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Improving multidisciplinary team meetings through use of innovative software

Multidisciplinary team (MDT) meetings in cancer services are not operating as efficiently as they could be, a report by Cancer Research UK (CRUK) has found.

Multidisciplinary team (MDT) meetings in cancer services are not operating as efficiently as they could be, a report by Cancer Research UK (CRUK) has found.


Katy Horton-Fawkes demonstrates the database she developed with colleague Amit Patel
to improve the efficiency of multidisciplinary team meetings. Picture: Jon Rowley

For Katy Horton-Fawkes, gynaecological cancer specialist nurse at University Hospitals Bristol NHS Foundation Trust, the findings are proof that an innovative database developed to improve the efficiency of MDT meetings could be beneficial for cancer services everywhere.

She and colleague Amit Patel – a consultant surgeon who has a talent for IT design – have been developing the database for the past two years. The CRUK report ‘validated our significant concerns’, she says.

‘We knew that MDT meetings are the cornerstone of cancer care, but they were being managed in an ad hoc way and Amit and I had been trying to work out what to do about this.

‘When Mr Patel joined us at University Hospitals Bristol NHS Foundation Trust, he had already begun working on a management tool for MDTs, and he wanted to look at developing a tool for systematic data collection which would address these problems,’ Ms Horton-Fawkes explains.

Privately accessed database

The result is a privately accessed database that enables MDT members to collect information from gynae-oncology patients to improve the efficiency of the service.

Ms Horton-Fawkes worked closely with Mr Patel to ensure the unique role of specialist nurses in interacting with patients was reflected in the software. For example, there is a page on the database showing communication with the patient and the family because, as she explains, ‘information on whether the patient is a single parent with a history of drug misuse, or a 90-year-old looking after a frail spouse frames the kind of treatment you can give’.

Key findings from ‘Meeting patients’ needs: improving the effectiveness of multidisciplinary team meetings in cancer services’

The CRUK report highlighted that the way meetings are organised has not kept pace with increases in patient demand. Meetings often took several hours but with only a few minutes to discuss each patient.

Because meetings took so long, these discussions might only involve a few professionals so opportunities to flag up information such as a patient’s preferences, comorbidities or whether the patient is suitable for a clinical trial are often missed.

Recommendations

  • Streamline MDT meetings and improve the quality of discussions
  • Investigate introducing a protocol pathway for patients who can be reviewed outside of MDT meetings
  • Introduce a triage system for identifying patients who can follow protocolised pathways to reduce the number of discussions in the full MDT meeting.

Visit here for the full report 

 

The database also contains an audit tool that enables the team to input that patients have received their information packs and when patients have been referred to palliative care.

‘This means we can systematically prove they are getting the care they should,’ Ms Horton-Fawkes says, adding that the database ‘really began to sing when the NHS England Cancer Strategy was rolled out’.

Now we can admit a patient within 20 minutes using the database

Katy Horton-Fawkes

It also meant that the service was easily able to comply with the strategy’s three key requirements to: undertake nurse-led holistic assessments; refer patients to next step events; and for GPs to record end-of-treatment summaries. ‘We were able to do this, even though two years ago trusts were saying “this is virtually impossible to achieve”,’ she says.

Comprehensive service

With the growing focus on cancer survivorship and rehabilitation, one of the database’s most progressive and timely additions is a function to identify patients who need to receive a cancer rehabilitation programme that refers them for a holistic needs assessment.

‘Suddenly we were able to deliver a comprehensive cancer rehab service that is routinely sending all patients that need it to cancer rehab. The only reason we are able to deliver this is because of the software. It means we are significantly well ahead in delivering cancer rehab programmes, not only in Bristol but across the country,’ says Ms Horton-Fawkes.

The service is now beginning to reap the benefits of the system. ‘Last year we came up as the top service for University Hospitals Bristol and across all gynae-cancer nursing services we scored top in the National Cancer Patient Experience Survey,’ she says, adding that Mr Patel puts this success down to being able to develop the software in a way that is meaningful to patients.

‘Patients are independently saying we are delivering an excellent service – that’s when you know you are getting it right.’

Next steps

The next set of innovations to be added to the database will be an ovarian cancer prehabilitation programme that will begin with a fitness assessment before surgery and a function in the database to track whether it is making a difference to outcomes.

‘We want to know if, after surgery, patients who have received prehab spend fewer days in hospital,’ she says.

Another addition, working with the clinical psychologist, will be a psychiatric assessment that will identify patients who are likely to struggle to cope psychologically with cancer treatment.

‘It’s about giving them support before they crash,’ explains Ms Horton-Fawkes.

Investment and collaboration

The database clearly has potential for national replication. Although Ms Horton-Fawkes says the model they developed ‘didn’t cost the trust a bean’, developing a replicable system for other services could involve significant investment and collaboration.

She admits that convincing NHS managers of the merits of developing the database was the biggest hurdle as ‘a lot of managers don’t like change’.

‘But we can prove that we are now so much more efficient, now we can admit a patient within 20 minutes using the database – whereas we know it can take other nursing colleagues upwards of an hour.’

She is in early discussions with major cancer charities and universities on how to take the system forward. ‘We are saying that with the right investment, this tool could be used by every cancer service in the country,’ Ms Horton-Fawkes adds.

Katy Horton-Fawkes’ advice

Amit Patel and Katy Horton-Fawkes with the database they created
Picture: Jon Rowley

Be passionate about innovation: ‘I think we need to be instilling in our nurses a culture of innovation – we are not followers, we are leaders.’

‘It’s also vital to innovate from the coalface; if you move away from the patient then it makes it hard to develop these ideas.’

‘Email me, I want to hear from nurses who are interested in this innovation.’

Contact: Katy.Horton-Fawkes@uhbristol.nhs.uk

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