Merker Louise, Conroy Soraya, El-Wakeel Hassan, Laurence Nicola
Department of Breast Surgery, Royal United Hospital, Bath, UK.
J Multidiscip Healthc. 2023 Mar 4;16:613-622. doi: 10.2147/JMDH.S387174. eCollection 2023.
The multidisciplinary team (MDT) approach has long been considered the optimal way in which to deliver a high standard of care to patients with breast cancer. With a growing number of patients and ever-increasing complexity of cases, the strain on time and resource of the MDT is becoming increasingly evident. It is therefore essential that local hospital departments adapt their MDT processes to better streamline discussions and optimise efficiency. The Royal United Hospital in Bath is a district general hospital in the UK. Approximately 500 patients with cancers are treated annually, and the MDT discusses approximately 60 patients per week.
To improve our MDT meeting processes and increase productivity, we created a concise MDT template using Microsoft Access™: giving all clinicians the ability to add patients and information in real time. We also allocated weekly preparation time whereby a senior clinician ensured all patients were prepared prior to the meeting with results and potential outcomes prepopulated where possible.
We recorded the time spent discussing patients during 6 MDT meetings before and after implementation of changes. Cases were classified by pathology category to determine if there were differences following the preparation changes. Overall, we significantly reduced our average MDT discussion time (p=0.02). We significantly reduced average discussion time in postoperative malignant cases (p<0.0006) and expected benign core biopsy cases (p<0.0047), allowing appropriate redistribution of time towards discussion of more complex cases, reflected by the significant increase in time spent discussing complex radiology cases (p<0.025).
We offer an effective method for improving the MDT meeting preparation and presentation by ensuring each patient is appropriately prepared prior to the meeting, and outcomes for those simple cases are already prepopulated. This creates additional time within the meeting to discuss more complex clinical cases while allowing all members of the team an opportunity to discuss all patients if needed.
长期以来，多学科团队（MDT）方法一直被视为为乳腺癌患者提供高标准护理的最佳方式。随着患者数量的不断增加以及病例复杂性的日益提高，MDT在时间和资源方面的压力越来越明显。因此，当地医院科室必须调整其MDT流程，以更好地简化讨论并优化效率。巴斯皇家联合医院是英国的一家地区综合医院。每年约有500名癌症患者接受治疗，MDT每周讨论约60名患者。
为了改进我们的MDT会议流程并提高效率，我们使用Microsoft Access™创建了一个简洁的MDT模板：使所有临床医生能够实时添加患者和信息。我们还分配了每周的准备时间，由一名资深临床医生确保所有患者在会议前做好准备，并尽可能预先填写结果和潜在结果。
我们记录了实施变更前后6次MDT会议期间讨论患者所花费的时间。病例按病理类别分类，以确定准备工作变更后是否存在差异。总体而言，我们显著缩短了平均MDT讨论时间（p=0.02）。我们显著缩短了术后恶性病例（p<0.0006）和预期良性核心活检病例（p<0.0047）的平均讨论时间，从而能够将时间适当重新分配用于讨论更复杂的病例，这体现在讨论复杂放射学病例所花费的时间显著增加（p<0.025）。
我们提供了一种有效的方法来改进MDT会议的准备和展示，通过确保每个患者在会议前得到适当准备，并且简单病例的结果已经预先填写。这在会议中创造了额外的时间来讨论更复杂的临床病例，同时让团队所有成员有机会在需要时讨论所有患者。
