Developing an Integrated Multidisciplinary Pituitary Management Team

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Key points

  • Team-based care allows for improved quality and value.

  • Administrative and systemic support for multidisciplinary programs is essential for both short- and long-term success (through provision and alignment of resources, metrics, and incentives).

  • Diverse qualities and values of team members can be leveraged for success in meeting metrics, providing high-touch patient care, innovating, and ensuring safety.

  • Teams may find it useful to discuss and protocolize all aspects of patient care and follow-up.

Who is on the team?

Although defining our team seems simple at first glance, it is easy to overlook critically important team members. Although our “frontline” team for decision-making and intervention consists of faculty from divisions in Neurosurgery, Endocrinology, and Otolaryngology, we rely on colleagues in Neuroradiology, Anesthesiology, Neuroophthalmology, Neuropathology, Radiation oncology, and Neurooncology. Our direct patient-facing frontline also includes clinic nurses and advanced practice providers

Benefits of teamwork

The benefits of teamwork include improved accessibility for patients, decreased medical errors, increased quality, decreased hospitalization duration and cost, decreased hospital readmission2 or return to the emergency department, decreased burnout, and leveraging of competing values and skills. Retrospective and observational studies have shown that lack of teamwork and impaired communication are among the most frequent contributors to adverse events and malpractice claims.3 The same review

Setting expectations and principles for communication and decision-making

Teams may find it useful to discuss and protocolize care. Our team found it useful to lay out expectations for new patient intake and evaluation, nonoperative care, preoperative assessment and management, intraoperative care (including complication and unexpected diagnosis management), inpatient postoperative care, early at-home postoperative care, and late postoperative management. Conversations about expectations and plans of care before enacting those plans allow for standardization where

Coordination of time and space

For our program, we were fortunate to build on the visions, hard work, and successes of our mentors, Dr Bill Chandler (neurosurgery—pituitary), Dr Ariel Barkan (neuroendocrinology—pituitary), and Dr Larry Marentette (otolaryngology—ventral cranial base). Clinical time and space ran concurrently for the pituitary surgeon and pituitary endocrinologist in the Neurosurgery Department space. Likewise, in the Otolaryngology Department space, the (ventral) Cranial Base Program had team clinic with the

Documentation and Billing

Setting expectations for billing multispecialty clinic visits and operative cases is also helpful in assuring team cohesion and shared expectations. It can be useful to engage institutional or other coding and billing experts in developing plans, and physicians should review current coding guidelines relevant to their cases. We have found it useful to give our coders the North American Skull Base Society white paper,10 particularly when billing for challenging unlisted procedure codes, and we

Sustainability

It is worth taking time to finally focus narrowly on sustainability. As noted previously, the foundation of our program lies in shared values and robust administrative and nursing support. Just before and then during the COVID-19 pandemic, our team changed dramatically, raising barriers to providing efficient, high-quality care. The single administrative assistant who provided frontline reassurance and expedited care moved to another unit; the Pituitary Clinic nurse practitioner retired; and

Summary

Interdisciplinary teams have many potential and proven benefits, including decreased burnout, decreased medical errors, increased quality, and leveraging of competing values and skills. Pituitary Tumor Centers of Excellence must have adequate volumes and high-functioning teams to provide exceptional, high-value care. Organizational logistics, attentive operations management, facilitated collaboration, and clear communication are key teamwork tools in delivering that care.

Disclosure

The authors have nothing to disclose.

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