Aligning The Needs Of The Complex Medical Inpatient With Their Interdisciplinary Team's Management Plan Using A Novel Visual Patient Engagement Tool: The Team And Patient Alignment Score (TAPAS)
Newnham H1& 2, Noel B2, Daley A2, Ritchie E2,
Nagalingam V2, Wallace E2, Aung A2, Jacob A2,
DeSilva D2, Duffy O2 , Munro A2, Holton S3.
Department of Medicine, Monash University,
2 General Medicine, Alfred Health; 3School of Public Health
& Preventive Medicine, Monash University.
of the care of acute general medical patients is hampered by the paucity of
measures of quality or outcomes for this complex comorbid patient cohort.
Despite symptom management being an important primary goal of their care, there
is little understanding of the predictive power of symptom distress on
important outcomes such as patient deterioration, rate of recovery, satisfaction,
length of stay or readmission rates for these patients. There is also a lack of
tools capable of providing a concise summary of the medical and functional
state of complex medical patients from the perspective of the interdisciplinary
team that cares for them. Accordingly it has not been possible to readily
document the size or nature of any gap between the team’s perception of a
patient’s progress and the patient’s own view of their current state, nor to
understand the effect of any gap on the outcomes of care.
To design a visual and semi-quantitative tool that measures patient symptom
distress on a daily basis and allows comparison to the treating team’s
perspective to help staff address any gaps in care.
A bedside survey of a cross section of twenty-eight GenMed patients was
used to assess the frequency and severity of seventy different symptoms. An on-line
survey of thirty-three medical, nursing and allied health staff assessed staff
perceptions of symptoms most likely to be causing patient distress. Each survey
was collated into Pareto charts of the frequency of current symptoms/concerns
affecting patients. A radial plot of corresponding interdisciplinary team
medical and functional assessments (T-view chart) and patient symptom distress
scores (P-view chart) was developed to facilitate rapid visual identification
of patient complexity and the range of patient concerns. The tool was used to
evaluate the status of a selection of forty GenMedA patients to ensure its
feasibility of use in a busy general medical environment.
A pareto chart of patient symptom distress
indicated that 34 symptoms across a variety of medical and functional domains accounted
for 80% of patient concerns. Comparison with the staff survey showed
significant differences between staff perceptions of common symptoms and those
of their patients. Notably the patients’ most common concern was their
inability to exercise. These symptoms were then mapped on a radar plot that
corresponded to a convenient distribution of medical and functional domains (T-view)
allowing the interdisciplinary team to readily make an assessment of the work
to be done in both the medical and functional domains for an individual
patient. It also allowed ready visual identification of any gap between the
team assessment and the patient’s concerns (P-view) on almost a real-time
basis. The TAPAS tool also showed readily identifiable differences from day to
day corresponding to clinical assessments of patient progress.
The novel TAPAS tool has potential to engage with patients to standardise
and improve communication of their symptoms to their treating team on a daily
basis. The consensus Team View (T-view)
component provides a convenient visual summary of patient complexity and the
balance of medical and functional issues requiring intervention, and can
numerically document patient progress over time. Used together the P-View and
T-view charts can rapidly identify gaps in understanding between the caring
team and their patient.