Description & Implementation
- Who will present the cases?
Case Example: One PACT-ICU site’s explicit goal was to integrate mental health into primary care. As a result, patients were selected based upon psychiatric commodity and complexity. Presentations are alternated between mental health trainees (psychology, psychiatry) that work in primary care and primary care provider trainees (NP residents and IM residents).
Case Example: The Boise PACT-ICU utilize a high-risk patient registry that lists patients who are at the highest risk of dying or being hospitalized in the next 90 days. PCP trainees (NP or IM residents) select a high-risk patient from their panel and present this individual to the team. The discussion incorporates the interprofessional team in the development of the care plan.
- PACT-ICU was developed as a workplace learning activity for interprofessional trainees to learn how to work together as a team. For this conference to be successful, multiple professions (ideally interprofessional trainees) will need to attend.
- If you have multiple training programs within your facility, discussing the adoption of PACT-ICU with all stakeholder early will enhance success in implementation.
- Use interprofessional meetings to negotiate the “need” (see above) for your site.
- Discuss existing curriculum and begin negotiating trainee scheduling changes needed to accommodate PACT-ICU.
- Identify facility PACT-ICU champions to aid in the logistics of implementation.
- Determine if facility needs to demonstrate increased revenue or value related to cost savings
- Consider the ideal list of attendees and the required list of attendee –Attempt to develop a schedule that could accommodate the growth and inclusion of the case conference to include ideal attendees
- Determine the length and frequency of the meeting
Case Example: To date, every site that has adopted PACT-ICU expressed the importance of including front-line clinical staff (LPN/MA, RN, etc.). Sites noted the value added from these staff members in both their clinical perspective and in future follow-up action items. These sites encouraged considerations for scheduling these embers early on in the implementation process.
Case Example: The Boise PACT-ICU meets biweekly (second and fourth Thursday of the month) for one hour. We typically have two presenters, 25 minutes for each patient and a five minute follow-up on the patient they discussed during their previous PACT-ICU presentation.
- Presentation equipment
- Computer – for electronic record access
- Ease of access for all attendees
- Programmatic Evaluation
- Importance of tracking impact the of PACT-ICU. Review the evaluation section for resources and processes that have been used to evaluate PACT-ICU.
Information and suggestions for the facilitator of the conference, to encourage interprofessional participation, as well as efficient means of developing a care plan that is patient-centered and clear to participants.
Instructions for the person who will help to coordinate the scheduling of conferences, selection of patients, and attendance of different professions. Trainees to include (professions and academic training levels that are appropriate)
- Staff to include/invite
- Trainee supervisors
Case Example: At the Boise PACT-ICU each professional training program determines the level of supervision needed for their individual trainees. For many of the training programs, this case conference affords the opportunity for supervising faculty to provide their trainees with feedback on their professionalism and ability to work as part of an interprofessional care team.
- Review PACT-ICU outline
- Use of a frame to structure the conference and chart review.
- Presenter Requirements/Expectations
- Patient selection
- Formal (PowerPoint) versus informal (verbal) presentation
- Use of Handout to frame chart review –Attendee Requirements/Expectations
- Prior patient chart review
Case Example: At the Boise VA we use the EFFECT model to organize our conference. In addition, the coordinator sends each attendee a worksheet to use when reviewing the patient information to help frame their discussion based on their specific expertise. (reference location for the handout)
Case Example: Another site developed a worksheet to frame their discussion based on specific areas of patient need. These areas included acute medical need, chronic medical problems, pain and somatic complaints, psychological issues and support system, and utilization. (reference location for the handout)
Case Example: One PACT-ICU site requires that presenters create a formal PowerPoint presentation that is reviewed by faculty prior to presentation. The creation of the presentation is viewed as a training opportunity in the development and organization of a case presentation that provides appropriate information for an interprofessional audience. Attendees do not review the chart prior to the case conference. The presentation is expected to provide an appropriate level of detail to facilitate the case discussion.
Case Example: At the Boise, PACT-ICU presenters complete a chart review using a provided handout, they then provide a brief (5 min) verbal presentation on their patient. All attendees have been provided with the same handout and the identification of that patient prior to the conference. Attendees are expected to have completed a profession-specific chart review and to bring relevant data on the patient to the conference to discuss with the group.