International Journal of Physical Medicine & Rehabilitation
Open Access

Abstract

Interdisciplinary Team Interactions in Stroke Units: Can Team Dynamics Influence Patient Outcomes from a Clinician?s Perspective

Tara Purvis, Julie Bernhardt, Bent Indredavik and Dominique A Cadilhac

Objective: Unlike patient-level data, qualitative research allows the exploration of interdisciplinary team (IDT) dynamics that may contribute to understanding why some stroke units (SUs) achieve better outcomes. Evidence from meta-analyses of randomised controlled trials suggests not all SUs perform equally with one hospital in Trondheim, Norway outshining others in terms of better patient outcomes. This study aimed to describe and compare the functioning of the IDT in a SU in Australia to the Trondheim SU, to begin to explore factors which explain why there are differences in outcomes. Methods: The Australian site, one of the longest established in Australia, was an ‘acute’ SU that provides care within the first 7-10 days after stroke (most common model in Australia). The Norwegian site, a ‘comprehensive’ SU, provides additional rehabilitation, with superior outcomes recognised internationally. Semi-structured interviews were conducted with clinical staff from each SU (Australia n=4; Norway n=3) using purposeful selection. All interviews were tape recorded, transcribed, with transcript content verified by respondents prior to thematic analysis. Using an inductive approach, a coding tree allowed extraction of major themes and sub-themes, with coded data then summarised. Another researcher verified the coding and summary. Results: Three nurses, two doctors and two allied health staff were interviewed. Clear differences were apparent in approaches to stroke care, working relationships and training. Most notably, in Trondheim, nurses were more strongly involved in decision making and planning of patient care, and exhibited more confidence in various aspects of patient management, including providing rehabilitation therapies. The reasons for this related to more specific stroke training for nurses and fewer professional boundaries in the Trondheim SU. Conclusion: The results of this study help understand the importance of IDT dynamics in the delivery of SU care, and highlight the need for more comprehensive investigation into team dynamics on outcomes.