Interdisciplinary Collaboration and Clinical Decision Support
Welcome to week 5 of GSNG 6700 😸, we are going strong💪 and making our way through the many topics of nursing informatics, and this week is especially intriguing! We are utilizing a case study created using chat GPT 💥that discusses interdisciplinary collaboration and its importance to providing care as an FNP.
Interdisciplinary collaboration in medicine is paramount to utilizing Clinical Decision Support (CDS) which encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools can include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools (The Office of the National Coordinator for Health Information Technology, 2018). These tools can increase the quality of care, improve patient outcomes, reduce adverse effects, and minimize errors (The Office of the National Coordinator for Health Information Technology, 2018). To utilize CDS most efficiently though, there needs to be interdisciplinary collaboration so that there is as much information about patients as possible, which helps promote better outcomes from CDS (McLaney et al., 2022). When it comes to care from FNPs there tends to be an even greater level of team collaboration, as with physicians partly due to the rules of your state and partly since APRNs and physicians have always worked in close collaboration, but even more so since COVID (McGilton et al., 2023).
(Now please enjoy this video demonstrating how CDS can detect, analysis, and alert a provider to changes in a patients status)
AI-Generated Case Study from Chat GPT: this case study was created using ChatGPT(2025) and was edited to be relevant to the current topic.
Name: Mrs. Linda Harris
Age:68 years
Gender: Female
Medical History
Ø
Type 2 Diabetes Mellitus (well-controlled with
metformin)
Ø
Hypertension (controlled with amlodipine)
Ø
Mild osteoarthritis
Ø
Previous history of diverticulosis, but no prior
episodes of diverticulitis
Ø
Smoker (20 pack-years, quit 3 years ago)
No known drug allergies
Presenting Problema
Mrs. Harris presented to the ED with a 5-day history of LLQ abdominal
pain, fever, nausea, and alternating diarrhea, and constipation. She also
reported a recent decline in appetite and unintentional weight loss of about 4
kilograms over the past month.
On examination, the patient had tenderness in the LLQ with
signs of guarding. Her vital signs were:
BP: 138/85 mmHg
HR: 102 bpm
Temp: 38.2°C
RR: 20 breaths per minute
Her history and clinical presentation suggested a probable
case of acute diverticulitis, and imaging was ordered for further evaluation.
Clinical Assessmenta
Laboratory Findings
Ø Complete Blood Count (CBC): Leukocytosis (WBC count 15,000/mm³), indicating an inflammatory response.
Ø C-Reactive Protein (CRP): Elevated at 45 mg/L, consistent with active inflammation.
Ø Electrolytes: Mild hypokalemia (3.3 mEq/L) and slightly elevated creatinine, likely due to dehydration.
Ø Blood Glucose: 150 mg/dL, indicating mild hyperglycemia.
Imaging
Ø Abdominal X-ray: Mild distention of the sigmoid colon.
Ø CT Scan of Abdomen and Pelvis: Confirmed acute diverticulitis with a small pericolic abscess in the sigmoid colon, and evidence of a thickened bowel wall suggestive of an inflammatory process. No perforation was noted.
Diagnosis
Acute Diverticulitis with Abscess Formation – Requiring surgical intervention due to complications, failure to improve with conservative therapy, and the presence of an abscess.
Interdisciplinary Collaboration
Given the patient's age, comorbidities (diabetes, hypertension), and the complexity of her condition, an interdisciplinary team was assembled to ensure comprehensive care and optimal outcomes. The team included:
1. **General Surgeon** (Lead in Surgical Decision-Making)
- Evaluated the need for surgery and discussed the benefits and risks of the procedure, including the potential for a **sigmoid colectomy** and primary anastomosis versus an alternative, like a staged procedure.
2. **Anesthesiologist** (Preoperative and Postoperative
Care)
- Assessed the
patient’s cardiac and respiratory status due to her age and comorbid
conditions.
- Managed anesthesia during the surgery and monitored vital signs throughout the procedure. Due to her diabetes and hypertension, careful fluid management was also necessary.
3. **Dietitian** (Postoperative Nutrition)
- Provided guidance
on a nutrition plan, particularly on advancing the patient’s diet
postoperatively to promote healing, avoid constipation, and prevent future
episodes of diverticulitis.
- Developed a plan to manage the patient’s diabetes post-surgery, including carbohydrate counting and regular blood sugar monitoring
4. **Nurse Practitioner** (Patient Education and Support)
- Coordinated care
by educating Mrs. Harris about her condition, the surgical procedure, and
postoperative care.
- Emphasized the
importance of early ambulation, pain management, and wound care.
- Assisted in addressing patient concerns and managing her preoperative anxiety.
5. **Pharmacist** (Medication Management)
- Reviewed Mrs.
Harris’s medications, adjusting for her diabetes and hypertension. This
included considering the effects of surgery on blood sugar control and
adjusting insulin dosing accordingly.
- Recommended appropriate prophylactic antibiotics preoperatively (metronidazole and ceftriaxone) to reduce the risk of postoperative infection.
