Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation

Objective: To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Design: Consecutive assessment of the three forms of care was completed. Subjects: The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. Intervention: (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. Results: MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two),and improved team working (measured using the team climate inventory) than do MDT meetings. Conclusions: In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF The use of a MDT ward round allows these standards to be achieved.