How To Manage A Cancer Oncology Clinic

Transcription

1 GYNAECOLOGICAL ONCOLOGY MULTIDISCIPLINARY TEAM MEETINGS: OPERATIONAL POLICY Version 3 Policy agreed Sept 2009 (updated Jan/Feb 2013) Agreed by: SCAN gynae group 2009 Update agreed SCAN gynae group May 2013 Page Introduction 2 Remit of the MDM 2 Responsibilities of the MDM 2 Membership of the MDM 2 Responsibilities of the Team Members: 3 Responsibilities of the Referring 3 Clinician/Member: Organisation of the meeting 4 Named lead MDM clinician 4 Chairing the meeting 4 Presentation arrangements 5 Role of the MDM meeting coordinator 5 Combined gynaecology oncology clinic 6 following the meeting Secretarial responsibilities MDM business meeting 7 Audit of MDM meeting 7 Cancelling of MDM meetings 7 Appendix 1 Appointments for clinic after 8 MDM Appendix 2 letter to new referring 10 clinician Appendix 3 letter to new MDM team 11 member 1

2 Introduction Cancer care can be complex, given the wide range and numbers of health care professionals involved, an enormous potential for poor co-ordination and miscommunication exists. Multidisciplinary teams (MDMs) should improve coordination, communication and decision making between health-care team members and patients, and hopefully produce more positive outcomes (Flesissig et al 2006). This operational policy is designed to help the MDM to operate more consistently and to agreed standards including the NHS QIS core standards for Cancer Services in Scotland REMIT The Gynaecological Oncology Multidisciplinary Team Meetings take place at the Western General Hospital on Thursday mornings, 8.30am to 10.00am in the Edinburgh Breast Unit Seminar Room. The remit of these meetings extends to all patients diagnosed with gynaecological cancer diagnosed within the Southeast Scotland Cancer Network (SCAN) Area. 2. RESPONSIBILITIES To establish, record and review diagnoses for all new patients with ovarian, primary peritoneal, fallopian tube, cervical, uterine, vaginal, and vulval malignancy To assess the extent and verify the stage of each patient s disease and discuss its probable course To provide guidance for subsequent treatment for all new patients taking into account patients own views, and to ensure these are to agreed national/local guidelines and protocols To provide a forum for discussion for complex patients, including those on followup To discuss the pathology of patients who have had resections for consideration of adjuvant chemotherapy, adjuvant radiotherapy, surgery and brachytherapy To consider patients other requirements such as palliative care or referral to other services. To inform primary care clinicians of any onward referrals resulting from the MDM. To ensure that all mechanisms are in place to support entry of eligible patients into clinical trials and other research studies predicated on patients giving fully informed consent To ensure registration of the required minimum dataset for all the cases of the relevant cancer within a specified area To ensure effective and quality management of the care pathway for all patients To act as a multi professional educational forum ensuring continuous professional development MDM attendance To ensure prompt, effective multi-disciplinary decision making, thus preventing delays in the patient s journey To be aware of patients that have experienced delays, to monitor where delays occur and to report these 3. MEMBERSHIP The Multidisciplinary Team should comprise consultant or senior members within groups including: 2

3 Gynaecological surgery, Clinical and Medical Oncology, Radiology, Pathology, Palliative Care, Clinical Nurse Specialist and Support Nurses, Research personnel, Audit personnel, Radiography, and Pharmacy. Other groups such as dietetics, GPs, trainees are very welcome to observe providing they have signed NHS confidentiality agreement. Responsibilities of the Team Members: Members should attend the majority (over 50%) of all meetings. During leave members should inform their group and MDM co-ordinator of planned leave. Groups should ensure one member is available for each meeting ensuring cross-cover whenever possible. Any team absences should be notified at least 6 weeks in advance. It is each groups responsibility, not the MDM coordinator, to ensure cover for absences. Members should arrive on time to participate fully in the meeting Members (or a named deputy) should attend the annual business meeting Unavoidable telephone calls should be taken outside the room and phones/pagers to silent where possible 4. REFERRALS Responsibilities of the Referring Clinician/Member: All referrals must be on the most up to date form kept on the shared drive (P:\WGH Gynecology MDM) which can be ed to the referrer as necessary Key fields, (Name, CHI, Address, GP address (out with Lothian), Consultant, History, Question to be answered at MDM) must be completed or the form will be returned Clinicians should ensure as far as possible that patients for discussion are referred via to (Gynaecological.CancerMDM@nhslothian.scot.nhs.uk) to the MDM Coordinator by Friday 5pm for the following Thursday. Any clinically urgent referrals after Friday (e.g. Monday/Tuesday/Wednesday) must be discussed with the named lead clinician to allow discussion on the following Thursday. For all late referrals it is the responsibility of the referring clinician to speak directly to pathology and/or radiology to arrange the review Unless otherwise stated referrals post surgery will be discussed 2 weeks post surgery to allow time for full pathology review Clinicians should always attend meetings at which their patients are discussed, or should ensure an appropriate, fully informed deputy is present Radiology are responsible for arranging that any radiology to be reviewed is put onto the FUSION server (i.e. National PACS). This should be discussed with the relevant radiology department. Clinicians should ensure as far as possible that accompanying documentation (where applicable - pathology report, operation note, radiology report) is provided to the MDM co-ordinator, via , to support the discussion of their patient if these are not available on TRAK or SCI store. If a patient needs seen the same day as the MDM discussion it is the responsibility of the referrer to contact the secretary of the consultant direct for the appointment. 3

