Why ‘multidisciplinary' matters

July 13, 2011

If you've read about the care at Children's, there's a good chance you encountered the adjective ‘multidisciplinary.' And if you don't have a medical background, there's also a good chance it doesn't mean anything to you.

The good news is that it's easy to understand. ‘Multidisciplinary' is just an abbreviation of ‘multiple disciplines.' In our context, it means that instead of only one caregiver determining what is best for a patient, several caregivers with different specialties analyze the patient from different angles and compare their perspectives.

The idea is that many heads are better than one. And the goal is that patients receive the best, most comprehensive care possible.

Too big of a problem for one person

A great example is the multidisciplinary effort led by Dr. Lawson Copley, pediatric orthopedic specialist at Children's and assistant professor of orthopedic surgery at UT Southwestern, to improve care for musculoskeletal infections – potentially lethal bone and joint infections caused by bacteria.

Around eight years ago, Dr. Copley realized that something needed to be done to address the substantial increase in musculoskeletal infection cases at Children's over the previous 20 years.

The number of cases for one type, septic arthritis, increased 220 percent from 1982 to 2002. Another type, osteomyelitis, jumped more than 600 percent during the same time frame.

"It seemed like it just exploded," Dr. Copley said.

The main dilemma caused by the increase was that tracking the care that patients received became more difficult. Because the infections often presented in ambiguous ways like red, swollen limbs, patients with the same condition were being admitted to a number of different departments – orthopedics, hematology, rheumatology and infection control among others.

"The fact that so many different services could administer care to that type of patient was something that needed to be addressed," Dr. Copley said. "We realized there might be inconsistent treatment of these patients and many communication problems caused by that."

Creating a team

In 2005, Dr. Copley assembled a group of representatives from all departments who could potentially treat patients with musculoskeletal infections. They discussed the treatment methods used in their respective departments, which enabled the different specialists to learn from each other's perspectives. At the end of the day, they were able to identify guidelines that incorporated the strengths of all their practices.

Then they compared their guidelines to existing medical literature on musculoskeletal infections to see if their methods matched up with what other practitioners around the country were suggesting. And it turned out that their guidelines were right on target with the top literature.

However, measuring the guidelines against theoretical suggestions was just a small part of the process.

"We had to apply the guidelines in a clinical setting and monitor how they actually impacted our care for patients," Dr. Copley said. "That was the most important step. You can develop guidelines all you want, but they won't be worth much if they aren't applied in real practice."

Already showing results

The group evaluated their new guidelines in practice during a yearlong trial. One of the first changes they made was to consolidate all musculoskeletal infection patients to two units, which allowed Dr. Copley and other members of his group to check on the patients more efficiently. It also limited the number of caretakers seeing the patients and reduced the possibility of inconsistent treatment.

The group saw 137 patients during that year. They haven't finalized their evaluation of the resulting data, but they've seen enough numbers to know they made a difference.

"We definitely showed significant improvements in patient care," Dr. Copley said. "The length of stay for children with osteomyelitis had been an average 11 days, and in our patients, it was 9.5 days. A day and a half less for families in the hospital is a big win.

Sounding like Dallas Mavericks' coach Rick Carlisle, Dr. Copley said that teamwork produces the best results.

"After our group began meeting to discuss musculoskeletal infection patients' treatment, our care improved and became consistent and families began hearing the same story from each of us," he said. "That couldn't have happened if one of us tried to make the improvements on his own. Teamwork and contrasting perspectives refine processes, and we're going to continue to work that way to come up with the best care possible for our patients at Children's."

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