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Patient Focus, Interdisciplinary Collaboration Key in CLI Teams
If properly functioning, a CLI team can help patients achieve better outcomes.
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It takes a village to build a critical limb ischemia 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.
Successful CLI teams are built on interdisciplinary relationships. 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.
Essential Personnel
The physician champion is somebody who is willing to walk a lot of extra miles and who brings different specialties together to sit and plan how to work together successfully. Then, you need to add providers that you are willing to train and teach. Even the scheduler, who answers the phone, needs to know about CLI, and the registered nurse who works with you needs to know as much as you do.
It is vital that someone such as a nurse navigator help coordinate patient care, especially out-of-area referrals.
Patients are frustrated to begin with, especially CLI patients. So, if you make it an easy and smooth transition for them, they are much happier. 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 also essential to building a successful interdisciplinary relationship. If a radiologist and a cardiologist don’t talk to each other, find somebody who will facilitate discussion between them.
A true interdisciplinary approach should increase mutual referrals and result in the best patient experience.
Other Important Factors
It is also crucial to address the elephant in the room: potential conflicts and concerns among CLI team members.
A team does not always have to agree. In order to have a good, true interdisciplinary team, the push should always be to 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.
Continued education of members of the CLI team is also important. For example, my team learns about new procedures, techniques, devices and medications on a regular basis.
Screening is an integral part of the care of patients with CLI, so it is a good idea for office staff to 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.
The staff is the front-line referral base and can help perform and document hemodynamics, can triage patients appropriately and can educate patients regarding awareness, treatment and prevention, so their education is very important.
In addition, the key to establishing a solid referral base is educating the referral physician. The earlier the patient can be seen, the sooner the limb can be preserved.
Better Teamwork, Better Outcomes
Other strategies to build a successful CLI team can include community outreach, media opportunities and marketing.
My experience and single-center data demonstrate significant increases in the volume of peripheral vascular disease encounters and endovascular procedures after introduction of the CLI team. We saw after the third year of implementation of a team that major amputation rates decreased. Minor amputations are to be expected when patients present with significant tissue loss and gangrene. However, when you start to see minor amputations replacing potential major amputations, you know you have made your CLI program successful.
- 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.
- For more information:
- Jihad A. Mustapha, MD, FACC, FSCAI, is co-founder and CEO of Advanced Cardiac and Vascular Amputation Prevention Centers in Grand Rapids, Michigan, and clinical associate professor of medicine at Michigan State University College of Osteopathic Medicine. He can be reached at jmustapha@acvcenters.com; Twitter: @mustapja.
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.