Optimizing the Team Approach: Designing a Clinical Care Pathway for Functional Neurological Disorder in the Inpatient Pediatric Setting

Research Objectives: 1) Identifying key stakeholders to support project goals and objectives
2) Understanding team dynamics when building a pathway with multiple users, garnering buy-in from leadership and personnel within hospital system and sustaining interest and forward movement
3) Observing the process for establishing common language in order to derive consistent and targeted conversations for a united approach in identifying themes in hospital’s current state
4) Applying quality improvement tools to identify, strategize and develop opportunities for intervention
5)Optimizing the balance between creating a user-friendly pathway for medical staff that is effective, equitable, feasible and yields optimal outcomes for patients
6) Demonstrating the capability of staff clinicians to identify a need for quality improvement, recognize and support organizational-wide systematic change

Design: Descriptive, qualitative

Setting: 312-bed pediatric, in-patient hospital in a large metropolitan area

Participants: Experienced clinicians representing rehabilitation (physical, occupational and speech therapies), psychology, psychiatry, emergency medicine, general medicine, neurology, pain and gastroenterology departments. 30% of team with some experience and background in quality improvement, though no formal hospital representative from QI department available until pathway’s completion.

Interventions: Monthly team meetings with targeted goals and deliverables. Individual department meetings, as needed, with rehab clinicians. Monthly rehab clinician meetings. Various clinician based educational seminars. Bench-marking with other institutions. Synthesis of conversations, discussions and application of QI tools.

Main Outcome Measures: Current State Analysis; Fish-bone and Key Driver Diagrams; Value Stream Map; SMART goal development; creation of project timeline.

Results: Comprehensive literature review. Clinician and leadership buy-in to drive forward organizational-wide systematic change. Development of hospital's clinical care pathway. Retainment of effective working team.

Conclusions: Designing a clinical care pathway for functional neurological disorder with multiple providers is a complex and iterative process which involves the identification of and buy-in for key stakeholders, development of cohesive communication and balance of comprehensive clinician inputs with action. Quality improvement tools are assistive in multiple aspects of this process. Clinical care pathway development is a first step in providing equitable care and for establishing a strategy for changing the outcome.

Author(s) Disclosures: None