The O&P EDGE: How do you develop relationships with other members of the coordinated care team?
Brett: First of all, you have to try and break into the community and establish a relationship so you can create a team. That is probably the biggest step and takes the most effort before you can make a team work. In the beginning, we didn’t realize that the biggest referral source for us in pediatrics was going to be the physical therapist (PT). We realized early on that they are the ones we needed to talk to, and we needed to educate them because they weren’t necessarily familiar with what was orthotically available to treat their patients.
Barbara: We have PTs…spend the day with us, and we will talk about mechanics, we will take them into our lab, we will show them how we modify casts, and we will go through our entire evaluation process with them. We send them home with…printed material about how we decide what to do in the design of an orthosis… [W]e put on courses… I’ve created a group list on Outlook contacts. Everybody can contact everybody else; all they have to do is reply to all. There will be discussions on there. We used to have monthly meetings…and we would sit around and talk about difficult childhood diagnoses like idiopathic toe walking.
The O&P EDGE: How do you coordinate orthotic care with other members of the care team?
Barbara: What often happens, whether a PT or occupational therapist (OT) refers a patient to us, is that they will call ahead and we will take notes of the conversation. When we see the family…the parents are already at ease because they know that we have already spoken [with the PT or OT]. After we have done our evaluation, we call the PT or OT and discuss our findings…and then we talk about what we feel we should do moving forward. We determine what the therapists are hoping for in the [child’s] growth or functional outcomes. [The ellipsis didn’t really seem necessary since you go to a new paragraph. I think it’s okay if you left something out here without the added ellipsis.]
We got some new pediatric orthopedic physicians in town who use the same model, so they actually contacted us to have us introduce them to our PT community; we have created a list of about 200 therapists that we work with.
Brett: In order to differentiate ourselves from what was the norm, we had to create a really functional team and prove that coordinated care was much more successful and [improved] functional outcomes. Once people realized that, they got on board quickly and wanted to work with us because they realized that the communication lines were always open and that anyone who wanted to be part of the team was always welcome to be involved in the patient’s care.
The O&P EDGE: What forms of communication do you use with the other members of the care team?
Barbara: It’s all forms of communications: e-mail, Facebook. If [an issue] really needs discussion, we make a phone date. We have everybody’s cell phone numbers, including the physiatrist and… orthopedists that we work with. I’ve called the physiatrist at eight at night. We sort out what we need to sort out, make our plan, and then move on.
Brett: We’ve even called surgeons while they are in the operating room. They know that if we are calling it is for a good reason… We are always willing to communicate.
The O&P EDGE: What are the benefits of coordinated care?
Brett: We learn a lot from the therapists about things we weren’t necessarily trained in. Our specialty is not sensory… [or] proprioceptive, our specialty is gait and biomechanics and bracing. Similarly, the therapists aren’t experts in bracing so when we brace children, the short-term functional outcomes are not that pretty and they require a lot of therapy and a lot of training and muscle patterning and work. In order to get them functional in their device, it is sometimes our job to educate the therapist on what they are seeing, why they are seeing it, and what they need to work on to make the kid functional.
Barbara: If each person on the team is able to contribute [to the patient’s care] in terms of their area of expertise, all of that results in a better functional outcome whatever that outcome happens to be. It keeps the patient in the center of the team, which is where they need to be.