Title : From transition to integration: Nurse-led coordination in a multidisciplinary pediatric stroke and neurovascular clinic

Pediatric stroke and neurovascular disorders are life-altering conditions that require coordinated, longitudinal, and multidisciplinary care. The Pediatric Stroke and Neurovascular Program at Children’s Hospital Colorado (CHCO) was established in 2006 through a collaboration between CHCO, which provided inpatient services, and the University of Colorado Denver Hemophilia and Thrombosis Center (HTC), which delivered outpatient care. With the opening of the CHCO Multidisciplinary Pediatric Stroke and Neurovascular Clinic in fall 2024, outpatient services were transitioned fully to CHCO, enabling the provision of comprehensive, integrated care for infants through young adults with stroke and neurovascular conditions. During program transition planning, it was recognized that optimal care necessitates seamless collaboration among a broad range of specialists, including neurologists, radiologists, physiatrists, neurosurgeons, endovascular neurosurgeons, cardiologists, neuropsychologists, therapists, and social workers. To support this complex care model, a dedicated nursing coordinator role was incorporated to promote continuity, communication, and consistency across the care continuum. Within the multidisciplinary clinic, the nurse coordinator serves as a clinical liaison, educator, advocate, and systems navigator. Core responsibilities include protocol development, interdepartmental coordination, family education, and facilitation of post-discharge follow-up. By centralizing communication and supporting adherence to evidence-based care pathways, the coordinator contributes to improve care delivery and patient outcomes. Although the value of care coordination within established multidisciplinary clinics is well recognized, its role in program transition and implementation has been less examined. In this setting, the nurse coordinator provided essential clinical insight and leadership by identifying and addressing challenges related to administrative infrastructure, clinic template development, scheduling and access, and communication with providers and referral sources. Overall, the nurse coordinator proved integral not only to advancing patient-centered care in pediatric stroke and neurovascular management, but also to the successful establishment of a sustainable and effective multidisciplinary program.

Jacqueline Murray, BSN, RN, CPN, AMB-BC has 19 years of nursing experience providing clinical care in a pediatric hospital setting. She has worked across both inpatient and outpatient services within neurosciences and rehabilitation. Jacqueline has been recognized for her excellence in nursing practice as a Magnet Nurse of the Year and Nightingale Award recipient. She is deeply passionate about care coordination and has played an integral role in the development of several multidisciplinary clinics, including the Non-Accidental Brain Injury Care Clinic, Acquired Brain Injury Care Clinic and the Multidisciplinary Stroke and Neurovascular Clinic at Children’s Hospital Colorado.