Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 314

The complex needs of elderly patients often require equally complex treatments or interventions, usually involving the combined efforts of a highly skilled multidisciplinary team. Of course, this is in general a highly beneficial way of working because decisions and clinical management are enhanced by the expertise contributed by a variety of professionals; however, working as a team can be associated with its own problems.

If optimal patient outcomes are to occur, the multidisciplinary team needs to communicate effectively. Some of the barriers to effective communication in healthcare teams described in the literature include conflict or ambiguity about individual roles within the team, perceived hierarchical difficulties, and interpersonal conflict.⁵⁰ There is some evidence that this is compounded by different professions differing in their ratings of collaboration, perceived barriers to teamwork, and beliefs of what the best outcomes for patients might be.⁵¹ In addition, there can be difficulty in ensuring that team members do not work in silos and have a common understanding of goals of care. Ineffective multidisciplinary teamwork can adversely affect communication with patients and carers, in turn causing decisions to be made without adequately involving patients.

Of course, the wider team caring for an older person usually extends across health and social care sectors; here, coordination and continuity of care can be a problem. In particular, poor communication at times of transition of care can cause problems. It has been shown that inadequate communication at discharge from the hospital, particularly in relation to medication management and monitoring arrangements, can lead to preventable readmissions in older people.⁵² It is also crucial that decisions made with patients about preferred levels of future intervention are adequately communicated at the time of discharge; otherwise, patients may be subjected to unwanted or unnecessary intervention after discharge.