Download MDT Meeting Audit Results

WCMICS MULTIDISCIPLINARY TEAM MEETING AUDIT
Background
In February-March 2009, the Western and Central Melbourne Integrated Cancer Service (WCMICS)
undertook an audit of Multidisciplinary Team Meetings (MDMs) as part of the ‘Strengthening
Multidisciplinary Meetings’ Program. This audit aims to:
ƒ Identify areas that require further improvement work
ƒ Benchmark each MDM against all other MDMs in the WCMICS
The results of this audit are presented in this report.
Methodology
Multidisciplinary meetings were identifying from information given by each site’s Tumour Group lead.
A snapshot audit was conducted using the same audit tool developed for previous 2007 audit, which
was adapted from the DHS Multidisciplinary Toolkit Audit Tool (3). The WCMICS Project Officer
observed one meeting at each site, and met with the Tumour Group lead from each site to clarify
questions that were not able to be answered by observation alone.
Results
The audit results for all WCMICS meetings are presented in the following pages. 35 meetings were
audited across all organisations and Tumour Streams.
Next Steps
Sharing of information
Aggregated audit results will be available from the WCMICS website (no sites/Tumour Groups will be
identifiable). Information from this audit (de-identified) will also be shared with the WCMICS
Tumour Groups, Clinical Management Advisory Committee, Supportive Care Advisory Committee and
each hospital’s Quality Department.
Future Audits
This audit will be repeated on a regular basis to assess further improvements to the meetings. In
addition, in order to assess progress against milestones in Victoria’s Cancer Action Plan, the DHS
have instructed each ICS to audit whether the multidisciplinary team treatment plan is documented
in patient’s medical records.
Improvement Work
Where there are Tumour Group-wide areas requiring improvement, it has been recommended that
the Tumour Group look to take improvement work forward to address these issues.
Where there are systemic issues, such as attendance and supportive care, it is recommended that
the WCMICS Governance Committee agree on how the WCMICS can support their organisations in
the delivery of the MDM measures set out in Victoria’s Cancer Action Plan (7).
April 2009
OBJECTIVE 1: A REGULAR MULTIDISCIPLINARY MEETING IS HELD TO DISCUSS
TREATMENT PLANNING
Frequency of Meetings
Recommendation:
MDT meetings should be held on a regular basis (1).
New Patients Discussed at the Meeting
Recommendation:
All patients with a newly diagnosed cancer should be considered for discussion by the
multidisciplinary team (1). Victoria’s Cancer Action Plan aims to increase the number of newly
diagnosed patients with a documented multidisciplinary care treatment plan to 80% by 2012 (7).
April 2009
Number of Patients Discussed per Meeting
Links with Other Teams
Collaborative links should be formed with smaller and larger referring centres to facilitate care
coordination and enable consideration of the full therapeutic range (8).
Conduct of the Meeting
Where it is not possible for all core team members to be present at one site, this may be overcome
by tele- or video-conferencing (1).
April 2009
Room Set-up
Recommendation:
Venues for the MDT meetings should be set-up in a round-table configuration so that participants can
face each other (1).
April 2009
OBJECTIVE 2: ALL CORE DISCIPLINES REGULARLY ATTEND MULTIDISCIPLINARY
MEETINGS AND PROVIDE INPUT TO THE TREATMENT PLAN WHERE RELEVANT
Attendance of Core Disciplines
Recommendation:
A core group of specialists should be present at the meeting (3). These are set out in the
Department of Human Service’s Patient Management Frameworks.
Which team members routinely
attend meetings?
All WCMICS
Surgical Oncologist
93
Medical Oncologist
86
Radiation Oncologist
85
Pathology
77
Radiology
83
GP
0
Haematologist
100
Neurologist
0
Respiratory Physician
100
Endoscopist
100
Gynaecologist
100
Dermatologist
100
Reconstructive Surgeon
100
Nurse
82
Social Work
28
Dietetics
50
Speech Pathology
100
Pharmacist
0
Palliative Care
0
Participation of Core Disciplines
April 2009
OBJECTIVE 3: MEETING PROTOCOLS AND/OR TERMS OF REFERENCE ARE DEVELOPED
Development of Team Protocols (e.g. Terms of Reference, Criteria for Discussion)
Recommendation:
Written protocols should be established to describe the organisation and content of the meeting (3).
