At Focus on Function, we have always believed that great outcomes are achieved through multidisciplinary care.
For many years, we have worked collaboratively with participants, families, funding bodies and external providers. More recently, we have been reflecting on the significant benefits of increasing co-consulting and joint clinical decision-making within our own team.
When managing catastrophic injuries such as spinal cord injury, traumatic brain injury or complex neurological conditions, challenges are rarely isolated to a single discipline. A seating issue may affect skin integrity. A pressure injury may impact mental health. Reduced mobility may affect nutrition, participation, independence and quality of life.
The more complex the situation, the greater the value of clinicians working together.
Looking Beyond the Pressure Injury
Recently, our Occupational Therapist and Clinical Nurse Consultant worked closely together to support a gentleman with a spinal cord injury who developed a pressure injury.
As is often the case, determining the exact cause was not straightforward. There were concerns regarding commode seating, pressure management, positioning and daily routines. The impact on the participant was significant, with restrictions to activity levels, reduced independence and the possibility of prolonged bed rest.
Anyone who has worked with spinal cord injury knows that bed rest is never just about wound management. It can have far-reaching impacts on physical health, mental wellbeing, social participation and overall quality of life.
By co-consulting, our OT and Clinical Nurse Consultant were able to:
- Explore potential causes of the wound from different clinical perspectives
- Develop a coordinated pressure off-loading plan
- Review equipment and seating options
- Provide consistent recommendations
- Ensure all stakeholders received the same message
The benefits were immediate.
Communication became clearer. The management plan became more specific. The participant reported feeling more informed and empowered. Rather than receiving separate pieces of advice from different clinicians, he received one coordinated plan that everyone understood and supported.
Solving Complex Problems Through Shared Thinking
Another recent example involved a young gentleman living with a spinal cord injury who had developed increasingly complex seating and posture challenges.
Over several years, he had become disengaged from traditional physiotherapy and stretching programs. As a result, muscle shortening, reduced flexibility and postural changes had begun to impact his seating position, functional ability and skin integrity.
A joint consultation between his Case Manager and Occupational Therapist provided an opportunity to look beyond traditional solutions.
Rather than focusing on what had not worked in the past, the team explored alternative ways of supporting the participant that aligned with his interests, preferences and lifestyle.
The collaborative approach identified opportunities to engage physiotherapy differently and ensure the participant’s goals remained central to the intervention plan.
As a result:
- Traditional physiotherapy arrangements were redesigned
- Cancellation costs were reduced
- Participant engagement improved
- Posture and seating outcomes improved
- Risk factors for pressure injury were reduced
- Communication between providers became more consistent
Most importantly, the participant’s priorities remained at the centre of every discussion.
For a young person living with a spinal cord injury, these decisions matter. He is likely to live many decades with his injury. Small improvements made today can have significant cumulative benefits over the course of a lifetime.
Maintaining joint range, minimising muscle shortening, optimising posture and protecting skin integrity are not short-term goals. They are investments in future health, independence and quality of life.
The Power of a Shared Plan
One of the greatest benefits of co-consulting is the development of a shared understanding.
When clinicians work together, participants receive consistent information. Goals remain aligned. Problems are viewed from multiple perspectives. Opportunities are identified earlier.
Importantly, co-consulting also helps clinicians challenge their own assumptions and learn from one another.
An Occupational Therapist may identify an equipment issue that influences skin integrity. A Nurse may recognise a clinical factor contributing to a functional challenge. A Case Manager may identify barriers to engagement that are preventing progress.
When these perspectives come together, better solutions emerge.
Looking Forward
At Focus on Function, we are continuing to increase opportunities for co-consulting across Occupational Therapy, Nursing, Case Management, Dietetics and Physiotherapy.
Our experience continues to reinforce a simple principle:
Complex problems are rarely solved by one clinician working alone.
Catastrophic injury management works best when clinicians collaborate, communicate and work towards shared outcomes.
The result is better decision-making, more consistent care, improved participant experiences and ultimately better long-term outcomes.
For participants living with life-changing injuries, that collaboration can make all the difference.
