Multidisciplinary teams ‘need to be in lockstep’ for optimal outcomes in stroke care

Stroke is the fifth leading cause of death in the U.S., responsible for more than 160,000 deaths yearly, and is strongly tied to heart disease, the leading cause of death, which is responsible for nearly 25% of deaths, according to the CDC.

Collaboration between interdisciplinary health teams, such as neurology and cardiology departments, should be a fundamental best practice to deliver a focused team-based approach to stroke care. While this approach can result in better outcomes for stroke patients, most modern hospitals and medical centers are not set up to support an interdisciplinary approach. Given the antiquated organizational structure in hospital systems, overlap between departments is limited, with each department designated with its own cost center and ultimately accountable for its own budget.

This siloed structure maintains rigid fiscal accountability but often impedes the ability of teams to adopt new, innovative technologies. Newer technologies are often expensive and, unless one department can convince another to share the expense, a single department would need to pay the full cost from its own budget.

Recently, industry leaders have advocated for a centralized budgeting approach to make it easier for medical centers to adopt new technologies, and the industry has begun to make moves in this direction. Calls for an interdisciplinary approach to care for complex conditions, such as stroke, may prompt more to follow suit.

The interdisciplinary advantage

A multidisciplinary approach to stroke treatment and care has proven to result in improved outcomes for many stroke patients. Founded more than a decade ago, the Mass General Institute for Heart, Vascular and Stroke Care is a model of how multidisciplinary care teams can be structured. Its stroke service coordinates all aspects of cerebrovascular diagnosis, treatment and ongoing care. Working in close contact with the medical center’s emergency department, this multidisciplinary team comprises a lead stroke physician who manages dedicated resources including emergency physicians, neurologists, neuroradiologists, cardiologists, physicians and others.

Simply assembling a cross-disciplinary stroke care team, however, doesn’t automatically result in better care outcomes. To be successful, these teams need to be in lockstep in terms of communication and coordination of care. While each team member will have their own area of expertise, treatment responsibilities and perspectives on appropriate care options, the larger group must align on the objectives of the care program as well as planning and decision-making based on the patient’s reaction to treatment.

Inevitably, distinctions between some care roles will become blurred. Potential confusion can be minimized through clear and consistent communication, both during and outside of regular meetings with the entire team. A U.K. review of randomized trials in which stroke patients were treated with a coordinated multidisciplinary approach found “unequivocal evidence” that this type of organized stroke care improved patient outcomes (Clarke DJ, et al).

The role of technology

Advanced technologies are enabling significant progress in stroke treatment. Many of these are minimally invasive or noninvasive, making stroke treatment and rehabilitation easier for the patient. Artificial intelligence holds considerable promise in honing the accuracy of platforms in use today, although it remains in relatively early phases. Other advanced technologies are in more common use today, helping to save lives and reduce the effects of stroke.

Telemedicine experienced a surge in use during the pandemic, making it one of the easiest technologies for interdisciplinary teams to implement. Telemedicine can provide patients in remote or underserved areas with access to neurologists and other stroke specialists who can coordinate treatment and rehabilitation via virtual consultations. Similarly, doctors in remote hospitals can leverage a “telestroke network” connecting remote facilities with regional stroke centers, allowing more patients to receive timely care.

Telemedicine can also be used to provide follow-up care, such as surgical checkups, physical and speech therapies, and other rehabilitation support. When paired with a wearable device such as a smartwatch, stroke patients’ vital signs can be monitored remotely, alerting health care providers if changes indicate a potential issue.

Another example is transcranial Doppler (TCD), a noninvasive monitoring technique that uses ultrasound technology to measure blood flow to the brain. TCD is used to provide real-time information that can help guide stroke treatment decisions.

For example, neurologists can use TCD to monitor patients after a brain hemorrhage to help with early identification of secondary issues like vasospasm. TCD can also be used to help determine the underlying cause of a stroke, which can enable more informed treatment decisions.

Because multiple care teams can benefit from TCD, the equipment is a good candidate for a shared investment between cardiology and neurology, and potentially the emergency department. This cost-sharing eases the impact on a single department’s budget while enabling the facility to provide leading-edge stroke care.

Increasingly, technology is being used to break down organizational barriers and facilitate interdisciplinary collaboration in stroke treatment. Only by continually working in tandem with complementary specialties will the prognosis and recovery of stroke patients improve.

References:

• Clarke DJ, et al. J Multidiscip Healthc. 2015;doi:10.2147/JMDH.S68764.
• Deaths and mortality. https://www.cdc.gov/nchs/fastats/deaths.htm.
• Hospital budget systems are holding back innovation. https://hbr.org/2018/03/hospital-budget-systems-are-holding-back-innovation. Published March 29, 2018. Accessed April 18, 2023.
• Massachusetts General Hospital launches Institute for Heart, Vascular and Stroke Care. https://www.healio.com/news/cardiology/20130411/10_3928_1081_597x_20130101_01_1098134. Published April 1, 2013. Accessed April 18, 2023.
• Multidisciplinary approach to patient care and research in the management of stroke patients. https://www.hmpgloballearningnetwork.com/site/eplab/articles/multidisciplinary-approach-patient-care-and-research-management-stroke-patients. Published April 2014. Accessed April 18, 2023.

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Ajay Yadlapati, MD, is an interventional cardiologist at Sharp HealthCare in San Diego.