educational material - ers e-learning · pdf fileeducational material how to make a...
TRANSCRIPT
ERS Annual Congress Amsterdam
26–30 September 2015
EDUCATIONAL MATERIAL
How to make a multi-disciplinary team work
Thank you for viewing this document.
We would like to remind you that this material is the
property of the author. It is provided to you by the ERS
for your personal use only, as submitted by the author.
©2015 by the author
Wednesday, 30 September 2015
07:00 – 08:15
Room G102-103 RAI
You can access an electronic copy of these educational materials here:
http://www.ers-education.org/2015htmake
To access the educational materials on your tablet or smartphone please find below a list of apps to
access, annotate, store and share pdf documents.
iPhone / iPad
Adobe Reader - FREE
With the Adobe Reader app you can highlight, strikethrough, underline, draw (freehand), comment
(sticky notes) and add text to pdf documents using the typewriter tool. It can also be used to fill out
forms and electronically sign documents.
http://bit.ly/1sTSxn3
UPAD Lite - FREE
UPAD Lite is an advanced note-taking application with annotation features. You can handwrite notes,
highlight text, add sticky notes and reference images and export any type of document as a PDF or
PNG file by email or to cloud services.
http://bit.ly/1mQ1j0K
Noteability - $4.99
Noteability uses CloudServices to import and automatically backup your PDF files and allows you to
annotate and organise them (incl. special features such as adding a video file). On iPad, you can
bookmark pages of a note, filter a PDF by annotated pages, or search your note for a keyword.
http://bit.ly/TCrNad
Android
Adobe Reader - FREE
The Android version of Adobe Reader lets you view, annotate, comment, fill out, electronically sign
and share documents. It has all of the same features as the iOS app like freehand drawing,
highlighting, underlining, etc.
http://bit.ly/1deKmcL
iAnnotate PDF - FREE
You can open multiple PDFs using tabs, highlight the text and make comments via handwriting or
typewriter tools. iAnnotate PDF also supports Box OneCloud, which allows you to import and export
files directly from/to Box.
http://bit.ly/1p2SV00
ez PDF Reader - $3.99
With the ez PDF reader you can add text in text boxes and sticky notes; highlight, underline, or
strikethrough texts or add freehand drawings. Add memo & append images, change colour / thickness,
resize and move them around as you like.
http://bit.ly/1kdxZfT
How to make a multi-disciplinary team work
AIMS: To discuss the aims and benefits of working in multi-disciplinary teams and how to develop
strategies to deal with difficult situations that can be encountered when cooperating with colleagues in
a multi-disciplinary team.
TARGET AUDIENCE: Pulmonologists, emergency medicine doctors, respiratory therapists,
respiratory physicians, general practitioners, intensivists, nurses, pathologists, radiologists, thoracic
surgeons, otolaryngologists and trainees.
CHAIRS: M. Gaga (Athens, Greece)
PROGRAMME
07:00 Introduction
07:10 Aims of working in a multi-disciplinary team
B. Grigoriu (Iasi, Romania)
07:35 How to deal with controversy in a multi-disciplinary team
D. Vassos (Athens, Greece)
08:00 Discussion
BOOKLET CONTENTS PAGE
How to make a multi-disciplinary team work presentation 5
Faculty disclosures 21
Faculty contact information 22
Each ERS Handbook is a concise, comprehensive reference to a broad area of respiratory medicine. Written by leading clinicians and researchers, they are the perfect educational tool and clinical reference.
• Th e ERS Handbook of Respiratory Medicine ISBN 978-1-84984-040-8 (print); 978-1-84984-041-5 (electronic)
• Th e ERS Handbook of Paediatric Respiratory Medicine ISBN 978-1-84984-038-5 (print); 978-1-84984-039-2 (online)
• Th e ERS Handbook of Respiratory Sleep Medicine ISBN 978-1-84984-023-1 (print); 978-1-84984-024-8 (online)
• Self-Assessment in Respiratory Medicine REVISED AND UPDATED ISBN 978-1-84984-077-4 (print); 978-1-84984-078-1 (online)
• Th e ERS Practical Handbook of Noninvasive Ventilation NEW! ISBN 978-1-84984-075-0 (print); 978-1-84984-076-7 (online)
To buy printed copies, visit the ERS Bookshop at the ERS International Congress 2015 (Hall 1, Stand 1.D_12).
WHICH handbook IS THE ONE FOR YOU?
Electronic WWW.ERSPUBLICATIONS.COMPrint WWW.ERSBOOKSHOP.COM
How to make a multi-disciplinary team work
Prof. Dr. Bogdan GRIGORIU
Sept 2015
5
I have no conflicts of interest
But there is always a hope ! 6
Agenda
What is an MDT ?
Aims
Participants
What to discus in an MDT ?
Taking decisions – and follow it up !
