Multi Disciplinary Team Working

Introduction

The British Geriatric Society (BGS) highlighted the need for workforce improvement and development of a skilled multidisciplinary team (MDT) in older people’s healthcare in their 2024 roundtable, “Transforming care for older people”. This survey aimed to gather views from pharmacy professionals on career progression and how the BGS and UK Clinical Pharmacy Association (UKCPA) can support their advancement in this speciality.

Method

A Google Forms questionnaire was designed to collect data on demographics, education, working practices, and specialisation. Respondents were asked about the need for defined core competencies and an advanced curriculum for the speciality, as well as the support professional groups should provide. The survey was distributed through BGS and UKCPA communication channels.

Results

Thirty-eight pharmacy professionals responded, with pharmacists comprising the majority (n=37, 97%), working primarily in secondary (n=21, 55%) and primary care (n=12, 32%). Most respondents were female (n=31, 82%) and 61% (n=23) identified as white British. Over 80% (n=31) were at a senior level (band 8a or above), with 68% (n=26) having over 10 years’ experience. Many identified as specialists in care of older people (n=29, 76%). There was unanimous support for an advanced pharmacist curriculum specific to older people’s care for those seeking to credential at an advanced level, and 90% (n=34) agreed on the need for core competencies for all pharmacy staff in this area. Key themes to enable progression included structured support, mentorship, clear career pathways, accredited courses, and opportunities to share expertise.

Conclusion

The BGS and UKCPA are well-positioned to develop an advanced curriculum in older people’s healthcare, aligned with existing professional pathways already implemented by the Royal Pharmaceutical Society. Joint initiatives to provide structured development opportunities could enhance the specialist workforce, ensuring high-quality pharmacy services are provided routinely as part of multidisciplinary teams caring for older people.

Introduction:

In geriatric medicine department of a large tertiary care university hospital, it was observed that multidisciplinary team (MDT) working was not standardised, morning huddles were inefficient, there was a lack of inclusion of all members in MDT meetings and the meetings were too medical focused. The aim of this project was to address these concerns through a multipronged approach.

Methods:

An initial survey was carried out with 34 participants from all disciplines of MDT. Areas needing improvement were identified from the survey and through discussions among doctors, nurses and therapists. A pilot of changes was introduced in the largest ward of the department. A post change survey was carried out, demonstrating improvement across multiple domains.

Results:

Initial Survey

• Are you satisfied with current MDT practices? 52% said they were partly satisfied or not satisfied
• Morning Board Rounds: 68% said it does not happen everyday/attended by most professions
• Feeling valued at MDT meetings / Opinion taken appropriately? 35% said they were not confident they felt valued / opinion taken appropriately
• Are MDT discussions patient centered and effective? 38% said they are not always patient centered/effective
• Do you understand the various concepts and acronyms used in our MDT’s? 30% said they do not understand most concepts/acronyms

Changes implemented

• Structured daily morning board round with all MDT disciplines using a new pro forma
• MDT meetings led by flow-coordinator via a structured format making them more holistic, person-centred and inclusive
• Published a handbook to improve understanding & purpose of MDT’s and terminologies used in meetings

Post change survey results

• 66% said meetings were now more structured and it was easier for them to share their views
• 75% respondents said they now felt more valued
• 76% thought meetings now were more person-centred

• Improved attendance & efficiency of morning huddle (mean time reduced to 10 from 30 minutes)

  These findings were presented and shared in departmental monthly meeting

Conclusion:

The true essence of MDT working lies in all professions coming together to achieve patient-centred care. This can only be achieved if all professions understand and respect each other’s role and responsibilities. Through best practices, we can achieve more holistic care and prevent harm. It results in resources being used more efficiently through reduced duplication, greater productivity and preventative care approaches.

Through a series of changes we demonstrated these in one ward and work is ongoing to implement these changes across the whole department.

Link for published Handbook: 

https://drive.google.com/file/d/1P6Cuz8u1N3cr1FjnG4y9KIwRhkX5qHFM/view?…

Introduction/Background: Teamwork is very important in hospitals where the medical on-call team manage the stroke and thrombolysis alert calls. In addition to technical skills, human factors play a very significant role in meeting a target door-to-needle time.

Aim: To improve door-to-needle time by improving human factors (leadership, understanding and delegation of roles and confidence in participation) and technical factors (quick NIHSS and efficient documentation of vital information on radiology request forms for urgent CT head).

Method: We conducted 6 simulation-based training sessions and de-briefing sessions (role-playing and education around technical and non-technical skills) starting from November 2022. We measured the participants’ responses before and after the sessions, with the help of Kirkpatrick’s four level training evaluation model. We measured and compared the thrombolysis breakdown data (total of 38 consecutive patients from May 2022 to February 2023) throughout the process. We used statistical process control (SPC) charts to calculate and visually represent median values to demonstrate the changes.

Results: Thrombolysis breakdown data revealed substantial improvement post intervention (November 2022) compared to data from May-October 2022. SPC charts demonstrated significant reduction and step change in median door-to-needle time (83.7 to 52.2 minutes) and CT imaging to reporting time (36.2 min to 19.5 min).

Conclusion: A series of simulation-based training sessions and debriefing sessions for stroke thrombolysis was able to demonstrate statistically significant improvement in door-to-needle time. We will continue the simulation sessions and will assess sustainability of the interventions.

References: 1. Ajmi SC, Advani R, Fjetland L, et al Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre. BMJ Quality & Safety 2019;28:939-948. 2. Chalwin, R.P. and Flabouris, A. (2013), Non-technical skills training for MET. Intern Med J, 43: 962-969. https://doi.org/10.1111/imj.12172

Introduction Factors contributing to frailty result in increased hospitalisations, with 5- 10% of patients attending Accident and Emergency department living with frailty, and 30% of those patients admitted to acute medical units (Conroy, 2013). Hospital admissions result in functional decline and deconditioning (Get It Right First Time, 2021). The number of people in the UK over the age of 85 is set to double in the next 20 years and treble in the next 30 (Office of National Statistics, 2013). Their needs are best met in the community with a multi-disciplinary approach. Method Patients, residing in Benfleet and Leigh-on-sea, discharged from Geriatric wards at Southend Hospital were identified during ward MDT meetings. Inclusion criteria: • Recurrent admissions • Prolonged hospital stay • Clinical Frailty Score > 5 • Social support Using this criteria, 216 patients were included. 7 day readmission and 30 day readmission data was collected and compared to readmission rate prior to intervention. Intervention On discharge patients were linked with Frailty Nurses within their Primary Care Network and were reviewed within 48- 72 hours of discharge. Community support was provided via MDT, with involvement from consultant geriatrician. Concerns that could result in readmission were highlighted during these meeting, with patients being seen in Day Assessment Unit for review of sub-acute frailty syndrome if appropriate. Results Following intervention of utilising community MDT there was a reduction in rate of readmission. 9 patients (4.1%) were readmitted within 7 days of discharge and 14 patients (6.4%) were readmitted within 30 days, in comparison to 7.6% and 19.3%, respectively, prior to commencement of MDT. Conclusion This concludes that utilising community MDT with review following discharge has positive impact in reducing readmission rates. Highlighting potential risks of readmissions allows the MDT to address issues within the community and use bridging services appropriately.