May 3, 2012

Multidisciplinary team huddle improves stroke service

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On the Stroke service, Case Manager Sarah Hutchison, R.N., left, leads a daily team huddle devoted to discharge planning. (Photo by John Russell)

Multidisciplinary team huddle improves stroke service

A multidisciplinary team huddle on the Stroke service at Vanderbilt University Hospital, held daily at 9:30 a.m., is the centerpiece of a strategy to improve discharge planning, better coordinate post-acute care and, when appropriate, retain more patients within the Vanderbilt health system who need rehabilitation services after they leave the hospital.

Leaders are evaluating the program and making plans to roll it out in other areas of the adult hospital.

“The huddle is a remarkable improvement in multidisciplinary communication, leading to improved outcomes and improved utilization of resources,” said David Charles, M.D., chief medical officer of the Vanderbilt Neuroscience Institute.

Since the huddle was launched in January, hospital length of stay for patients on the Stroke service has decreased by 15 percent.

“I was glad to see that stroke was the pilot service for this new strategy. At a time when the hospital is very full, it’s especially important that discharge not be delayed and that all beds are occupied by patients who are actively receiving treatment,” said Howard Kirshner, M.D., professor and vice chair of Neurology and director of the Vanderbilt Stroke Center.

Each morning prior to the huddle a lead case manager for the service meets briefly with the senior resident or attending provider to discuss each patient’s status and anticipated discharge needs.

The case manager presents that information at the huddle, which includes other case managers, a charge nurse and representatives from social work, physical therapy, occupational therapy, speech and language therapy and all relevant Vanderbilt post-discharge rehabilitation facilities. (Vanderbilt facilities that provide rehab services for post-discharge stroke patients include Vanderbilt Stallworth Rehabilitation Hospital, Vanderbilt Home Care, and Vanderbilt’s Pi Beta Phi Rehabilitation Institute.)

“Everyone comes out of the meeting with the same information on what needs to be done. Then they disperse and work on the discharge plan,” said Jack Boone, an administrative director with Vanderbilt Medical Group and leader for the pilot and the anticipated house-wide rollout.

The case managers, social workers and therapists use iPads for bedside documentation and carry cell phones to speed communication.

“The patient and family fully understand what the next steps are. The huddle supports continuity of care and patient satisfaction,” said Donna Rice Cella, R.N., VMG senior operations engineer and project manager for the initiative.

The Neurosurgery and General Neurology services are now adapting the strategy. “We’ll work with each service to adapt the strategy to their patients and their operation,” Rice Cella said.

The initiative includes making sure patients and families have the information they need to make informed choices about post-discharge rehabilitation services.

Since the start of the pilot, post-discharge retention of stroke patients by rehabilitation facilities within the Vanderbilt health system has increased from 15 percent to 34 percent.