Aligning The Needs Of The Complex Medical Inpatient With Their Interdisciplinary Team's Management Plan Using A Novel Visual Patient Engagement Tool: The Team And Patient Alignment Score (TAPAS)

Newnham H^{1& 2}, Noel B², Daley A², Ritchie E², Nagalingam V², Wallace E², Aung A², Jacob A², DeSilva D², Duffy O² , Munro A², Holton S³.
¹ Department of Medicine, Monash University, ² General Medicine, Alfred Health; ³School of Public Health & Preventive Medicine, Monash University.

Evaluation of the care of acute general medical patients is hampered by the paucity of measures of quality or outcomes for this complex comorbid patient cohort. Despite symptom management being an important primary goal of their care, there is little understanding of the predictive power of symptom distress on important outcomes such as patient deterioration, rate of recovery, satisfaction, length of stay or readmission rates for these patients. There is also a lack of tools capable of providing a concise summary of the medical and functional state of complex medical patients from the perspective of the interdisciplinary team that cares for them. Accordingly it has not been possible to readily document the size or nature of any gap between the team’s perception of a patient’s progress and the patient’s own view of their current state, nor to understand the effect of any gap on the outcomes of care.

Aim: To design a visual and semi-quantitative tool that measures patient symptom distress on a daily basis and allows comparison to the treating team’s perspective to help staff address any gaps in care.

Methods: A bedside survey of a cross section of twenty-eight GenMed patients was used to assess the frequency and severity of seventy different symptoms. An on-line survey of thirty-three medical, nursing and allied health staff assessed staff perceptions of symptoms most likely to be causing patient distress. Each survey was collated into Pareto charts of the frequency of current symptoms/concerns affecting patients. A radial plot of corresponding interdisciplinary team medical and functional assessments (T-view chart) and patient symptom distress scores (P-view chart) was developed to facilitate rapid visual identification of patient complexity and the range of patient concerns. The tool was used to evaluate the status of a selection of forty GenMedA patients to ensure its feasibility of use in a busy general medical environment.

Results: A pareto chart of patient symptom distress indicated that 34 symptoms across a variety of medical and functional domains accounted for 80% of patient concerns. Comparison with the staff survey showed significant differences between staff perceptions of common symptoms and those of their patients. Notably the patients’ most common concern was their inability to exercise. These symptoms were then mapped on a radar plot that corresponded to a convenient distribution of medical and functional domains (T-view) allowing the interdisciplinary team to readily make an assessment of the work to be done in both the medical and functional domains for an individual patient. It also allowed ready visual identification of any gap between the team assessment and the patient’s concerns (P-view) on almost a real-time basis. The TAPAS tool also showed readily identifiable differences from day to day corresponding to clinical assessments of patient progress.

Conclusion: The novel TAPAS tool has potential to engage with patients to standardise and improve communication of their symptoms to their treating team on a daily basis.  The consensus Team View (T-view) component provides a convenient visual summary of patient complexity and the balance of medical and functional issues requiring intervention, and can numerically document patient progress over time. Used together the P-View and T-view charts can rapidly identify gaps in understanding between the caring team and their patient.