A collaborative review of studies by researchers at the University of Miami Miller School of Medicine and the Emory University School of Medicine has found that during inpatient rehabilitation greater attention to team functioning, and especially team conference leadership and structure, may improve function and discharges to home, rather than to institutional care or back to acute care, in people with stroke.
“Clinical teams that interact and communicate better provide more effective coordinated care,” said David S. Kushner, M.D., medical director for privileging and credentialing at the University of Miami Medical Group and University of Miami Hospital and Clinics, and clinical professor of physical medicine and rehabilitation at the Miller School, who was first author of the review that appeared in the April issue of the Journal of Stroke and Cerebrovascular Diseases. Dr. Kushner’s co-author was Dale C. Strasser, M.D., associate professor of rehabilitation medicine at Emory.
In the review, the two researchers identify and analyze literature on theory and structure of effective teams, with the focus on stroke interdisciplinary rehabilitation team conferences. They describe potential flaws of commonly used team conference formats and offer suggestions for improvement. Studies are outlined showing associations between stroke patient outcomes and better care coordination and leadership in medical teamwork. The authors also provide two examples of successful interdisciplinary team conference models used in stroke inpatient rehabilitation that support a case for a proactive, conscious structure to team conferences.
“The prevalence of Americans living with stroke is expected to gradually increase as the U.S. population ages, as will the related direct and indirect costs. Effective interdisciplinary team conferences during acute-stroke inpatient rehabilitation are key to managing long-term costs while improving functional outcomes. Effective team conferences help to identify patients at risk for medical complications and institutionalization and help to determine interventions that will focus on patients’ medical, physical, cognitive, emotional, and social barriers to recovery and barriers to a community/home disposition,” the authors wrote.
“Although it may seem intuitive, our review shows that improving interactions for clinical problem solving at weekly interdisciplinary team conferences during inpatient rehab is associated with improved function at discharge in stroke patients,” Dr. Kushner said. “Getting clinical treatment teams that include physicians, nurses, and therapists to work together more effectively improves recovery of function, and this finding should also apply to diverse patient populations and interdisciplinary clinical care situations.”