Necessary paperwork
Skill to develop
Impact in practice
7
MDT - Definition
A Multidisciplinary team is a group of health care/social care
workers, experts in different areas, working for the purpose of
planning/delivering the best available diagnostic/therapeutic
interventions for a medical condition
Synonyms: multi-disciplinary meeting (MDM), tumour boards,
cancer conferences (common in oncology)
More and more common for non-acute medical conditions and
sometimes in “distressing” acute cases
It is a form of institutionalised communication
8
Reasons for
MDT development
Variations in treatment outcome among various teams/regions
Need for a more accurate diagnosis (i.e. larger tissue samples)
Difficulties in diagnosis/staging
Multiplication of available treatment alternatives
Lack of unquestionable data concerning relative efficacy of different
treatment modalities
Insure all relevant aspect of the patient and its disease are
taken into account
Adapt available diagnostic/treatment modalities to patient status and
thus minimizing risks
9
Reasons for
MDT development
Implementation and continuous improvement of quality
management of health care (traceability of decisions)
Compliance with standards/recommendations
Support from a collegial environment/increase in “job
satisfaction” for team members
REGLEMENTARY/INSURANCE/RESPOSABILTY CLAIMS
10
MDTs - Aims
PATIENT CENTERED
MAIN: ameliorate treatment results (i.e. survival)
For ex: improving resection rate
Save time and improve “time to first therapy”
Improving continuity of care
Not forgetting about unusual treatment options (i.e. trials)
Reducing variation in decisions
Preventing treatment side effects
11
MDTs - Aims
“HEALTH SYSTEM CENTERED”
Reducing costs
Despite the use of “very expensive” specialists
Reduce unnecessary investigations
Reduce duplication in services offered
Optimal use of resources
Improve coordination between services
Creation of fast-track/rapid referral pathways
Better definition of responsibilities
Provide an optimized environment for learning
12
Participants Participants should be recognized experts in the area
Composition mirror the steps for diagnosis/treatment
Recommendations vary by country but at least:
Pulmonary physician
Oncologist
Thoracic surgeon
Radiotherapist
Radiologist / Nuclear medicine
Pathologist
(early phase) Clinical trials coordinators
Palliative care, GP (patient will, symptoms/pain management)
Nurses (and other: dietician, social worker etc )
A coordinator is needed (administrative work) but equal voice
to all specialities is mandatory – attendance recorded13
MDT – which questions ?
Is diagnosis/staging adequate or extra steps are required?
Which diagnostic approach is the most suitable ?
Need of additional investigations for:
evaluating “fitness for (a specific) therapy”
evaluating comorbidities
Choice of “optimal” therapy and schedule
(Un)Tolerable toxicity ?
Decisions for follow-up
YOU NEED to come with an opinion/question to discuss
NOT FOR: finding appointments, making referrals, escape
from patient/family pressure etc
14
Cases to be presentedTwo Philosophies
1. Specific (“unusual”/”problematic”) patients only!
Pro: Lack of time, “simple”/”inside guideline”/”repetitive”
cases
Con’s: Frequent “leftovers” (ensure that care is up-to-date),
Avoids the “We should have … “
2. “ALL” patients need to be presented
Prioritisation possible: Curative intent, post operative,
oligo-metastatic (incl. extra-thoracic), adv. ECOG 2,
“end” of treatment, relapses good PS,
PROGRESSIVE implementation possible
Standardized sheet MANDATORY (minimal dataset)15
How to reach a decision ? Failure to reach decisions
Keep in mind that medicine is not an exact science and not
always evidence based decisions can be made
“Mille viae ducunt homines per saecula Romam"
Keep decisions participative
Make decision-making transparent and visible
Encourage and sometimes define leadership
Always explicit the reason for the taken decision
Produce a written consensual document FOR EACH patient
(like any other investigational/therapeutic procedure)
Involve patient in decision making (personal preferences)16
Is there a
mandatory “technology” ? Most important: regularity !!! (at least twice monthly)
Preregistration of cases useful !
Do not make long meetings (>2h ?)
Room with good acoustics
Availability of raw data for all investigations
Images, not only interpretation (PACS+++)
(Possibility for other exams if necessary)
Ideally BEFORE the meeting
Direct access to current available guidelines
If possible continuous access to literature
Clear explanation, recording and traceability and
communication of decisions (Clerical support essential)17
Which paper work
Generally is mandatory "to document”
Sometime few details are given
Recommendations:
1. Keep track of all patients presented
2. Produce a staging sheet (AT the MDT)
3. Have a MDT sheet – SIGNED
4. Document (with references from literature) any non
guideline-compliant decision
5. MOST IMPORTANT: PATIENT INFORMATION !!!
State who will “be in charge”
18
Skills to develop
Communication skills
Promote dialogue between different participants
Give equal voice to everyone
Include allied professionals in discussion
DO NOT discuss cases if referring physician not present
Leadership skill
Promote consensual decisions
Avoid personal/subjective/”selfish” attitudes
Presentations skills
Present ALL relevant info (role of predefined forms +++)
Clear and quantifiable information
Use international accepted definitions
19
Reasons for not following MDT
Patient decision (from Active to more conservative 90%)
Deterioration in patients status
Availability of additional clinical data (comorbidities)
Organisational issues
Agreements for “urgent” decisions should be discussed
in advance
20
Faculty disclosures
There are no faculty disclosures for this session.
21
Faculty contact information
Dr Mina Gaga
Sotiria Chest Diseases Hospital
eHealth Unit
152 Mesogion Av.
11527 Athens
GREECE
Prof. Dr Bogdan Dragos Grigoriu
Regional Institute of Oncology
University of Medecine and Pharmacy
Str General Berthelot 2-4
700384 Iasi
ROMANIA
Dr Dimitrios Vassos
General hospital of thoracic diseases "Sotiria"
Oncology unit
Messogeion 152
11527 Athens
GREECE
22