4 5. ORGANISATION OF THE MEETING The meeting will take place weekly on Thursday at 8.30am until at WGH The meeting will be held in the Breast Unit Seminar Room, Western General Hospital The meeting will be chaired by the named chair The MDM co-ordinator will be in attendance Teleconference facilities will be available for remote access from RIE, St Johns, Victoria Hospital, Borders General Hospital and Dumfries. It is the responsibility of the remote users to arrange booking of the teleconference rooms IT support is available through Video Network Manager, Lothian ( ) 6. NAMED LEAD MDM CLINICIAN The named lead clinician will be voted for by the MDM group on an annual basis at the business meeting. They will have a named deputy for leave. Responsibilities of the lead clinician: Organising annual business meeting Follow up on any attendance issues Follow up on any issues from monthly waiting times reports Screening of late referrals for urgency Cancelling meeting if appropriate Answering any written complaints on behalf of the MDM team Allowing/Signing access to the gynae MDM shared drive (P:\WGH Gynecology MDM) and gynae MDM inbox 7. CHAIRING THE MEETING A chairperson will be appointed by the MDM team on a rotating basis. The rotation will be decided at the annual business meeting. In the case of absence of the chairperson those members present will elect a chair for that meeting. The chair will make themselves known at the beginning of each meeting. Welcoming new members Recording of attendance, including chair Make clear by name, DOB and number on list which case is being discussed Invite referring clinician to summarise the case Invite review of pathology and radiology as appropriate Ensure equal opportunities for all disciplines to contribute to discussion Summarise decision made Checking the decision at the meeting with help from MDM co-ordinator Recording allocation of oncology case notes after the meeting with help from MDM co-ordinator Ensure meeting runs to time To encourage completion of key fields in the referral letter such as Date of referral, amount of residual disease, and date of surgery Allow time for transfer of documentation to the appropriate clinician for the onward referral of the patient 4

5 Ensure decision of meeting is made available to referring clinician and GP in a timely fashion (e.g. by fax or online) by delegation to appropriate secretary/mdm co-ordinator 8. PRESENTATION ARRANGEMENTS Patients to be discussed at the meeting should be added to the meeting notes by the time of the meeting or under exceptional circumstances the MDM chair can be informed at the start of the meeting of any additional patients that are to be presented at the meeting. Any patient not on the online referral form should have written documentation available to the MDM chair. Documentation including operation notes, pathology reports, test results and radiology reports to support effective management of patients should be available at the meeting Radiology reviews should be highlighted in the referral form. It is the responsibility of the referring clinician to ask the radiology department for these to be put onto FUSION server. The MDM co-ordinator should be made aware if help is needed in getting these on to the FUSION server. At the end of each patient s discussion there will be a named individual on the form responsible for follow up appointments to be made. 9. ROLE OF THE MDT MEETING COORDINATOR The MDT meeting coordinator provides the support to enable the requirements of the meeting to be met by undertaking the following actions: Meeting Arrangements To work with the team to ensure that an operational policy for the meeting is prepared and implemented To work with the team to ensure that optimal meeting room arrangements are in place and are maintained To establish links with IT to ensure that any IT systems and teleconferencing facilities are available and in use where required To keep a record of planned absences in advance of the meeting of key personnel for the discussion of patients To send online/fax a letter of responsibilities for new referring clinicians, new team members and new chairs (see appendix) After the meeting ensure that the room is cleared of Patient information and the room has been returned to its original state Patients for discussion at meeting To list and number patients for the MDM in the appropriate categories, and inform those attending the meeting. To review and organise the MDM in-box To place patients for discussion into the relevant date folders and list on the agenda on the shared drive (P:\WGH Gynecology MDM) To place patients for discussion on TRAK on gynae MDM list To ensure that operation notes, radiology reports and full pathology reports if available on TRAK/SCI store are available for patients being discussed. To Fax/ referral of cases for pathology review to pathologist at RIE/Fife by Monday 11am. 5

