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Creighton, CHI Health Pioneering Team-Based Approach to Clinical Care

Huddle 1It’s 8:40 a.m.

A diverse group of health care clinicians, residents and students is gathering behind the scenes at the new University Campus of CHI Health Creighton University Medical Center on 24th and Cuming streets. 

They call it the “huddle.”

It starts with a roll call: behavioral health … check … Community Link … check … faculty, front desk, interpreters, physicians, occupational and physical therapy, pharmacy, radiology, residents, registered nurses, pharmacy students. Check, check, check.

The group, which on this day numbers about 30, represents University Campus’ family medicine team. They meet for about 10 minutes, as patients arrive for the first appointments of the day at 9 a.m.

Team members go over issues or challenges they may be facing. They talk about what’s working well. And they spotlight a particular group within the team.

One recent spotlight was the Community Link – an initiative backed by a $1.1 million grant from the national arm of Catholic Health Initiatives (CHI) to improve overall patient wellness and access to care. A Community Link representative assists patients with a variety of nonmedical issues – from finding a bus route to the clinic to helping them apply for food stamps. (A day after their presentation to the team, in-house patient referrals to Community Link jumped dramatically.)

The team members bring different backgrounds and expertise to the meeting. Some come wearing the traditional white coats, stethoscopes draped around their necks. Others are dressed in blue or gray scrubs. 

After the meeting, they break into smaller groups to continue discussions and learn from each other.

This interprofessional approach represents the future of clinical care and is an extension of Creighton’s classroom teaching, says Joy Doll, executive director of Creighton’s Center for Interprofessional Practice, Education and Research (CIPER).

“In academia, we’re doing a really good job of talking about team-based care, but it’s not necessarily happening in practice,” says Doll, who earned a Doctor of Occupational Therapy degree from Creighton in 2003.

“Creighton is on the leading edge nationally in offering our students in the health sciences — in dentistry, medicine, nursing, occupational therapy, pharmacy and physical therapy, along with a developing physician’s assistant program — opportunities for interprofessional education and practice in the clinical setting,” adds Doll. “We are a front-runner in this new model of health care.”

At the new University Campus, Creighton University and CHI Health are pioneering this team-based approach to clinical care. The family medicine team, for example, holds two 10-minute team meetings daily (once at 8:40 a.m., and again at 12:40 p.m.) in a private, centralized space called the “pod.”

Family medicine, as one of first areas to move into the new University Campus facility, is piloting the interprofessional initiative. Other services will be joining the effort as they move over from the current CHI Health Creighton University Medical Center at 30th and California streets, which closes this summer.

Final touches are still being made to the construction of the 80,000-square-foot University Campus clinic, which opened in January. When completed, the out-patient health center will house family medicine, an imaging center, pediatrics, women’s health services, an emergency department, an on-site pharmacy and physical therapy – offering plenty of opportunity for interprofessional collaboration. (Inpatient and trauma care will move to new facilities on the Bergan Mercy Campus in south-central Omaha.)

“It’s so exciting,” Doll says. “There are so many opportunities.”

Thomas Guck, PhD, professor and director of behavioral sciences at Creighton, is currently coach of the family medicine team. As a clinical psychologist, he sees many benefits to the collaborative approach – including having pharmacists and a pharmacy on-site to quickly address patients’ medication needs.

“We have already seen patients fill their prescriptions at our pharmacy who otherwise might not have done so because of transportation or language issues,” says Guck. “Access to pharmacy as well as other professional services will improve treatment adherence and patient outcomes.” The pharmacy will be hosting a public open house on Feb. 10 from 11 a.m. to 1 p.m. The entrance is on the north side.

Doll says the team-based model is in line with changes coming in Medicare and Medicaid reimbursements, which will focus less on fee for service and more on patient outcomes. “The idea is that we’ll pay for more bundled services,” Doll says. “So the idea was to try that here, and get ready for that.”

For patients, this means more holistic care – where, for instance, they might see a nurse, physician, pharmacist and psychologist all in one visit.

“Yesterday, I had this resident come up to the team and say, ‘I have this patient and she needs dentures, but she won’t go to the hospital to get her teeth pulled. She seems like she has anxiety. I’m not sure what to do,’” Doll says. The team connected the resident with a clinician from behavioral health, who saw the patient that day.

“The idea is that the patient can hopefully get what they need while they are here, instead of having all of these follow-up appointments.” 

For Creighton students in the health sciences, it means real-life, hands-on experiences in the future of clinical care.

“The idea is that our students will come over here and see this as a lived experience,” Doll says, “and they will recognize what can happen. CHI agreed to really invest in this clinic to be that facility as our starting point.”

Huddle 2




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