When it comes to healthcare, one size does not fit all. Patients can have a variety of needs that require specialized attention from different medical professionals.
Trying to coordinate care between multiple specialists is often difficult and time consuming for both patients and providers. This can lead to gaps in care, delays in diagnosis, and other issues that can negatively affect patient outcomes.
This post will explore what an interdisciplinary healthcare team looks like, how they function within a system of care delivery, and the advantages that these teams offer both providers and patients alike.
Table of Contents
What is an Interdisciplinary Team & Members
Nursing Team Members
RN: The RN is often the center of the health care team, providing direct patient care. The RN will assess and monitor the patient’s condition, administer medications and treatments, provide education to patients and families, coordinate with other healthcare professionals involved in the care of the patient, and ultimately serve as an advocate for their well-being.
LPN: The LPN works closely under the direction of the RN to provide basic patient care. They may administer medications, take vital signs, and assist with changing dressings or managing IVs.
CNA: The CNA is responsible for providing basic patient care such as bathing, dressing, eating assistance, ambulation support, and other activities of daily living.
Case Manager: The case manager is responsible for coordinating the care of patients and ensuring that all appropriate resources are available. They will typically work closely with other healthcare providers to ensure continuity of care.
Example of when to call the case manager RN: When a patient is admitted to the hospital, the RN should contact the case manager for assistance with coordinating care. The case manager can ensure that all necessary specialists are consulted, that follow-up appointments are scheduled, and any needed resources or support services are available.
Palliative Care RN: The palliative care RN provides a special type of care to patients with life-limiting or terminal conditions. These nurses focus on providing comfort and improving quality of life, while also supporting families and caregivers.
Example of when to call the palliative care RN: When a patient is diagnosed with a terminal illness or condition, the RN should reach out to the palliative care team for assistance. The palliative care nurse can provide emotional support and address end-of-life issues such as pain management and hospice care referrals.
Hospice RN: The hospice RN provides care to terminally ill patients and their families. They may provide pain management, emotional support, home health aide services, and other palliative care services.
Example of when to call the hospice RN: When a patient is entering the end stages of life, the RN should contact the hospice team for assistance. The hospice nurse can provide comfort, support, and resources to help both the patient and their family during this difficult time.
Stroke Coordinator RN: The stroke coordinator RN is responsible for coordinating care for patients who have had a stroke. This may include arranging follow-up appointments, providing education to the patient and their family, and connecting them with other healthcare resources.
Example of when to call the stroke coordinator RN: When a patient has had a stroke, the RN should contact the stroke coordinator for assistance with follow-up care. The stroke coordinator can ensure that the patient is getting the necessary follow-up appointments, as well as connecting them with other healthcare professionals to help manage their symptoms.
WOCN: The Wound, Ostomy and Continence Nurse (WOCN) provides specialized care for patients with wounds or ostomies. They may provide wound assessment and management, education on proper skin and stoma care, as well as assistive devices to help improve the patient’s quality of life.
Example of when to call the WOCN: When a patient has an open wound or an ostomy, the RN should contact the WOCN for assistance. The WOCN can provide assessments and treatments to help promote healing of the wound or stoma, as well as providing education on proper care and management.
Physician/Advanced Practice Team Members
From family doctors to heart surgeons, physicians play an essential role in keeping us healthy and even saving lives. These highly trained professionals work tirelessly to provide patients with the best possible care, often going above and beyond to ensure proper diagnosis, treatment, and follow-up care.
Whether they’re working in a hospital, clinic, or private practice, physicians must possess a wealth of medical knowledge and a compassionate bedside manner to provide their patients with the support they need. We rely on physicians to help us through some of the most difficult times in our lives, and their dedication to their craft is truly awe-inspiring.
When taking on the responsibility of tending to a patient, it is essential to be aware of which medical professionals are part of their care team. This will allow you to know who to contact depending on the current state of the individual’s health. Such as:
- MD: The MD is the base level of specialist that you will find in a care team. These individuals are usually referred to as “generalists” and are typically responsible for managing overall health by diagnosing and treating acute and chronic illnesses.
- DO: A DO is an osteopathic physician and has the same credentials as a MD, however they have an additional emphasis on preventative care.
- ARNP: ARNPs are nurse practitioners who have completed an advanced practice nursing program and work in collaboration with physicians. They can often take on the role of primary care provider or specialist, depending on their area of expertise.
- Pediatrician: Pediatricians specialize in providing care for children from birth through adolescence. They perform physical exams, prescribe medications, and provide advice on a wide range of health related topics.
- Surgeon: A surgeon is a highly skilled medical professional who typically specializes in performing operations. These individuals may perform anything from minor surgical procedures to complex organ transplantation surgeries.
- Gynecologist: Gynecologists specialize in providing care for female reproductive organs including diagnosis, preventative care, and treatment of disorders.
- Psychiatrist: Psychiatrists specialize in the diagnosis and treatment of mental health disorders. They may use a variety of therapeutic approaches including medication management, cognitive behavioral therapy, and psychotherapy.
- Physician Assistant (PA): PAs are mid-level professionals who provide medical services under the supervision of a physician. They may diagnose and treat illnesses, prescribe medications, and provide patient education.
- Nurse Practitioner (NP): NPs are mid-level professionals who are trained to perform advanced medical services. They can diagnose and treat illnesses, order tests, prescribe medications, and provide patient education.
