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Interprofessional Ambulatory Care Program

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Discharge planning

The importance of family and team collaboration

This interprofessional learning through simulation resource package consists of two components: an audiovisual resource and a supporting facilitator manual. In order to optimise the learning opportunities from this package it is recommended that participants are firstly introduced to the concepts of interprofessional learning and human factors in health care.

The package has been created in a format to enable flexibility in its application depending of the educational setting. The audiovisual resource is made up of three parts. These can be viewed in its entirety initially and/or then viewed in sections.

Recommended format

Seven vignettes depicting communication and interaction between various healthcare team members and the patient’s family.
Health care team conference. During the meeting, the communication within the health care team transitions from inadequate to effective.
Family conference. Focus of the meeting is the patient’s discharge and outpatient support for him and his family.

Throughout the second part, three pause points are suggested, during which discussion can take place relating to the interprofessional learning objectives.

Scenario brief

Gary Mitchel is a 20-year-old man who has experienced a traumatic brain injury during a car accident nine months ago. Gary‘s physical injuries and brain damage have resulted in him having to relearn basic tasks including walking, talking and swallowing. Frontal lobe damage has resulted in significant behavioural changes: he is impulsive, aggressive and sexually uninhibited, which is challenging for the staff caring for him.

Both staff and family are unhappy with the current care environment. The clinical nurse manager arranges a team meeting to discuss Gary’s behaviour and the choices that need to be made to manage his physical and psychological issues, his ongoing rehabilitation and discharge planning.