Local MDT Reports on Communication
Between Local and Specialist MDTs
CNSs & MDT Co-ordinators
South Mersey SMDT
Graeme Totty, Urology SMDT Co-ordinator
Jeni Nixon, Local Urology Co-ordinator, WUTH
Karen Beckett, Local Urology Co-ordinator, CoCH
Linda Mallanaphy, Local Urology Co-ordinator, NCH
Referrals to SMDT
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> from local co-ordinator via MDT/verbal
> from Uro-Oncology Nurse by phone
> Clinic letters from Consultants
> for NCH & CoCH, patients are referred
by local MDT co-ordinators by e-mail
• > proformas not currently used
Liaison between SMDT & local
MDT co-ordinators
• > Wirral MDT co-ordinator works in same
office
• > Visit CoCH co-ordinator at least once a
week & regular e-mails & phone calls in
between
• > Visit NCH co-ordinator each Wednesday
& in contact by phone or e-mail
Collection of case notes & slides
• Case Notes & slides collected from CoCH
MDT co-ordinator each Wednesday
• Slides collected from NCH Pathology Lab
each Wednesday (case notes needed at
local Hospital for video-conferencing to
SMDT)
Pathology review
• All slides from CoCH & NCH (along with
WUTH cases) are reviewed prior to SMDT
by Consultant Histopathologists
• Histology from CoCH & NCH is displayed
& discussed only if there is disagreement
with the original report
Role of Co-ordinator @ SMDT
meeting in relation to chair
• Changed from start of 2010
• Meeting chaired on rotational basis by
Consultant Urologists + Oncologists
• Cases discussed in order on agenda
Timeline for referrals
• > Most CoCH & NCH referrals are made
on Wednesday following discussion at
local MDT & discussed @ SMDT on the
Friday of the same week
• > Majority of Wirral cases go straight to
SMDT without previous discussion.
SMDT Outcomes
• > Outcomes are e-mailed to all members
each Monday
• > The completed SMDT pro-forma is faxed
to patients G.P. on Monday after the
meeting
• > Pro-forma faxed to Consultant @ NCH &
CoCH at same time
• > Patients are contacted by Specialist
Nurse if applicable
Other responsibilities
• Track patients journey in relation to cancer
Waiting Time Targets (now on SCR).
• Co-ordinate cases for discussion @
weekly Penile SnMDT
• Provide data for Audits/Peer Review etc
Challanges
• Adapting to Somerset Cancer Registry for
use in SMDT
• Obtaining feedback on patients discussed
@ SMDT & followed up at local hospital.
• Dealing with increasing number of patients
discussed
North Merseyside Urology
Specialist MDT Group
Will Maitland
Interaction and co-ordination with
Local MDT groups
North Merseyside Urology SMDT Group
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Royal Liverpool and Broadgreen NHS Trust
Southport and Ormskirk NHS Trust
University Hospital Aintree NHS Trust
Whiston Hospital NHS Trust
Nobles Hospital NHS Trust
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Referrals also accepted from South Liverpool NHS Trusts
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SMDT Referrals
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Referral deadline = midday Wednesday.
Sent via facsimile or secure email links.
Referrals consist of completed patient proforma accompanied by
all relevant radiology and histopathology reports.
Majority of patients discussed at SMDT have been discussed at
the Local MDT groups the previous week.
SMDT outcomes are sent back to referring Trust by midday the
following Monday and official letters are dictated by SMDT
Chair.
ISSUE – Illegible hand-writing makes data entry difficult, leading
to data errors on SMDT discussion lists.
SMDT Histopathology Review
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Reviews are undertaken by either Dr Paul Mansour, Dr Vijay
Aachi or Prof. Chris Foster.
Pathology review takes place for specified patients at the SMDT,
not every patient at present.
Slides are either sent by Local Trust teams ahead of SMDT
referral or facsimile requested by the SMDT co-ordinator after
initial discussion.
