Optimizing Transplant Ambulatory Care Utilizing Multidisciplinary Rounds

Topic Significance & Study Purpose/Background/Rationale

Multidisciplinary rounds (MR) are a standard model used in hospitals. Our Transplant Center performs approximately 500 Hematopoietic Cell Transplants (HCT) annually.  Care of the HCT patients has moved from the inpatient setting to the ambulatory clinic. In the clinic, complex care is managed for HCT patients coordinating clinical care, nutritional needs, medication management, psych-social issues and scheduling. Labs, radiology, medications, pathology, and symptom management require close observation and review at 24 hour increments. This complex patient care management is best implemented with the utilization of MR.

Methods, Intervention, & Analysis   Each patient is followed by a team comprised of an Attending MD, Primary Care Provider, RN, Pharmacist, Registered Dietician, Social Worker and Team Coordinator.  The team meets daily for 30 minutes to review current status of all patients, each discipline providing input and making suggestions for care adjustments needed.  There is full team discussion of any issues—medical, nursing, social, financial, compliance—that impact care on any level.  Anticipated workups that need orders, upcoming procedures that require teaching such as chemotherapy or dressing changes, as well as any recent pertinent results are also briefly discussed so orders and appointments can be obtained in a timely fashion.

Findings & Interpretation

Daily MR in the outpatient HCT clinic has been found to provide an opportunity to make adjustments to the patient’s care and allow for more HCT care to be performed in the outpatient setting as evidenced the ability to perform HCT sometimes solely in the outpatient setting, with no admission to the hospital.  Satisfaction with this care is evidenced by Patient Satisfaction scores. Discussion & Implications The inpatient model of daily MR can be replicated in the outpatient HCT setting.  A Team RN acting as the care coordinator facilitates the outpatient care and serves as the patient voice.  This can safely increase the time a patient is able to spend outside the hospital which decreases costs and increases quality of life.