Successful MDTs: What Are They?

A Patient’s Journey through the QEH Stroke Team

Cilla WilliamsStroke Physiotherapist

Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

28 bed (+ 1 thrombolysis bed) stroke unit, combining acute stroke and stroke rehabilitation

545 strokes per year Ward manager – Sister Diane Benefer Consultants – Raj Shekhar, James Phillips, Umesh

Rai Stroke OT/PT Team Lead - Anne-Marie Hurst QEH Stroke AHPs cover entire stroke pathway

(successful bid in 2008)

Who are we?

A coordinated multidisciplinary team that meets at least once a week for the interchange of information about individual patients (RCP, 2012)

Staff should have specialist expertise in stroke and rehabilitation (RCP, 2012)

Stroke units should have multi-disciplinary notes (Clarke, 2010)

Is that it??!!!

What is teamworking in Stroke?

Current measures of teamworking in stroke are inadequate

Location of staff, frequency of team contact, team size, management structure, defined team membership and shared goal planning are key determinants of teamworking practice

(Baxter & Brumfitt, 2008a)

What is real teamworking in Stroke?

The inpatient journey – an overview

Board round

30 minute MDT meeting held in day room, 5 days per week

Exceptional multi-professional attendance – doctors (including consultants), specialist stroke nurses, physiotherapists, occupational therapists, speech & language therapists, stroke coordinator sister, dietician, social worker, clinical psychologist, Stroke Association Coordinator

Week to view documentation “I don’t think decisions are made above your head,

they involve you” (Patient Experience Survey 2012)

Board round

A typical day – joint working

Patient with midbrain infarct, presenting with reduced postural control, aphasia, ptsosis, visual disturbance, dysphagia

Tilt table session in stroke therapy gym with PT and Therapy Assistant (dual OT/PT), as well as…….

SLT Orthoptist

A typical day – joint working

Unplanned, problem orientated interaction between team members unconstrained by location, time, or team member status (Clarke, 2010)

Occurs on the ward, in the day room, in the therapy gym, in the therapy office

Close proximity to Wheelchair Services, Social Services departments

Not only with staff members but also patient and carers

A typical day –opportunistic dialogue

A typical day –opportunistic dialogue

Comprehensively trained staff Electronic nursing handover updated by all

of the team Six day PT & OT Stroke service Early inpatient contact with Stroke

Association Information, Advice and Support Coordinator

A typical day…

Dedicated Stroke Coordinators (1 WTE) Discharge Planning Assistant (0.5 WTE) Formal meeting with patient and carer if

required Community Stroke Team Comprehensive therapy discharge summary

Discharge Planning

Monthly MDTs and interdisciplinary MDT training

Stroke Association Communication Group Advice/support Prevention Long term support groups

In the community

“They demonstrate true interdisciplinary working” Liz Bennett, Anglia Stroke Network Lead

The integrated physiotherapy and occupational therapy services “reduces duplication and increases effectiveness and efficiency of service delivery” Caroline Hayden-Wright, Rehabilitation Services Review, October 2012

What do others say?

“My family and I wish to express our gratitude and admiration for this team of talented health care professionals” Patient AS, September 2012

“Seems to be a well practised unit” “Absolutely brilliant” [about QEH Stroke Unit] Patient Experience

Survey 2012

What do our patients say?

QEH Stroke Team achieved a total organisational score of 89.1 in

the SSNAP 2012 (national average 73.3)

The results?

Service user participation in service development

Restructuring our community service 6 month reviews

For the future…

Effective team work is complex and requires frequent contacts at a variety of levels, not only between professions but with patients and their carers

Successful interdisciplinary working is vital in stroke but national guidelines do not go far enough when describing what makes teams most effective

The QEH Stroke Team demonstrates a range of qualities of effective team work including co-location, good leadership, skilled staff, joint working and opportunistic dialogue

The patient and their carer will be physically or virtually present at every stage of the pathway

Conclusion

?

Any questions?

Baxter, S. K. & Brumfitt, S. M. (2008a) Once a week is not enough: evaluating current measures of teamworking in stroke. Journal of Evaluation in Clinical Practice, 14, 241-247.Baxter, S. K. & Brumfitt, S. M. (2008b) Benefits and losses: a qualitative study exploring healthcare staff perceptions of teamworking. Quality Safety Health Care, 17, 127-130. Clarke, D. J. (2010) Achieving teamwork in stroke units: The contribution of opportunistic dialogue. Journal of Interprofessional Care, 24 (3), 285-297.Enefer, C. & Scantlebury, K. (2012) Patient Experience: Patient Satisfaction Interviews (West Raynham Stroke Unit), QEH Audit Dept.Hayden-Wright, C. (2012) Review Rehabilitation Services Queen Elizabeth Hospital King’s Lynn.

 

References

Monaghan, J., Channell, K., McDowell, D. & Sharma, A. K. (2005) Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. Clinical Rehabilitation, 19, 194-199.RCP (2012) National Clinical Guideline for Stroke, 4th Edition, London, Royal College of Physicians.RCP (2o12) Sentinel Stroke National Audit Programme (SSNAP)Acute organisational audit report, London, Royal College of Physicians.Suddick, K. M. & De Souza, L .(2006) Therapist’s experiences and perceptions of teamwork in neurological rehabilitation: reasoning behind the team approach, structure and composition of the team and teamworking processes. Physiotherapy Research International, 11 (2), 72-83.

References (continued)