Improving MDT meetings in stroke rehabilitation: findings from the GMASTER project

Transcription

1 Imprving MDT meetings in strke rehabilitatin: findings frm the GMASTER prject Sarah Tysn Prfessr f Rehabilitatin, University f Manchester Sarah.Tysn@manchester.ac.uk Schl f Nursing, Midwifery and Scial Wrk

2 MDTs are recmmended One f the mechanisms fr superirity f specialist strke care ver generalist services An effective MDT can enhance decisin-making and c-rdinatin f care cmmunicatin and trust between prfessins Imprve service quality

3 BUT Very little n hw an effective team perates hw t imprve peratin what (bjective) impact MDTs have n team functin and patient utcmes

4 Aim f G-MASTER prject (Greater Manchester Assessment Tlkit fr STrkE Rehabilitatin) Explre hw strke rehabilitatin MDTs perate Develp an interventin t imprve practice Evaluate the impact n team functin and patient utcmes Wrked with all the strke rehab teams in Manchester (n=10)

5 We undertk Nn-participant bservatins f MDT Meetings and semistructured staff interviews in the rehab units What was discussed, hw What decisins made, hw Prgress mnitred Dcumentatin used Measurement tls used Cmmunicatin within and utside the meetings Staff pinins what's gd, bad, culd be imprved, hw

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7 Manchester MDT Meeting Mdel (M4) THE CONTEXT Venue/ facilities; mdel f service delivery; staff resurces; ther meetings/ team prcesses MEETING INPUTS Persnal cntributin f team members Meeting structure and rganisatin MEDIATING PROCESSES Leadership and chairing style Team / scial climate MEETING OUTPUTS Inf exchanged Decisins and plans made Actins allcated Prgress and cmpletin mnitred and reviewed Attributes f successful meetings

8 Meeting Inputs: Cntributin f team members Attendance Punctuality Active cntributin Preparatin knw patients cmplete assessments actins

9 Agenda Inputs: Meeting Structure and rganisatin Specific dcumentatin Use f standardised measurement tls Gal setting Actin planning with specific peple and time scales Reviewed prgress Nature f the talk Objective language > anecdtes Patient > prfessin fcussed Respectful and c-perative Stick t the pint One cnversatin at a time Little repetitin r cntradictin Staff fllw the cnversatin

10 Mediating Prcesses: leadership & chairing Effective teams - + ve team climate

11 Leadership & chairing: Ineffective teams

12 Meeting utputs and attributes Infrmatin exchanged Decisins and plans jintly made Actins allcated Prgress and cmpletin mnitred and reviewed Cmprehensive/ hlistic Patient fcussed Objective Relevant Timely and cmpleted Accurate, succinct and cnsistent Respectful

13 Develped the M4 Frmalised agenda including intrductin review f actins assessment r review impairments and activity using standardised measurement tls statement r review f patients gals plans fr treatment and discharge, actins allcated t a specific persn with date fr cmpletin Standardised dcumentatin t supprt and recrd discussin and decisins Tlkit f standardised measurement tls Guidelines fr successful cnduct f the meetings

14 Evaluatin f impact f the M4 Chrt study Assessed MDT meeting perfrmance and patient utcmes fr 3 mnths befre and after implementatin f the M4 Data cllected thrugh nn-participant bservatins f weekly MDT meetings staff interviews at each site

15 Outcmes Patient utcmes length f stay discharge n destinatin change in Barthel Index scre MDT meetings perfrmance assessed against pre-defined criteria cvering The venue, Attendance Punctuality Preparatin Chairing Cmmunicatin Use f standardised measures (G-MASTER) Dcumentatin

16 Meeting perfrmance befre & after M4 100 % Pass rate befre M P<0.002 % Pass rate after M4

17 Patient utcmes befre & after M N significant differences Befre M4 After M4 0 Mean n. Patients Mean LS (days) % institutinalised

18 5 Mean change in Barthel Index P= Befre M4 After M4

19 Discussin and cnclusins An evidence-based structured mdel fr MDT meetings and the use f standardised measurement tls (M4 and G-MASTER) Can imprve perfrmance f MDT meetings in strke rehabilitatin May imprve patient recvery withut increasing length f stay r reducing prductivity BUT chrt design risk f bias Other changes may have affected utcmes - Perid f change +++ Randmised trials needed

20 Acknwledgements

21 Further inf G-MASTER handbk system.imprvement.nhs.uk/imprvementsystem/viewdcument.aspx?path=strke/nati nal/website/presentatins/120712/lb_g_master_presentatin_1207.pdf Or Greenhalgh et al (2008). Scial Science & Medicine. 67;1; Greenhalgh et al (2008). BMC Health Services Research 8:217. Tysn et al (2010). Clinical Rehabilitatin 24;74-81 Tysn et al (2012). J f Evaluatin f Clinical Practice 18:2: Tysn & Cnnell (2009). Clin Rehab 23; Tysn & Cnnell (2009). Clinical Rehabilitatin 23: Cnnell & Tysn (2012). Arch Phys Med Rehab 93; Cnnell & Tysn (2012). Clinical Rehabilitatin 26(1):68-80 Tysn et al (2007). Disability & Rehabilitatin 30;2; Tysn, Burtn & McGvern (2014). Clinical Rehabilitatin e-pub February 26, 2014 Burtn & Tysn (2014). Psychlgical Medicine e-pub 28 th Feb 2014 Tysn & Brwn (2014). Clinical Rehabilitatin e- published February 11, 2014 Tysn & Brwn (2013). Clinical Rehabilitatin e-pub Dec 9 th 2013.

22 Implementing the M4 Prject champin in each site Liaisn between research and clinical team Driver f change in practice Full time prject manager Senir management buy-in All f Manchester s teams Evidence-based

23 Implementatin techniques Prcess mapping Actin planning PDSA (Plan, D, Study, Act) cycles Test f change; prcess nrmalisatin thery On-ging mnitring f uptake, review, revisin