6. **Physical Therapist** (Postoperative Mobility)
- Assisted in the
patient’s postoperative rehabilitation by designing an early mobilization
program to reduce the risk of deep vein thrombosis (DVT), promote lung
function, and encourage bowel motility.
- Provided guidance
on posture and movement after surgery to prevent complications like abdominal
strain.
Surgical Intervention
Preoperative
Preparation
- Mrs. Harris was started on intravenous fluids and
broad-spectrum antibiotics to manage the infection.
- A consultation with the dietitian confirmed that her blood
glucose levels were being managed, and she was advised to follow a low-residue
diet leading up to surgery.
- Anesthesia reviewed her medical history and performed a
preoperative assessment, which revealed that her hypertension and diabetes were
stable under current medications. Adjustments were made to ensure optimal
perioperative management.
Surgical
Procedure
Sigmoid Colectomy with Primary Anastomosis: The patient
underwent laparoscopic sigmoid colectomy with primary anastomosis, involving
the removal of the inflamed section of the sigmoid colon and reconnecting the
remaining colon. The surgeon confirmed the presence of localized diverticulitis
with small abscesses, but there were no signs of perforation or peritonitis.
Intraoperative Collaboration
Ø
The anesthesiologist managed the patient’s
sedation and fluid balance carefully, considering her age and underlying
conditions.
Ø
The surgical team used minimally invasive
laparoscopic techniques to minimize recovery time, which was discussed as part
of the preoperative plan with the patient.
Postoperative Care
Immediate Postoperative Management:
- Mrs. Harris was transferred to the recovery room, where
she was monitored by the nursing team.
- Pain management was initiated with a combination of IV
analgesics and later transitioned to oral medications.
- The physical therapist assisted in her early mobilization
on the first postoperative day, encouraging walking to improve circulation and
prevent complications like DVT.
- The dietitian adjusted her nutrition plan and started her
on clear liquids on day 2 post-surgery, with progression to a low-residue diet
by day 4. Her blood glucose was carefully monitored, and insulin was adjusted
based on her levels.
- The nurse practitioner continued to provide patient
education, explaining how to care for the surgical wound and the importance of
adhering to the diet plan to prevent future episodes of diverticulitis.
Challenges
Postoperative Ileus: On day 2, Mrs. Harris developed a mild
ileus (slowed bowel motility), common after abdominal surgery. This was managed
conservatively with IV fluids, bowel rest, and monitoring for signs of
complications.
Blood Sugar Control: Mrs. Harris's blood sugar fluctuated
postoperatively, but the pharmacy team worked with the nursing staff and
dietitian to ensure appropriate adjustments to her insulin regimen.
Outcome
Mrs. Harris was discharged on postoperative day 7 with no
major complications. She was prescribed antibiotics for continued infection
prevention and given instructions on wound care and activity restrictions. Her
blood glucose remained stable following discharge, and she was encouraged to
continue her diabetic management as per the dietitian's recommendations. The
patient was advised to follow up with the surgical team in 2 weeks for wound
check and with the dietitian to monitor her nutritional status.
Long-Term Management and Follow-Up
Follow-Up
Appointments
Ø Surgical
Follow-Up: In 2 weeks to assess wound healing and ensure no signs of infection.
Ø
Dietitian Follow-Up: In 4 weeks to adjust her
diet for long-term digestive health and prevent future diverticulitis episodes.
Ø
Physical Therapy Follow-Up: In 6 weeks to ensure
optimal recovery and mobility.
Preventive Measures
Mrs. Harris was advised to adopt a high-fiber diet to reduce
the risk of future diverticulitis. Smoking cessation and weight management were
emphasized to improve overall health and prevent recurrences.
Conclusion
This case of sigmoid colectomy for diverticulitis highlights the value of interdisciplinary collaboration in ensuring optimal care for a patient with multiple comorbidities. The team approach involving surgery, anesthesia, nutrition, nursing, pharmacy, and physical therapy allowed for comprehensive management of the patient’s condition, from preoperative preparation through to postoperative recovery and long-term follow-up. By working together, the interdisciplinary team ensured that Mrs. Harris received coordinated care, leading to a successful outcome and a strong foundation for her continued recovery and health management. With cases such as Mrs. Harris, she may also require long-term interdisciplinary support as her needs with her health change as she ages. However, without the support of each care team, Mrs. Harris would have likely faced other challenges post-operatively.
References
Dodson, C., & Layman, L. (2022). Interdisciplinary Collaboration Among Nursing and Computer Science to Refine a Pharmacogenetics Clinical Decision Support Tool Via Mobile Application. CIN: Computers, Informatics, Nursing, Publish Ahead of Print. https://doi.org/10.1097/cin.0000000000000960
McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-03798-1
McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Prospero, L. D. (2022). A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours. Healthcare Management Forum, 35(2), 112–117. https://doi.org/10.1177/08404704211063584
The Office of the National Coordinator for Health Information Technology. (2018, April 10). Clinical Decision Support. Healthit.gov. https://www.healthit.gov/topic/safety/clinical-decision-support
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