The MDT Process: BSUH and WSHT (Worthing) M.F. Caruana (on behalf of all the team)

The MDT Process: BSUH and WSHT

(Worthing)M.F. Caruana (on behalf of

all the team)

Good starting point.

No information on: Morbidity Efficiency Cost. Sustainability.

Objectives: Inclusive MDT process.

All patients put forward for elective AAA treatment. All relevant HC workers.

Sufficient detail Anatomy considered at work station. Sufficient information about patient’s physiology and

condition. Proper documentation and patient tracking.

Need for MDT coordinator. Patient communication safeguarded. Practical, sustainable and equitable (pts and carers).

Acceptable to all as centralization proceeds.

Currently: BSUH and Worthing (WSHT) working as one unit.

Centralization into BSUH next major shift.

Where are we and what can we do better? Simple audits

20 AAAs recently treated at BSUH. Last 20 AAAs worked up in Worthing for Rx in

BSUH. Issues identified.

From above. From personal experience.

Anaesthetists, surgeons, Specialist nurse etc.

Solutions proposed.

Issues identified: Worthing patients:

Separate work-up pathway involving SPAM/CPX clinic Mean 8 week wait for appointment. Sometimes pt sent for MIBI scan by surgeon. Not led by current vascular anaesthetist. Some pts also referred to BSUH pre-assessment:

Unnecessary journeys identified. All pts presented at MDM but not all information

available. Paper barrier between two trusts.

Important information not always available.

Issues identified: BSUH patients:

Fairly standard work-up includes Echo and MIBI scan

Not all pts go through current MDM. Not all pts go through vascular anaesthetic led

pre-assessment clinic. (clinic currently not formally funded).

Difficult to track some patients. Significant delay with some patients.

Common issues: No documentation of early pre-op consent for

NVD. No documentation of any written information

given. Widely varying complexity. Delays from work-up to Rx

Referral to cardiology. Capacity issues masked by inefficient work-up.

Proposed solutions:

Early vascular anaesthetic involvement.1) Secure funding for BSUH VA led clinic

sessions (Done).

2) WSHT model will depend on the centralization process.

Simple integrated care pathway.3) Common to all patients irrespective of Trust.

4) Started at first anaesthetic assessment.

5) Triggers proper communication.

Proposed solutions:

Appointment of MDT coordinator. (Done)1) Patient tracking

2) Data collection

3) Audit.

Separate aortic MDM.4) CTs reviewed at work station with sizing at

same sitting.

5) Anaesthetic report present at the meeting.

The next steps: Pilot the above. Marry it into an ICP. Get all above in place.

Simplify and standardize rest of paperwork. Better information sheets. Better coordination and data collection. Simplify the patient journey.