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Successful MDTs: What Are They? A Patient’s Journey through the QEH Stroke Team Cilla Williams Stroke Physiotherapist Queen Elizabeth Hospital King’s Lynn.

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Presentation on theme: "Successful MDTs: What Are They? A Patient’s Journey through the QEH Stroke Team Cilla Williams Stroke Physiotherapist Queen Elizabeth Hospital King’s Lynn."— Presentation transcript:

1 Successful MDTs: What Are They? A Patient’s Journey through the QEH Stroke Team Cilla Williams Stroke Physiotherapist Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

2  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?

3  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?

4  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?

5 Patient and Carer Discussed at 8.45am board round Assessment and treatment by MDT Feedback to board round Commence discharge planning The inpatient journey – an overview

6 Board round

7  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

8 A typical day – joint working

9  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

10  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


12  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…

13  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

14  Monthly MDTs and interdisciplinary MDT training  Stroke Association  Communication Group  Advice/support  Prevention  Long term support groups In the community

15  “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?

16  “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?

17 QEH Stroke Team achieved a total organisational score of 89.1 in the SSNAP 2012 (national average 73.3) The results?

18  Service user participation in service development  Restructuring our community service  6 month reviews For the future…

19  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

20 ? Any questions?

21 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

22 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, 4 th 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)

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