RESULTSOF UPPER GIMDT QUESTIONNAIRE
Sukhbir UbhiNational Clinical Lead for Upper GI
Cancer Services Collaborative 'Improvement Partnership'
Aims
• Obtain a “snapshot” view of the structure and function of Upper GI MDTs
• Identify organisational issues with MDTs
• Assess the use of “mapping” to identify problem areas
• Identify bottlenecks
Upper GI MDT Questionnaire
1. Is your Upper GI MDT up and running FULLY? Yes/No PARTIALLY? Yes/No 2. How often does it meet? Weekly/Fortnightly/Monthly/Other 3. Roughly how often do the following attend? Consultant Surgeon 9/10 7/10 5/10 3/10 0/10 Medical Oncologist 9/10 7/10 5/10 3/10 0/10 Clinical Oncologist 9/10 7/10 5/10 3/10 0/10 MDT Clerk 9/10 7/10 5/10 3/10 0/10 Specialist Nurse 9/10 7/10 5/10 3/10 0/10 Histopathologist 9/10 7/10 5/10 3/10 0/10 Radiologist 9/10 7/10 5/10 3/10 0/10 Gastroenterologist 9/10 7/10 5/10 3/10 0/10 Palliative Care Representative 9/10 7/10 5/10 3/10 0/10 4. Do you have any major organisational problems with your MDT? Yes/No If yes, what are they?……………………………………………………………………………………………………. …………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………… 5. Have you carried out a Mapping Exercise for your patients’ Upper GI Journey? Yes/No 6. Was this exercise a success? Yes/No 7. If “No”, why not?………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………… 8. What have you identified as your three major “Bottlenecks” in your patients journey?
a) ……………………………………………………………………………………………………………………….. b) ……………………………………………………………………………………………………………………….. c) ………………………………………………………………………………………………………………………...
Responses
• 57 Replies received
• 51 Upper GI MDTs are fully up and running
• 6 Upper GI MDTs are partially up and running
Frequency Of Upper GIMDT Meetings
11
2
44
05
101520253035404550
Fortnightly Monthly Weekly
Frequency That Consultant Surgeons Attend MDTs
3
51
2 1 0 00
10
20
30
40
50
60
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That Medical OncologistsAttend MDTs
0
26
4 31
23
0
5
10
15
20
25
30
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That Clinical Oncologists Attend MDTs
0
24
8
30
22
0
5
10
15
20
25
30
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That MDT Clerks Attend MDTs
1
37
1 0 0
18
0
5
10
15
20
25
30
35
40
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That Specialist NursesAttend MDTs
2
43
50 0
7
05
101520253035404550
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That HistopathologistsAttend MDTs
2
24
8 7
2
13
0
5
10
15
20
25
30
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That RadiologistsAttend MDTs
2
41
5 62 1
05
1015202530354045
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That GastroenterologistsAttend MDTs
2
38
85
04
05
10152025303540
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Frequency That Palliative CareRepresentatives Attend MDTs
0
19
7
3 3
25
0
5
10
15
20
25
30
10/10. 9/10. 7/10. 5/10. 3/10. 0/10.
Attendance at MDTs
0 20 40 60 80 100
Surgeon
Oncologist
MDT Clerk
CNS
Pathologist
Radiologist
Gastro
Pall Care
% Attendance
Major Organisational Problems With MDTS?
32 replied that they had major organisational
problems including:• No MDT co-ordinators• No timetabled activity• Limited or No dedicated accommodation or
equipment• Audit/data collection• Obtaining notes/X-ray
Mapping Exercise For Upper GI Patient Journey• 27out of 57 have already processed mapped
with a 50% success rate• 5 are currently being planned• Difficulties encountered:
- Complex pathway
- Poor documentation/feedback of findings
- Lack of action following process mapping
- Hidden issues not "teased" out
- No CSC person in post
- No allocated time
"Bottlenecks"
• Primary Care– Referral pathway
– Patients not going to GP with symptoms
– Poor support for patients
– GP not recognising alarm symptoms
"Bottlenecks"
• Radiology/Endoscopy– Booking
– Capacity
– CT Waiting Times
– CT Staging
– Access to PET scanning
"Bottlenecks"
• Delays to first diagnostic test due to referrals to Gastroenterology, A&E or Care of the Elderly
• Chemotherapy/Radiotherapy start dates
• Histology reporting
• Access to palliative care
• Insufficient time for surgery
• Bed availability HDU/POCCU/ITU
• No Upper GI nurse specialist
Summary
• Major Organisational issues with most MDTs
• Variable attendance of “key” personnel at MDTs
• Bottlenecks at every stage of the patient journey