pain pills and other drugs. Released eight months ago, he wanted to resume Sally’s care and had petitioned the courts to receive full custody. He was employed as a mechanic and lived in a second-floor apartment.
  • Sally’s foster mother was devastated she couldn’t take Sally back due to her care requirements and other children in the home.

Further complicating matters were that it might not be wise for Sally’s father to be around her medications for pain, given his addiction, and one goal of her discharge was to find a way for her to participate in school.

So what should Sally’s “caregivers” recommend?

In reality, they were approximately 80 students in the osteopathic medicine and physical therapy programs at DMU; the nursing programs at Grand View University and Mercy College; and the pharmacy and occupational therapy programs at Drake University. Gathered around tables in the Munroe Center, they began discussing the case with classmates in their in own academic programs. Then they met in small, interprofessional groups in study rooms in the Academic Center to devise Sally’s discharge plan.

Students from DMU, Mercy College of Health Sciences, Drake University and Grand View University participate in an interprofessional education session involving a pediatrics case. (DMU photo by Brett T. Roseman)

The pharmacy students shared insights on her medications and potential interactions. The nursing students shared how Sally did during the night and the worries she expressed about “what happens next.” A physical therapy student reviewed possible strategies for her daily life at home; an osteopathic medical student raised concerns about possible future surgeries Sally would need for her condition. All the students discussed frequency of home health visits, whether a skilled care facility would be a better short-term option and possible connections with allied services such as a dietitian, school liaison and social worker. Through the process, some students admitted what they didn’t know.

“It’s a lot of information,” said one student as his group worked to connect the many dots in Sally’s case.

The exercise was hosted on February 20 by the Des Moines Area Interprofessional Education (IPE) Collaborative, of which the four participating institutions along with the Des Moines Area Community College are members. Their primary goal is to foster students’ IPE skills, increasingly considered crucial for high-quality, cost-effective care. According to the Health Professions Accreditors Collaborative, IPE is important amid the growing complexity of health care in the U.S. and an emphasis shifting from primarily acute care settings to broader multi-faceted approaches in achieving health.

An interprofessional team discusses the case as Julie Ronnebaum, M.P.T., GCS, D.P.T., Ph.D.,
associate professor of physical therapy, observes. (DMU photo by Brett T. Roseman)

In a final debriefing session among all the students on Sally’s case and the IPE process itself, they talked about how important it is for an effective discharge planning team to have good communication, diverse expertise and awareness of one’s own unconscious biases. In leading the discussion, Laura Delaney, PA-C, M.P.A.S., director of clinical education in DMU’s physician assistant program, acknowledged the challenges of justifying additional resources against their cost, of having adequate time for each patient and enabling each member of the IPE team to contribute his/her knowledge to the bigger picture.

“Be conscious that even though you’re trying to be very open when working with those in other health professions, sometimes you have to step back and ask yourself, ‘Why am I making that recommendation?’” she said. “You should be able to feel confident you’re doing so for the good of the patient.”

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