To Improve Rehabilitation Team Conferences: Is There Data? Yes!
Haven’t we all heard that data is needed to solve problems? An especially worthwhile read, with theory and data, is a scientific review by Drs. David Kushner and Dale Strasser looking at models for more effective team conferencing.
Dr. Kushner, Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Miami, is a medical director of a free-standing inpatient rehabilitation hospital. He noted improvement in his rehabilitation team conferences when applying the Siebens Domain Management Model (SDMM) to guide team discussions (Blog, October 22, 2018). Several quality indicators improved:
lengths of stay shortened
readmissions to acute care hospitals decreased
patients' function at discharge increased, and
discharges home rose.
In this review, Dr. Kushner teamed up with Dr. Strasser, Professor, Department of Rehabilitation Medicine at Emory University School of Medicine who has devoted his career to studying team function. With colleagues, Dr. Strasser developed a theoretical team effectiveness model with measures. He created a team training intervention that improved stroke rehabilitation outcomes.
The review noted that essential components for improving team effectiveness - structure and leadership - were addressed through the SDMM, as a patient-centered clinical model, in Dr. Kushner’s studies.
Managerial practices allowed any team member to contribute to the discussion of the SDMM’s four domains addressing all major components of care.
The teams’ professional network improved as different disciplines recognized the collaborative work required to address discharge barriers.
Team leadership broadened through a shared structure including the physician and the case manager.
The authors also note that the principles leading to improved team function should apply across health care services beyond rehabilitation. Our blog Parkinson disease care management simplified: a positive randomized trial using the SDMM (October 19, 2019) supports this as the SDMM was successfully used in this nurse-led outpatient intervention done in collaboration with Parkinson disease specialists.
Many thanks to Drs. Kushner and Strasser for a clinically relevant review and acknowledgement of the merits of the SDMM in enhancing patient outcomes.
David S. Kushner MD FAAN, Dale C. Strasser MD. Stroke inpatient rehabilitation team conferences: leadership and structure improve patient outcomes. J Stroke Cerebrovas Dis 2020; 29 (4);104622.