Target turn-around for pathology review is 14 days after initial
discussion.
Pathology review reports are sent back to original pathologist at
the referring Trust.
SMDT Radiology Review
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Reviews undertaken by either Dr Jane Belfield, Dr Peter
Rowlands, Dr Gabby Lamb or Dr Kirsty Slaven.
Radiology reports sent by facsimile with the individual SMDT
referral proformas and passed to the core radiologists.
SMDT co-ordinator completes individual ‘Image Request’
proformas for each individual patient.
‘Image Request’ proformas are emailed to the Trust PACS Team
who arrange for the notes to be transferred electronically from
the referring Trust.
ISSUE – Original radiology reports cannot be sent electronically
with the images?
SMDT Patient Casenotes
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Notes sent to and from the centre Trust from Aintree and
Whiston hospitals only.
Notes are addressed to the recipient and sent by registered taxi
courier.
ISSUE – Reconstituted notes from Whiston Hosp makes
locating and presenting patient info during SMDT difficult.
Conclusion and Future Challenges
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An efficient and robust service however there are areas which
need to be addressed….
Hand-written referral proformas.
Sending of electronic radiology reports with requested images.
Reconstituted Whiston notes.
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Pathology review of all patients discussed at Urology SMDT.
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Communication/
Issues from local MDT’s
Michelle Thomas UHA
North SMDT
Duplication of information sent to SMDT.
Patients are contacted before outcomes
are given.
Organisation of patients to be discussed.
Access to MDT co-ordinator.
Renal service appears to be fragmented.
Video link.
Outcomes of patient attending joint clinic.
Reliant on CNS giving outcome.
South SMDT
Video link not reliable.
Patients wait one week for oncology appt.
Patients require separate appointment to
discuss surgery.
Patients prefer to be seen at local hospital.
Completely reliant on CNS giving outcome
over telephone.
No Issues with outcomes/proformas etc.
Key worker Transfer
Beverley Rogers/Gill Riley
Urology MacMillan Nurse Specialists
Mersey South Urology Cancer Centre
POLITICAL AGENDA
• Manual for Cancer Service Standards
2004
• NICE Improving Supportive and
Palliative Care for Adults with Cancer
2004
• Cancer Reform Strategy 2007
• MCCN Key Worker Guideline
WHAT IS A KEY WORKER?
The key worker is defined in the NICE
guidance (2004) as:
“A person who with the patient’s consent
and agreement takes a key role in coordinating the patient’s care and
promoting continuity, ensuring the
patient knows who to access for
information and advice.”
WHY DO PATIENTS NEED A
KEY WORKER?
There is a need to ensure integration
and co-ordination of care, throughout
the patients cancer journey
The aim should be to provide continuity
of care throughout the patient pathway.
DESIGNATING THE KEY
WORKER
Each patient should have a named key
worker who will be identified at the
MDT where the initial cancer diagnosis
is made and treatment planning
decisions discussed.
The key worker will ideally be a Clinical
Nurse Specialist.
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The named key workers should be
reviewed at key points in the patient’s
cancer journey:
Around the time of diagnosis
Commencement of treatment
Completion of the primary treatment
plan
Disease recurrence
The point of recognition of incurability
The point at which dying is diagnosed
RECORD KEEPING
The name, designation and contact details of the key
worker should be recorded within the patient notes.
Multi-disciplinary teams must agree a method of
documentation, for example, the MDT proforma,
which is signed and dated.
The patient should be provided with written
information detailing the name of the key worker,
designation and contact details.
The key worker’s details should be included in all
correspondence.
What happens South of the
Mersey….
• Uro oncology nurses both attend SMDT
• Pick up patients who will need
appointments/investigations at cancer centre
• Ensure appropriate appointments made
• Ensure available at clinic appointment
(transfer of key worker)
Tools Used
• “business card” and information leaflet with
specialist nurse contact names and direct dial
number
• Patient access to permanent record of
consultation
• Letter link
• Diaries!!
