Department of Medicine for the Elderly, Monklands Hospital, Monkscourt Avenue, Airdrie, UK.
King's College London, Institute of Psychiatry, Psychology & Neuroscience Centre for Implementation Science, Health Service and Population Research Department, PO 28, David Goldberg Centre, De Crespigny Park, Denmark Hill London, UK.
Age Ageing. 2019 Jul 1;48(4):498-505. doi: 10.1093/ageing/afz021.
Geriatric medicine is a speciality that has historically relied on team working to best serve patients. The nature of frailty in older people means that people present with numerous comorbidities, which in turn require a team-based approach to be managed, including allied health professionals, social work and nursing alongside medicine. The 'engine room' of the speciality has thus for many years been the multidisciplinary team (MDT) meeting-something other specialities have discovered only recently. Yet, rather paradoxically, the speciality has been slow compared to others (e.g. trauma, surgery, cancer) to reflect more formally on how team working can be enhanced, trained and supported in geriatric teams. This paper is a reflective review, grounded on our respective expertise in geriatric medicine and improvement science, on practice and its changing patterns within geriatric medicine, and the role of MDTs within it (Part 1). It offers a perspective from behavioural safety science, which has been studying team-working in healthcare for the last 20 years (Part 2) and concludes with practical suggestions, based on evidence, on how to integrate evidence and best practice into modern geriatric medicine-to address current and future challenges (Part 3).
老年医学是一门历史上依赖团队合作以最好地为患者服务的专业。老年人虚弱的性质意味着他们会出现许多合并症，这反过来又需要团队合作的方法来管理，包括联合健康专业人员、社会工作者和护理人员以及医学人员。因此，多年来，该专业的“核心”一直是多学科团队 (MDT) 会议——其他专业最近才发现的东西。然而，具有讽刺意味的是，与其他专业（例如创伤、外科、癌症）相比，老年医学在更正式地思考如何加强、培训和支持老年医学团队中的团队合作方面进展缓慢。本文是一篇反思性评论，基于我们在老年医学和改进科学方面的专业知识，讨论了老年医学实践及其不断变化的模式，以及 MDT 在其中的作用（第 1 部分）。它提供了行为安全科学的视角，该科学在过去 20 年中一直在研究医疗保健中的团队合作（第 2 部分），并基于证据提出了一些实用建议，说明如何将证据和最佳实践整合到现代老年医学中，以应对当前和未来的挑战（第 3 部分）。
