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