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
Who are we?
 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)
What is teamworking in Stroke?
 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 real 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)
The inpatient journey – an overview
Discussed
at 8.45am
board
round
Commence
discharge
planning
Patient
and Carer
Feedback to
board
round
Assessment
and
treatment
by MDT
Board round
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)
A typical day – joint working
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 –opportunistic
dialogue
 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…
 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
Discharge Planning





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
In the community
 Monthly MDTs and interdisciplinary MDT training
 Stroke Association




Communication Group
Advice/support
Prevention
Long term support groups
What do others say?
 “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 our patients 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
The results?
QEH Stroke Team achieved a total
organisational score of 89.1 in the
SSNAP 2012 (national average 73.3)
For the future…
 Service user participation in service development
 Restructuring our community service
 6 month reviews
Conclusion
 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
Any questions?
?
References
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 (continued)
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), 7283.