- When a patient needs specialized care, the best course of action is to reach out to a specialist. These medical professionals are highly trained in a specific area and can provide more detailed treatments or diagnoses than would be possible with generalists.
- Anesthesiologist: Anesthesiologists specialize in providing anesthesia care before, during, and after surgery. They are also responsible for managing pain relief medications and monitoring the patient’s vital signs during procedures.
Example of when to call an anesthesiologist: When a patient is undergoing a surgical procedure, the RN should contact an anesthesiologist for assistance. The anesthesiologist can provide anesthesia care to ensure the patient’s comfort and safety during the procedure.
In addition to the medical professionals listed above, there are other disciplines that may be part of a patient’s care team. These individuals provide support and resources to help both the patient and their family during this difficult time.
Social Worker: Social workers are trained to provide emotional and practical assistance to patients and their families. They may provide counseling, arrange for home care services, or connect the individual with financial assistance programs.
Example of when to call a social worker: When a patient is in need of emotional support or practical resources, the RN should contact a social worker for assistance. The social worker can provide counseling and other resources to help them cope with their condition and improve their quality of life.
Physical Therapist: Physical therapists specialize in restoring movement and function to those who have been injured or ill. Through physical therapy, they can help improve the patient’s mobility and strength, as well as reduce pain and discomfort.
Example of when to call a physical therapist: When a patient has sustained an injury or illness that has impaired their mobility, the RN should contact a physical therapist for assistance. The physical therapist can provide treatments and exercises to help the patient regain their strength and range of motion.
Wound Care Nurse: Wound care nurses are specially trained in wound management, stoma care, and ostomy education. They can provide assessments of wounds or stomas, create wound care plans, and teach patients how to properly manage these conditions.
Example of when to call a wound care nurse: When a patient needs assistance managing a wound or stoma, the RN should contact a wound care nurse for assistance. The wound care nurse can provide assessments and help create an individualized plan of care to ensure proper healing and management.
Dietician: Dieticians are experts in nutrition and can help patients create healthy eating plans to meet their individual needs. They also provide counseling on food safety, dietary supplements, and lifestyle changes.
Example of when to call a dietician: When a patient is looking for nutritional advice or assistance creating an eating plan, the RN should contact a dietician for assistance. The dietician can provide guidance and suggestions to ensure the patient gets the nutrients they need for optimal health.
Speech Language Pathology Therapist: Speech language pathology therapists specialize in diagnosing and treating communication disorders. They can help those with speech impediments, difficulty understanding language, and other related issues.
Example of when to call a speech language pathology therapist: When a patient is having difficulty communicating or understanding language, the RN should contact a speech language pathology therapist for assistance. The therapist can provide assessments and treatments to help the patient improve their communication skills.
Occupational Therapist: Occupational therapists specialize in helping patients with physical or mental disabilities develop, recover, and maintain the skills needed for daily activities. They can provide home safety assessments, adaptive equipment recommendations, and training on how to use these resources.
Example of when to call an occupational therapist: When a patient has difficulty performing daily activities due to a disability, the RN should contact an occupational therapist for assistance. The occupational therapist can provide assessments and treatments to help the patient improve their quality of life.
Supportive Roles Members:
Beyond medical professionals, there are many other supportive roles members who can help the patient and their family during this time. These individuals provide a variety of services to make the healing process easier and more comfortable for those involved.
Caregiver: Caregivers offer physical assistance with daily activities such as bathing, grooming, dressing, and cooking meals. They also provide emotional support and companionship to those in need.
Example of when to call a caregiver: When a patient needs assistance performing daily activities or would benefit from having someone around for conversation and companionship, the RN should contact a caregiver for assistance. The caregiver can provide physical and emotional support to make sure the patient’s needs are met.
CNA or PCT: Certified Nursing Assistants (CNAs) and Patient Care Technicians (PCTs) provide basic bedside care to patients. They can help with bathing, dressing, taking vital signs, administering medications, and providing companionship.
Example of when to call a CNA or PCT: When a patient needs assistance with daily activities such as cooking meals or getting dressed, the RN should contact a CNA or PCT for assistance. The CNA or PCT can provide basic care to ensure the patient’s needs are met.
Chaplain: Chaplains offer spiritual and emotional support to patients and their families during difficult times. They provide counseling, prayer services, bereavement support, and other resources as needed.
Example of when to call a chaplain: When a patient needs spiritual or emotional support, the RN should contact a chaplain for assistance. The chaplain can provide counseling and prayer services to help them cope with their condition and improve their quality of life.
Volunteer: Volunteers are people who donate their time and resources to help those in need. They offer a variety of services such as visiting with patients, running errands, providing transportation, and more.
Example of when to call a volunteer: When a patient needs assistance with tasks such as grocery shopping or transportation to medical appointments, the RN should contact a volunteer for assistance. The volunteer can provide practical help and companionship to make sure the patient’s needs are met.
Social Worker: Social workers provide a variety of services to help patients and their families during difficult times. They can help with finding resources, filing for benefits, and providing emotional support.
Example of when to call a social worker: When a patient needs assistance connecting with community resources or filing for benefits, the RN should contact a social worker for assistance. The social worker can provide guidance and support to help the patient get the resources they need.
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.