The Role of the MDT Coordinator. Laura Throssell

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1 The Role of the MDT Coordinator Laura Throssell

2 NHS Cancer Plan (2000) the care of all patients with cancer should be formally reviewed by a specialist team. all patients have the benefit of the range of expert advice needed for high quality care.

3 Rise of the MDT Coordinator To meet the commitment set out in the National Cancer Plan, multi disciplinary team (MDT) meetings per specialty were set up. These mainly run on a weekly basis The introduction of MDT meetings established the need for an MDT Coordinator role. Core MDT Team Members include: Surgeons Physicians Oncologists Radiologists, Histo-pathologists CNSs MDT Coordinator

4 MDT Meeting Compile agenda Patient notes/ electronic notes Proformas (patient record of discussion) Download radiology images Collect histology slides and reports Before- Preparation During Live recording of patient discussion and treatment plan Operate visual display equipment and video conferencing links Prompt for mandatory data items (TNM staging and performance status) After- Outcomes Circulate outcomes of patient discussions Update the cancer database

5 Successful discussion MDT meetings can be very fast paced with some discussing over 50 patients per weekly meeting To ensure the smooth running and efficiency of the meeting MDT Coordinators must be highly organised, dynamic and work with an excellent level of detail and accuracy They are recognised as a core member of the MDT team by the National Quality Surveillance Programme (formally Peer Review)

6 What does an MDT Coordinator do outside of the MDT Meeting

7 DATA (.. And lots of it!)

8 Cancer Waiting Time Standards (CWT) 62-Day (Urgent GP Referral To Treatment) Wait For First Treatment: All Cancers 85% 62-Day Wait For First Treatment From Consultant Screening Service Referral: All Cancers 90% 31-Day (Diagnosis To Treatment) Wait For First Treatment: All Cancers 96% 31-Day Wait For Second Or Subsequent Treatment: Anti Cancer Drug Treatments 98% 31-Day Wait For Second Or Subsequent Treatment: Surgery 94% 31-Day Wait For Second Or Subsequent Treatment: Radiotherapy Treatments 94% All Cancer Two Week Wait 93% Two Week Wait for Symptomatic Breast Patients (Cancer Not initially Suspected) 93%

9 Mandatory Data Items Cancer Waiting Time Standards (CWT) 62 day first treatments (2ww referrals) 31 day first treatments (2ww, urgent, routine) 31 day subsequent treatments Surgery, Drug treatments Radiotherapy 62 day target: Screening patients 62 day target: Consultant upgrades National Cancer Audits Colorectal: NBOCAP Upper GI: NOGCA Head & Neck: HANA (DAHNO) Prostate: NPCA COSD (Cancer outcomes and services dataset) TNM staging Performance status CNS present at diagnosis National Quality Surveillance Program (Peer review) MDT members attendance

10 Manual Process Worcester Acute Trust use Somerset Cancer Register to collect and upload patient data to the national systems and cancer registries. (Other systems include Infoflex, Dendrite and in-house cancer databases) The Cancer Database is updated live during MDT so patient outcomes can be clinically validated by the MDT lead, all other information is inputted mainly by the MDT Coordinator (some further information is added by CNSs, AHPs, 2WW booking clerks) Data collection can be a very manual process Mandatory data items are available on a number of different systems that don t automatically interface with the Cancer database.

11 Forming relationships Ensuring a 2 way flow of information MDT Team Members Directorate Managers/ Leads Tertiary Centres MDT Coordinator Oncology Cancer Team Supportive Services

12 No I in Team The MDT Coordinator is an independent role required to manage their own workload The role also forms part or a team within Cancer Services As a department Cancer Services provides MDT Coordinator support to 10 specialities: Breast Colorectal Gynaecology Haematology Head & Neck Lung Palliative Care Skin Upper GI Urology

13 Building the Team Non Clinical role (only one in the room) Learning new terminology Understanding different site specific patient pathways and referral routes Learning investigations required Understanding diagnoses Understanding jargon and abbreviations Training Online courses In house training Skill/ experience mix Able to cover/ move between specialities Equitable role All team members confident and able to complete all tasks required Sharing knowledge and learning from mistakes Keeping up to date with national guidance, changes is process or procedures bottle necks and in pathways

14 Managing the Team Cover arrangements Buddy system Defined cover roles Consistency Core member/ key relationships Expertise Clear contact details Flexible working Part time Full time Flexible working Different Requirements MDT meetings can start early, finish late, happen during lunch or a morning or afternoon session Variation in the volume of patients discussed per speciality Variation in the number of 2WW referrals received and amount of patients to be tracked through the pathway

15 Can one model fit all?

16 Things to consider Provide and maintain a robust service to the MDT team 100% MDT Coordinator attendance Adequate and efficient cover Ensure a fair split of workload tasks To support knowledge, understanding and personal development Do all coordinators have to attend regular MDT meetings? Provide a dynamic, well trained team of MDT Coordinators Versatile and experienced Maintain a well motivated team and good work culture The face of Cancer Services Support all specialites equally Some specialities have a higher volume of patients Some have many varied and complicated diagnostic and treatment pathways Some have varied referral routes to tertiary treatment centres Maintain a good reputation for Cancer Services

17 Headache?

18 Group Exercise Scenario Cancer Services has to provide MDT Coordinator provision for the Breast and Head & Neck MDT teams. As well as co-ordinating the MDT meetings, this provision also includes all the relevant MDT prep, data collection and audit data collection.

19 Group Exercise Task You have 2 MDT Co-Ordinators, Co-Ordinator A = working full time, 37.5 hours per week Co-Ordinator B = working 22.5 hours per week All the tasks listed on the instruction sheet need to be assigned to an MDT Coordinator to support the two MDT teams. How would you go about sharing and assigning the tasks to ensure adequate and equitable workload is assigned both teams?

20 Group Exercise Green Tasks: Purple Tasks: Head & Neck Breast On a separate flip chart sheet please indicate any problems you faced in making your decisions, or other things to consider. You have 15 minutes to work on this activity within your groups.

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