Examples of the effect of multidisciplinary team care
| Refinement of management plans during labor and/or delivery . | Merging of expertise . | Improved professional collaboration and team communication . |
|---|---|---|
| Creation of individual patient care plans, with real-time documentation into the electronic health record | Capitalizes on the distinct perspectives and training of hematologists, obstetricians, and other specialists (anesthesia, neurology, cardiology, pediatrics)* | In-person meetings increase familiarity, mutual respect, and candor |
| Decisions on timing of anticoagulation interruption and restart based on expected obstetric course | Allows modification of treatment plans based on information that other teams impart | Timely patient care results from continuous collaboration |
| Example: Anticoagulation planning for a woman with a third trimester PE makes allowances for expected labor timeline (ie, is she nulliparous, or has she had 3 prior, rapid deliveries), and/or mode of delivery. | Example: Timing of the transition from LMWH to UFH for VTE prophylaxis (ie, in a woman with no preterm birth risks vs a woman carrying twins, or with a history of preterm birth at 32 wk). | Example: A first obstetric visit for a woman with a complex thrombosis history: a telephone call made to the hematology team results in immediate shared decisions on care, without waiting for a formal consultation. |
| Refinement of management plans during labor and/or delivery . | Merging of expertise . | Improved professional collaboration and team communication . |
|---|---|---|
| Creation of individual patient care plans, with real-time documentation into the electronic health record | Capitalizes on the distinct perspectives and training of hematologists, obstetricians, and other specialists (anesthesia, neurology, cardiology, pediatrics)* | In-person meetings increase familiarity, mutual respect, and candor |
| Decisions on timing of anticoagulation interruption and restart based on expected obstetric course | Allows modification of treatment plans based on information that other teams impart | Timely patient care results from continuous collaboration |
| Example: Anticoagulation planning for a woman with a third trimester PE makes allowances for expected labor timeline (ie, is she nulliparous, or has she had 3 prior, rapid deliveries), and/or mode of delivery. | Example: Timing of the transition from LMWH to UFH for VTE prophylaxis (ie, in a woman with no preterm birth risks vs a woman carrying twins, or with a history of preterm birth at 32 wk). | Example: A first obstetric visit for a woman with a complex thrombosis history: a telephone call made to the hematology team results in immediate shared decisions on care, without waiting for a formal consultation. |
At our institution, we have a quarterly conference between obstetric care providers and hematologists, with review of shared patients kept on a continuously updated list. Members of other disciplines are asked to join the meeting when needed. In-person discussion of patient care plans are scheduled outside of these quarterly conferences on an as-needed basis, and frequently involve multiple disciplines.