Case Study: Teamwork Challenges
Ms. Trivaldi is a 53-year-old patient with uncontrolled diabetes. She is severely underweight and has gastroparesis that interferes with nutritional absorption and metabolism. The bariatric surgeon wanted to put a PICC (peripherally inserted central catheter) line to supplement her nutrition. He referred the patient to a gastroenterologist (GE) for management of the total parenteral nutrition (TPN) solution. However, the GE was concerned with the management of her diabetes, so she contacted the patient’s endocrinologist for consultation on the amount of insulin that should be added to the TPN mixture. The bariatric surgeon did not wait for the GE and the endocrinologist to make their recommendation and placed the PICC line. He then told the GE to get the TPN solution prescribed, but she told the bariatric surgeon that she was not comfortable prescribing the nutritional supplement without the endocrinologist recommendation. When the patient asked the bariatric surgeon why she had not been started on the supplement, the surgeon told her it was because the GE did not want to prescribe the supplement. The patient was very upset with the GE and became difficult to work with after talking with the surgeon. Furthermore, once the endocrinologist reviewed the case, he recommended against the TPN because of her uncontrolled diabetes, and the PICC line had to be removed.
Discussion Questions
- Who are the members of the interprofessional healthcare team?
- Can you identify positive and negative examples of interprofessional collaboration? Describe at least one of each.
- What is the main problem in this case study?
- Which Core Competencies and specific Sub-competencies could have improved care in this situation? Identify at least three and explain your rationale.
- Members of the interprofessional healthcare team:
- Bariatric surgeon
- Gastroenterologist (GE)
- Endocrinologist
- Patient (Ms. Trivaldi)
- Positive and negative examples of interprofessional collaboration:
- Positive example: The collaboration between the gastroenterologist, endocrinologist, and bariatric surgeon shows an attempt at multidisciplinary care, recognizing the need for expertise in different areas to address the patient’s complex condition.
- Negative example: Lack of communication and coordination among the team members led to misunderstandings and misinterpretations of decisions, causing confusion for the patient and resulting in a breakdown of trust between the patient and the healthcare providers.
- Main problem in this case study:
- The primary issue lies in the breakdown of communication and collaboration among the healthcare team members. There was a lack of clear communication regarding decision-making, leading to conflicting information given to the patient and inappropriate actions taken without consensus among the specialists involved.
- Core Competencies and specific Sub-competencies for improved care:
a. Communication:
- Sub-competency: Verbal and written communication skills among team members.
- Rationale: Improving communication channels between the specialists could have prevented misunderstandings and ensured a unified approach in the patient’s care plan.
b. Collaboration:
- Sub-competency: Understanding roles and responsibilities within the healthcare team.
- Rationale: Clarifying each member’s responsibilities and establishing a collaborative approach could have avoided conflicts and improved the coordination of care for the patient.
c. Patient-Centered Care:
- Sub-competency: Incorporating patient preferences and values into care plans.
- Rationale: Involving the patient in discussions regarding their treatment options and ensuring transparency in communication could have prevented the misunderstanding that led to the patient’s upset and dissatisfaction.
In summary, improving communication, fostering collaboration, and prioritizing patient-centered care could have significantly enhanced the outcome in this complex healthcare scenario.