6 To referral of cases for radiology review to radiologist at RIE/Fife by Monday 11 am. To provide numbered copies of referrals for MDM team members at the WGH room. To ensure oncology case folders (for old or new patients being seen that day) are available for patients being discussed. To arrange follow up appointments for patients discussed but not yet seen only as requested and as documented at the meeting. To keep a record of MDM discussions and decisions for audit and review, enlisting help, as necessary at the meeting to ensure accuracy of the record. To record of MDM discussions to referring clinician after the meeting of patients discussed that day. To complete TRAK MDM letter and arrange (Lothian GP) or first class posting of letter to GP (out with Lothian) To track oncology notes taken from meeting by consultants To liaise with oncology secretaries for clinical and medical oncology appointments required post MDM To arrange surgical follow up reviews only when requested and only for Thursday combined Gynae OPD clinic at WGH 10. COMBINED GYNAECOLOGY ONCOLOGY CLINIC FOLLOWING THE MEETING Secretarial responsibilities This is the responsibility of the gynaecological oncology secretaries (at WGH and RIE). They will liase closely with the MDM co-ordinator and review operational procedures to ensure smooth running of the MDM. If a patient needs seen the same day and the MDM discussion it is the responsibility of the referrer to phone the secretary of the consultant direct for the appointment. (see appendix 1) To make up oncology folders and assign oncology numbers for patients to be seen. To ensure all documentation is in the oncology folders including MDM discussion, pathology and radiology reports To make appointments for surgical, clinical oncology and medical oncology staff for the following clinic. To inform patients of appointments at the clinic. To arrange transport where necessary. To fax/ record of MDM discussions to GP and referring clinician after the clinic of patients being seen that day. To ensure a copy of the MDM referral/decision is placed in the patients case notes. To liaise with gynae MDM co-ordinator for clinical and medical oncology appointments required post MDM 6

7 11. MDM BUSINESS MEETING Annual business meetings should take place with a member of patient public involvement invited to attend (DOH 2004, NHS QIS 2007) At this meeting the lead and chair arrangements will be discussed and voted upon by majority. The operational policy will be reviewed and updated as necessary. Audit report will be reviewed and agreed. Any incident reports and/or complaints will be reviewed and actions agreed. 12. AUDIT OF MDM MEETING An annual audit will be performed. The responsibility of this audit lies with the lead clinician and the MDM prior to the annual business meeting. Outcomes to be audited could include; MDM attendance Percentage of patients who agreed/declined/defaulted/not suitable from MDM recommendations Percentage of patients with a confirmed pathology not discussed at MDM Review of GP/referring clinician communication between acute and primary care Percentage of meetings disrupted by IT issues Percentage of referrals occurring after 5pm Friday and reasons for this 13. CANCELLING OF MDM MEETINGS The MDM meeting will only be cancelled if one of the following situations arise: There are no patients to be discussed Inappropriate representation of disciplines The quorum for the MDM meeting shall be no less than 6 members Public holidays If one of these situations arise the lead MDM clinician will have the ultimate responsibility for cancelling the meeting and letting members know. 7

8 Appendix 1 - Thursday Clinic appointments following Gynae cancer MDM Reason for change: Previously the gynae cancer MDM form allowed the referring doctor to ask for an appointment to see either gynaecologist, medical oncologist (MO) or clinical oncologist (CO) consultant after the MDM discussion. This has been present for many years and allowed flexibility of team working. However it was noted that a number of changes over the years have made this system unsustainable. Multiple incidents, including formal complaints were documented from 2009 onwards including: Patients being unaware they had cancer prior to receiving appointment with the letter heading from the Edinburgh Cancer Centre. Staging investigations being incomplete e.g. PET, MRI awaited and patients having to be seen a second time Pathology incomplete e.g. awaiting immunohistochemistry Patients not having cancer being given appointments No triage of multiple requests meaning the routine patients given the remaining slots and clinically urgent patients having to wait Patients referred to the wrong gynae specialist (e.g. medical instead of clinical oncology) leading to wasted slots for one specialty and overbooked slots for another Patients with non gynaecological cancer being seen by the wrong specialist altogether, delaying their appointment with correct specialist Forms increasingly being poorly filled in by junior non specialist doctors rather than specialist consultants and using the form as a referral letter Increasing number of new patients to be seen for discussion of increasing number of treatments available for increasing elderly population No increase in the number of clinic room/time slots available (since early 2000s) After discussion at recent MDM meetings it has therefore been agreed to change the previous system to allow the scarce and expensive resource of new patient appointments to be managed more actively, with involvement of the consultants. New system 2013: The new gynae cancer MDM form 2013 has no box to request patient attendance. Any old forms using this box will be returned to the sender to fill in the new form. For routine patients Their case will be discussed at the MDM If all information is available and the patient needs to be seen on the whole they will be offered an appointment the following 1-2 weeks 8

