Literature Collection

BACKGROUND: Individuals with serious mental illness at a Toronto mental health hospital receive interdisciplinary team (IDT) care through a reverse integration model supporting both mental and physical health. Nurses play a central role in this model, yet face barriers including unclear role definitions, limited resources and workflow constraints. Enhancing nursing autonomy and IDT collaboration may improve patient outcomes and workforce retention. METHODS: This quality improvement study aimed to reduce nursing-initiated hospitalist requests by 25% across four pilot units by October 2023. From February to May 2023, 99 nurses completed 1 hour refresher training sessions to strengthen clinical decision-making, clarify scope within the IDT, and improve workflow efficiency. Pre-training and post-training surveys assessed nurses' self-reported knowledge and comfort, and an implementation survey assessed perceived impacts on practice and collaboration. A retrospective electronic health record (EHR) chart review (September 2022-June 2024) evaluated total and declined hospitalist requests (outcome measures), focused nursing assessments (FNAs; process measures) and direct allied health requests (AHRs; balancing measures). RESULTS: Pre-training and post-training surveys were completed by 69 and 72 nurses, respectively. Mean composite self-reported knowledge scores increased from 3.56 (SD 0.88) pre-training to 4.57 (SD 0.57) post-training (mean difference 1.02; 95% CI 0.77 to 1.26; p<0.001). Implementation surveys indicated improved clinical practice, enhanced IDT collaboration, and strong endorsement of the training. However, nursing-initiated hospitalist requests (monthly mean=339.4) and declined requests (monthly mean=30.6; 9% decline rate) showed no sustained reduction. Common reasons for declined requests included completed assessments (18.8%), duplicate requests (18.8%), and redirected AHRs (13.0%). FNAs (monthly mean=91.77) and AHRs (monthly mean=14.3) remained stable. CONCLUSION: Targeted nursing education improved nurses' self-reported knowledge and IDT perceived collaboration but did not reduce hospitalist requests. Sustained impact may require ongoing education, integrated onboarding, EHR workflow enhancements, and clearer role definitions.

OBJECTIVES: In response to rural communities and practice concerns related to opioid use disorder (OUD), the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs) developed a training intervention for full primary care practice (PCP) teams in MAT for OUD. This evaluation reports on training implementation, participant satisfaction, and impact on perceived ability to deliver MAT. METHODS: PCPs in the High Plains Research Network and Colorado Research Network were randomized to receive team training either in-person or through virtual tele-mentoring. Training attendance logs recorded the number of participants and their roles. Participants completed a survey within one month of the last training session to evaluate satisfaction and ability to deliver components of MATs. RESULTS: 441 team members at 42 PCPs were trained, including 22% clinicians, 47% clinical support staff, 24% administrative support staff. Survey respondents reported high levels of satisfaction, including 82% reporting improved understanding of the topic, and 68% identifying actions to apply information. Self-rated ability was significantly higher after training for all items (P < .0001), including ability to identify patients for MAT and to manage patients receiving MAT. Mean change scores, adjusted for role, were significantly greater for all measures (P < .001) in SOuND practices compared to ECHO practices. CONCLUSIONS: The IT MATTTRs Practice Team Training successfully engaged PCP team members in diverse roles in MAT for OUD training and increased self-efficacy to deliver MAT. Results support the training as a resource for a team-based approach to build rural practices' capacity to deliver MAT.