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MDT Overload & Inefficiency: What are the implications?
EP30669
Poster Title: MDT Overload & Inefficiency: What are the implications?
Submitted on 26 Sep 2019
Author(s): Mohammad Al-Tibi, Haren Wijesinghe, Shahid Hussain
Affiliations: University Hospitals Birmingham
This poster was presented at BIR annual congress 2019
Poster Views: 207
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Poster Information
Abstract: Background:

Multidisciplinary team (MDT) meetings are well established as a core component of medical care and are mandatory within NHS hospitals providing cancer cervices. In England, it is estimated that 55,000 MDT meetings take place each year within the NHS, with a total time spent by consultants of 1.2 million hours. The current MDT re-discussion rate in England is 10%. Re-discussion happens due to unavailability of specialists, inability to reach a diagnosis, evolution of disease and for regular follow-up. The aims of this closed loop audit were to determine the number and reason of prepared cases and not subsequently discussed at MDT, and to estimate opportunity costs incurred of undiscussed cases.

Methods:

Retrospective observational analysis of cancer MDT meetings including thoracic, breast, upper GI, colorectal, haematology, adrenal, urology, gynaecology, and cancer of unknown primary taking place in January 2018 (audit) and April 2019 (re-audit) across University Hospitals Birmingham.

Results:

From a total of 726 patients prepared to be discussed in cancer MDTs, 69 patients (10%) were not discussed. The main reasons of which were unavailability of histopathological diagnosis (n = 29), incorrect patient listing to MDT (n=17), or radiological imaging unavailable (n=10). The estimated total time lost by radiologists for not discussing previously prepared patients was 8.3 hours each month. MDT coordinators and consultants from each specialty were made aware of these results and efforts were made to avoid incorrect addition to MDT or listing patients for discussion with incomplete investigations. The re-audit results showed similar results as 60 out of 819 patients (7%) were prepared by radiologists but were not discussed. The difference in the rate of no discussion between the initial audit and re-audit results was not statistically significant.

Conclusion:

Despite best efforts in reducing the number of undiscussed patients in cancer MDT, clinicians put their patients first by listing patients with incomplete cancer workup or listing patients inappropriately. This remains to be on the expense of preparation time lost by radiology consultants.
Summary: The aims of this closed loop audit were to determine the number and reason of prepared cases and not subsequently discussed at MDT, and to estimate opportunity costs incurred of undiscussed cases.
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Chinai N, Bintcliffe F, Armstrong EM, Teape J, Jones BM, Hosie KB. Does every patient need to be discussed at a multidisciplinary team meeting? Clin Radiol 2013;68(8):780e784.
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Department of Health England. National Peer Review Report Cancer Services 2012/2013. An overview of the findings from the 2012/2013 National Peer Review of Cancer Services in England. London 2014.
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