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The MDT Process: BSUH and WSHT (Worthing)

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.

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The MDT Process: BSUH and WSHT (Worthing)

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

  2. Good starting point. • No information on: • Morbidity • Efficiency • Cost. • Sustainability.

  3. 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.

  4. Currently: BSUH and Worthing (WSHT) working as one unit. • Centralization into BSUH next major shift.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Proposed solutions: Early vascular anaesthetic involvement. • Secure funding for BSUH VA led clinic sessions (Done). • WSHT model will depend on the centralization process. Simple integrated care pathway. • Common to all patients irrespective of Trust. • Started at first anaesthetic assessment. • Triggers proper communication.

  10. Proposed solutions: Appointment of MDT coordinator. (Done) • Patient tracking • Data collection • Audit. Separate aortic MDM. • CTs reviewed at work station with sizing at same sitting. • Anaesthetic report present at the meeting.

  11. 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.

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