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Published on: January 20, 2019
Development and implementation of an interdisciplinary plan of care
Cynthia Lewis1, Mary Lou Hoffmann, Angela Gard
1Same Day Surgery, PACU, Preadmission Test Center and Pain Management Clinic. cindy.lewis@aurora.org
Summary
Aurora Health Care developed a patient-centered interdisciplinary care planning process. This integrated approach involves patients, families, and all clinical teams for comprehensive care throughout acute episodes, leading to successful implementation of the Interdisciplinary Plan of Care (IPOC).
Area of Science:
- Healthcare Management
- Patient Care Coordination
- Clinical Process Improvement
Background:
- Developing effective patient-centered care planning is crucial for optimizing acute care episodes.
- Traditional care planning often lacks comprehensive interdisciplinary and patient/family integration.
- Aurora Health Care identified a need for a structured approach to interdisciplinary care planning.
Purpose of the Study:
- To describe the development and implementation of a patient-centered interdisciplinary care planning process.
- To detail the creation of a structure that includes patients, families, and all clinical disciplines.
- To focus on the journey of the team in achieving successful implementation of the Interdisciplinary Plan of Care (IPOC).
Main Methods:
- Chartering an interdisciplinary team in January 2002.
- Developing a process encompassing patient, family, and all clinical disciplines.
- Integrating prioritized problems, outcomes, and measurement within the care plan.
Main Results:
- Successful creation of a patient-centered interdisciplinary care planning process.
- Implementation of an Interdisciplinary Plan of Care (IPOC) from system entry through acute care.
- Demonstrated integration of problems, outcomes, and measurement for goal attainment.
Conclusions:
- The developed IPOC process successfully integrates patients, families, and multidisciplinary teams.
- The journey highlights the effectiveness of a dedicated interdisciplinary team in implementing complex care planning.
- This model provides a framework for enhancing patient-centered care coordination in acute settings.
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