9 The appointments will be booked after the MDM by the gynae cancer coordinator, backed up by the CNS checking the appointments are made CO appointments will be booked by Anne Fergusson on discussion with the CO consultants MO appointments will be booked by Collette Bone on discussion with the MO consultants Gynaecology appointments will be booked by the Gynae cancer co-ordinator for the Thursday am (CBE) clinic ONLY. All other gynae appointments are to be made by the consultant referring the patient. For clinically urgent patients Definition of clinically urgent is usually too unwell to go home to await treatment or a rapid (daily) growing tumour e.g. teratoma Please do not wait for the MDM date Phone consultant secretary direct (contacts below) If needed speak/ consultant to consultant to arrange in patient transfer Secretary will be able to give the appointment time and date usually directly to you or after a brief discussion with the relevant consultant Submit MDM form as per protocol If form over the cut off time referrer must phone radiology and pathology direct to ask for urgent review Contact details Clinical oncology (Drs Zahra and Stillie): Anne Ferguson or Anne.M.Ferguson@nhslothian.scot.nhs.uk Medical oncology (Drs Mackean and Nussey, Prof Gourley): Collette Bone or Collette.Bone@nhslothian.scot.nhs.uk Gynaecology (Dr Busby Earle); Gynae cancer co-ordinator ; at present Gill Wilkie, Directorate Assistant on or Gynaecological.CancerMDM@nhslothian.scot.nhs.uk Author Dr Mackean. March Review date

10 Appendix 2 letter to new referring clinician Dear Dr, Thank you for referring your patient for discussion at South East Scotland Gynaecological Oncology multi-disciplinary team meeting. We have an operational policy and would like to inform you of your responsibilities to help get the best results from our discussions. Please let us know of any difficulties you encounter to help improve our service. We undertake to let you know the results of our discussions in a timely manner and would be grateful if you could make your preference for destination of online communication known. Your responsibilities are; If the patient needs an appointment for the clinic the same day, please contact the appropriate consultant secretary directly Any urgent referrals after Friday (e.g. Monday/Tuesday/Wednesday) must be discussed with the named lead clinician to allow discussion on the Thursday Clinicians should always attend meetings at which their patients are discussed, or should ensure an appropriate, fully informed deputy is present Clinicians are responsible for arranging that any radiology to be reviewed is put onto the FUSION/National PACS server. This should be discussed with the relevant radiology department. Clinicians should ensure as far as possible that accompanying documentation (where applicable - pathology report, operation note, radiology report) is provided to the MDM co-ordinator to support the discussion of their patient. All referrals must be on the most up to date MDM form kept on the shared drive (P:\WGH Gynecology MDM) which can be ed to you as necessary Key fields, (Name, CHI, Address, GP address (outside Lothian), Consultant, History, Question to be answered at MDM) must be completed or the form will be returned Please only ever use secure NHS addresses for patient confidential material Please note your responsibility to inform the patient of any onward referral With many thanks, MDM Co-ordinator; Tel ; Gynaecological.CancerMDM@nhslothian.scot.nhs.uk 10

11 Appendix 3 letter to new MDM team member SCAN GYNAECOLOGICAL ONCOLOGY MULTIDISCIPLINARY TEAM MEETINGS: OPERATIONAL POLICY The role of the MDM team member Dear Welcome to the SCAN Gynaecological Oncology MDM team. We have an operational policy (enclosed) and would like to inform you of your responsibilities to help get the best results from our discussions. Please let us know of any difficulties you encounter to help improve our service. We would be grateful if you could make your preference for online communication known. Your main responsibilities are; Members should attend the majority (over 50%) of all meetings. During leave members should inform their group and MDM co-ordinator of planned leave. Groups should ensure one member is available for each meeting ensuring cross-cover whenever possible. Any team absences should be notified well in advance. Members should arrive on time to participate fully in the meeting Members (or a named deputy) should attend the annual business meeting If you have any suggestions or problems please do not hesitate to contact myself or the MDM lead clinician for discussion. With many thanks, MDM Co-ordinator Tel Gynaecological.CancerMDM@nhslothian.scot.nhs.uk 11