Coordinating care for patients through multidisciplinary teams offers many benefits to both patients and hospitals. When patients' needs are supported by a group of experts working together, they receive higher quality care; when patients receive higher quality care, there is a reduced chance for adverse events or readmissions, which saves hospitals money. One area of care delivery that is particularly in need of coordinated care is stroke care, as "time is brain" — every second lost can mean lost brain tissue.
A stroke team should be led by a stroke coordinator, who oversees the entire stroke program, and a physician champion, who engages physicians and leads process change. The team itself should involve multiple stakeholders from several departments. Timothy Shephard, PhD, vice president of Bon Secours Virginia Health System's Neuroscience Institute, explains the roles of some key members of a stroke team for inpatient care.
1. Emergency medical services staff. EMS providers are often the first point of contact that stroke patients have in their treatment. Depending on the community, many stroke patients are transported to a hospital emergency department via EMS. Hospitals should engage EMS early in the process of stroke program development to expedite stroke care and demonstrate how the system can support EMS. Hospital collaboration not only yields superior care, but also increases transparency between the two care providers, creates trust and increases the likelihood that EMS will transport patients to that hospital over another, according to Dr. Shephard.
2. ED physicians and nurses. ED physicians and nurses are tasked with the time-sensitive effort to recognize the variable symptoms of stroke, complete a diagnostic work-up and collaborate with the team to decide on possible treatment options. Dr. Shephard says the opportunity for a stroke patient to leave the hospital with minimal or no deficits is dependent on: a) the patient's recognition of stroke symptoms and calling EMS; b) rapid transport by EMS to the nearest stroke center; and c) the skill and coordination of the stroke response in the ED.
3. Radiologists and lab staff. Radiologists and technical staff are key members of the stroke team because they need to acquire and interpret brain imaging quickly to determine subsequent treatment. Similarly, lab staff need to complete lab tests for stroke patients quickly to be able to move forward with the patient's treatment.
4. Hospitalists. In many facilities the hospitalist service admits and provides inpatient services to stroke patients, which gives them significant responsibility in overseeing the acute care of the patient, preventing complications and implementing secondary prevention of further strokes.
5. Neurologists and neurosurgeons. Neurologists are specialty physicians that guide the stroke-specific care of these patients, in consultation with the hospitalist, or assume the primary role in neurologically complex patients. Neurosurgeons are consulted if emergent intracranial surgery is required for severe ischemic or hemorrhagic stroke and may also serve as the interventional member of the stroke team, according to Dr. Shephard.
Post-acute care
There are several additional roles in a stroke team that provide care, including case managers, physical medicine and rehabilitation physicians, dieticians and speech and occupational therapists. These members of the stroke team are important in assessing and preparing the patient for discharge. Dr. Shephard suggests beginning discharge planning within the first 24 hours of a stroke patient's arrival so the transition from inpatient to outpatient care is quick, safe and efficient.
Coordinating care is a team effort
While each individual's role is important in and of itself, it's the combination of skills and services that make a stroke team effective in treating stroke patients. "If all these stakeholders develop the program together, the patient benefits because everyone knows their role, understands the role of their colleague and are more likely to operate as an integrated care delivery team," Dr. Shephard says.
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A stroke team should be led by a stroke coordinator, who oversees the entire stroke program, and a physician champion, who engages physicians and leads process change. The team itself should involve multiple stakeholders from several departments. Timothy Shephard, PhD, vice president of Bon Secours Virginia Health System's Neuroscience Institute, explains the roles of some key members of a stroke team for inpatient care.
1. Emergency medical services staff. EMS providers are often the first point of contact that stroke patients have in their treatment. Depending on the community, many stroke patients are transported to a hospital emergency department via EMS. Hospitals should engage EMS early in the process of stroke program development to expedite stroke care and demonstrate how the system can support EMS. Hospital collaboration not only yields superior care, but also increases transparency between the two care providers, creates trust and increases the likelihood that EMS will transport patients to that hospital over another, according to Dr. Shephard.
2. ED physicians and nurses. ED physicians and nurses are tasked with the time-sensitive effort to recognize the variable symptoms of stroke, complete a diagnostic work-up and collaborate with the team to decide on possible treatment options. Dr. Shephard says the opportunity for a stroke patient to leave the hospital with minimal or no deficits is dependent on: a) the patient's recognition of stroke symptoms and calling EMS; b) rapid transport by EMS to the nearest stroke center; and c) the skill and coordination of the stroke response in the ED.
3. Radiologists and lab staff. Radiologists and technical staff are key members of the stroke team because they need to acquire and interpret brain imaging quickly to determine subsequent treatment. Similarly, lab staff need to complete lab tests for stroke patients quickly to be able to move forward with the patient's treatment.
4. Hospitalists. In many facilities the hospitalist service admits and provides inpatient services to stroke patients, which gives them significant responsibility in overseeing the acute care of the patient, preventing complications and implementing secondary prevention of further strokes.
5. Neurologists and neurosurgeons. Neurologists are specialty physicians that guide the stroke-specific care of these patients, in consultation with the hospitalist, or assume the primary role in neurologically complex patients. Neurosurgeons are consulted if emergent intracranial surgery is required for severe ischemic or hemorrhagic stroke and may also serve as the interventional member of the stroke team, according to Dr. Shephard.
Post-acute care
There are several additional roles in a stroke team that provide care, including case managers, physical medicine and rehabilitation physicians, dieticians and speech and occupational therapists. These members of the stroke team are important in assessing and preparing the patient for discharge. Dr. Shephard suggests beginning discharge planning within the first 24 hours of a stroke patient's arrival so the transition from inpatient to outpatient care is quick, safe and efficient.
Coordinating care is a team effort
While each individual's role is important in and of itself, it's the combination of skills and services that make a stroke team effective in treating stroke patients. "If all these stakeholders develop the program together, the patient benefits because everyone knows their role, understands the role of their colleague and are more likely to operate as an integrated care delivery team," Dr. Shephard says.
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