Liaison with Key Worker at
Referring Hospital
• Not on a routine basis
• No formal handover
• Contact on an individual basis following
patient assessment of understanding
Does it work ?
• Three patient experience surveys
undertaken;
• > penile cancer
• > cystectomy
• > nephrectomy
PENILE CANCER
• 63% RETURN
• 95% knew who specialist nurse/key
worker was
• 84% Knew how to contact specialist
nurse/ key worker
Cystectomy
• 61% return rate
• 100% patients knew who their specialist
nurse/key worker was
• 100% of patients knew how to contact
their specialist nurse/key worker
Nephrectomy
• 85% return rate
• 100% of patients knew who their
specialist nurse/key worker was
• 100% of patients knew how to contact
their specialist nurse/key worker
Issues
• Lack of uro oncology cns at CCO
• Major impact on workload WUTH (from
a local perspective)
• Can not transfer key worker
CONCLUSIONS
• Appears to work well
• Patient satisfaction
• No need for another form of paperwork
• ???
The Role Of Radiotherapy
Liaison & Support Practitioner.
Martin Woods
Radiotherapy Liaison & Support Practitioner
Clatterbridge Centre for Oncology
0151-334-1155 Ext 4727 Bleep 4195
martin.woods@ccotrust.nhs.uk
Key Skills
Communication
Patient centred approach
Liaison & Teamwork
Signposting
Documentation & Accuracy
Enthusiasm & Motivation
I provide holistic assessment & care to patients’
receiving radiotherapy& chemo-radiotherapy
who are not linked with a site specific CNS.
This includes:-
• Bladder Cancer
• Prostate Cancer
• Upper G.I. Cancers (oesophagus, stomach,
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gall bladder, liver).
Brain Tumours
Lymphomas
Melanomas/Sarcomas
Testicular Cancers
Communication
NICE Guidance states: Interpersonal communication is
the process through which patients & carers can explore
issues & arrive at decisions in discussions with health &
social care professionals. It is most effective when there
is mutual understanding, respect & awareness of
individuals’ roles & functions.
• Important to establish an excellent rapport with
patients’ & carers – vital to enable me to assess
their immediate & future needs.
Communication
•Establishing that initial rapport can pay dividends for the
future relationship with the patient – common ground
•I have a patient centred approach & provide an
empathetic & sympathetic ear to patients’ & their carers’.
•Discussions with patients and carers at key stages
aids holistic assessment and identifies existing and
potential needs.
•I monitor patients’ progress throughout the course of
treatment & make further referrals if necessary.
Liaison & Teamwork
I have an excellent working relationship Radiotherapy
colleagues, with members of the CReST team &
Doctors.
Developed good working relationship with Specialist
Nurses.
Signposting
The Radiotherapy Support Practitioner is a link
to the other professionals & services the
patient/carer may need
• CReST Team
• Cancer Nurse Specialist (CNS)
• District nurse
• Macmillan Nurse
• Occupational therapist
• Social workers
• Psychologist
• Chaplain
Signposting
I am aware of my limitations & can
recognise when the solution to the
patient’s needs are outside of my
competencies – referring to the
appropriate professional.
What makes this post special?
The difference between involvement and
commitment is like egg and bacon.
The chicken is involved; the pig is
committed!
I am committed to giving the best care &
support to patients’ & their carers
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Local MDT’s – common problems
◦ Reliance on CNSs to give feedback on outcomes
◦ Difficulties with video link
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SMDT co-ordinators –
◦ Issues variable
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Lack of a forum between the CNSs and the
MDT co-ordinators within the Network to
discuss issues and share good practice
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Need to identify how there can be a seamless
transition in the role of key worker from
centre to centre
◦ CNSs from local centres attend joint clinics – i.e. the
key worker stays with the patient where possible
◦ Improved transfer of information between key
workers if different at each centre – how??
◦ Leaflets to be given to patients at diagnosis /
transfer of care explaining how the key worker
changes