Patient focus, interdisciplinary collaboration key when building a CLI team

Jihad A. Mustapha

HOLLYWOOD, Fla. — A focus on patient-centered treatment and interdisciplinary collaboration is crucial to the success of a critical limb ischemia team, Jihad A. Mustapha, MD, FACC, FSCAI, said during a presentation at the International Symposium on Endovascular Therapy.

“It takes a village to build a CLI team,” Mustapha, CEO of Advanced Cardiac and Vascular Amputation Prevention Centers in Grand Rapids, Michigan, said.

Building a CLI team

The cornerstone of a successful CLI team is a strong interdisciplinary relationship spearheaded by a physician champion and involving an array of health care professionals across various disciplines.

According to Mustapha, a CLI team might include:

a physician champion;
revascularization specialists;
mid-level providers;
schedulers;
registered nurses;
medical assistants;
radiology-vascular technicians;
vascular sonographers;
nurse navigator; and
research staff.

Successful CLI teams are built on interdisciplinary relationships, he said. CLI teams involve centralized and/or virtual representation from primary care, podiatry, wound clinics, vascular medicine, revascularization specialists, imaging, infectious disease and rehab/physical therapy.

The physician champion is “somebody is who is willing to walk a lot of extra miles … who brings different specialties together to sit and plan how to work together successfully,” Mustapha said. “Then, you need to add providers that you’re willing to train and teach. Even your scheduler, who answers your phone, needs to know about CLI, and the registered nurse who works with you needs to know as much as you do.”

Mustapha also stressed the importance of someone, such as a nurse navigator to help coordinate patient care, especially out-of-area referrals.

“Patients are frustrated to begin with, especially CLI patients,” Mustapha said. “So, if you make it an easy and smooth transition for them, they are actually much happier, and you want to see that. The patient should always be the center of attention, not the physician. The patient is the most important piece of the puzzle.”

A liaison between members of the CLI team is essential to building a successful interdisciplinary relationship, Mustapha said.

“If you have a radiologist and a cardiologist who don’t talk to each other, find somebody who will facilitate discussion between them,” Mustapha said.

“A true interdisciplinary approach should actually increase mutual referrals and result in the best patient experience,” he said.

Other important factors

Mustapha also discussed the importance of addressing the “elephant in the room,” when it came to potential conflicts and concerns between CLI team members.

“You don’t always have to agree. In order to have a good, true interdisciplinary team the push should always be that you discuss the issues that are causing tension. When you do that, you’re going to find your CLI team far more successful than any other team. Yes, it might be an uncomfortable position for 10 minutes, but you resolve issues for months,” he said.

Continued education of members of the CLI team is also important. Mustapha cited his own CLI team, which he said learns about new procedures, techniques, devices and medications on a regular basis.

Screening is an integral part of the care of patients with CLI. Mustapha suggested that office staff should also be trained to recognize the signs and symptoms of peripheral artery disease and CLI. Further, all patients should receive educational materials, including risk-assessment tools and smoking-cessation materials. Creation of office protocols and flow documents may help integrate PAD screening into the daily routine of the office, he said.

Investing in staff education — who Mustapha noted are “your frontline referral base — can help perform and document hemodynamics, can triage patients appropriately and can educate patients regarding awareness, treatment and prevention, for example.

It is also important to educate your referral physician, he said.

“The key to establishing a solid referral base is educating your referral physician,” he said. “The earlier the patient can get to you, the sooner you can preserve the limb.”

Other strategies to build a successful CLI team can include community outreach, media opportunities and marketing.

Mustapha cited single-institution data that demonstrate significant increases in the volume of peripheral vascular disease encounters and endovascular procedures after introduction of the CLI team.

“After the third year, major amputation rates flattened and we started to see minor amputations,” he said. “When you start to see minor amputations instead of major amputations, then you’ve made your program successful.” – by Earl Holland Jr.

Reference:

Mustapha JA. CLI Teams: What is needed for success. Presented at: the International Symposium on Endovascular Therapy (ISET); Jan. 27-30, 2019; Hollywood, Fla.

Disclosure: Mustapha reports he has financial ties with BD Bard, Boston Scientific, Biothelium, Cagent Vascular, Cardio Flow, Cardiovascular Systems Inc., Medtronic, Micromedical Systems, Philips Healthcare, PQ Bypass, ReFlow Medical and Terumo.