Role Designation
Recommendation:
Team purpose, membership, and roles should be documented (5).
April 2009
April 2009
OBJECTIVE 4: ALL PATIENTS ARE PROVIDED WITH INFORMATION ABOUT
MULTIDISCIPLINARY CARE
Provision of Information about Multidisciplinary Care to the Patient
Recommendation:
All patients should be provided with written information about multidisciplinary care (1)
Patient’s Consent sought before Discussion
Recommendation:
The patient’s consent should be sought before their case is presented at the MDT meeting (3).
April 2009
OBJECTIVE 5: SUPPORTIVE CARE ISSUES ARE CONSIDERED FOR ALL PATIENTS WHEN
DEVELOPING THE TREATMENT PLAN
Consideration of Supportive Care Issues
Recommendation:
Psychosocial status and support needs should be considered at the meeting (1).
Input from Relevant Staff when Supportive Care Issues are Discussed
Recommendations:
All core disciplines, including supportive care, should provide input into the meeting (1).
April 2009
OBJECTIVE 6: THE TREATMENT PLAN IS DOCUMENTED AND PLACED IN THE MEDICAL
RECORD SO THAT IT ACCESSIBLE TO ALL TEAM MEMBERS
Data Currently Collected at Meetings
Recommendation:
The meeting recommendations, lead clinician, attendance, and follow-up plan should be recorded as
a minimum (1, 3).
Verbal Summary of Treatment Plan
Recommendation:
The Meeting Chair should summarise the discussion before moving on to the next case (1).
April 2009
Recording of Meeting Recommendations
Recommendation:
The recommendations from the meeting should be documented using a standardised treatment plan
(1,3). Victoria’s Cancer Action Plan aims to increase the number of newly diagnosed patients with a
documented multidisciplinary care treatment plan to 80% by 2012 (7).
OBJECTIVE 7: OUTCOMES OF THE MULTIDISCIPLINARY MEETING ARE COMMUNICATED TO
THE PATIENT’S GP IN A TIMELY MANNER
Input from the Patient’s GP
Recommendation:
The patient’s GP is a core team member and effective processes for communication between the GP
and the Treating Clinician should be implemented (4).
The patient’s GP does not provide input into any of the meetings audited.
April 2009
Communication of Meeting Outcomes to the GP
Recommendation:
The patient’s GP should be informed of the meeting outcome as soon as practicable after the meeting
(3).
OBJECTIVE 8: PATIENTS ARE INFORMED OF THE PROPOSED TREATMENT PLAN AND GIVEN
THE OPPORTUNITY TO PROVIDE INPUT
Communication of Meeting Recommendations to the Patient
Recommendation:
The MDT meeting outcomes should be communicated with the patient (1,3) via whatever method is
preferable to them (3).
All sites communicate the Treatment Plan to the patient verbally only.
April 2009
REFERENCES
1. National Breast Cancer Centre. Multidisciplinary meetings for cancer care: a guide for health
service providers. 2005 National Breast Cancer Centre, Camperdown, NSW
2. Department of Health and Ageing. Medicare Benefits Schedule. 2007
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&qt=NoteID&q=A.50, Accessed
13/12/07
3. Cancer Coordination Unit. Multidisciplinary Meeting Toolkit. 2006 Victorian Department of
Human Services, Melbourne, Victoria
4. Ministerial Taskforce for Cancer, Patient Management Framework – Central Nervous System
Tumour Stream: Malignant Glioma. 2006 Victorian Department of Human Services,
Melbourne, Victoria
5. Evans A, Zorbas HM, Keaney MA, Sidhom MA, Goodwin HE, Peterson JC. Medicolegal
implications of a multidisciplinary approach to cancer care: Consensus recommendations from
a national workshop. 2008 Medical Journal of Australia 188(7): 401-404
6. Butow P, Harrison JD, Choy ET, Young JM, Spillane A, Evans A. Health Professional and
Consumer Views on Involving Breast Cancer Patients in the Multidisciplinary Discussion of
Their Disease and Treatment Plan. 2007 Cancer 100(9): 1937-1944
7. Victorian Government Department of Human Services, Victoria’s Cancer Action Plan. 2008
Victorian Department of Human Services, Melbourne, Victoria
8. Department of Human Services, Achieving best practice cancer care: A guide for
implementing multidisciplinary care. 2007 Victorian Department of Human Services,
Melbourne, Victoria
April 2009