The effect of COVID-19 on multidisciplinary team meetings in a tertiary hospital - DEMPSEY PJ, YATES A, POWER JW, MURPHY MC, MURRAY JG. DEPARTMENT ...

The effect of COVID-19 on
multidisciplinary team meetings
in a tertiary hospital

DEMPSEY PJ, YATES A, POWER JW, MURPHY MC, MURRAY JG.
DEPARTMENT OF RADIOLOGY
MATER MISERICORIDAE UNIVERSITY HOSPITAL

Background
 •   The pandemic resultant from the SARS-CoV2 coronavirus has caused
     unprecedented disruption to global healthcare, economies and
     human life. Many hospitals have been forced to reduce provision of
     services, for example elective surgeries, to increase capacity for
     COVID-19 patients [1].
 •   This has seen the introduction of novel measures such as increased
     use of video-conferencing, “virtual clinics” and radiology
     departments increasing the provision of home PACS workstations [2],
     to maintain adequate social distancing and reduce potential
     exposures.
 •   The multidisciplinary team meeting (MDM) is a cornerstone of
     management and coordination of patient care and is invaluable in
     complex cases. The National Cancer Control Programme (NCCP) has
     recommended that they continue, but should do so in a manner safe
     for staff within the constraints of the individual organisation [3].
 •   The purpose of this project was to review the effect of COVID-19 on
     MDM delivery and the measures taken to allow their provision in a
     challenging new environment.

Timeline of COVID-19 in Ireland
•   The first case of COVID-19 in
    Ireland was reported on
    2/29/2020. Since then, the
    country has reported 28,720
    cases, and 1,777 deaths as of
    30/8/20 [4] with cases peaking in
    May.
•   There have been over 7,986
    cases in healthcare workers in
    Ireland, or 31.87% of the total
    caseload [5]
•   There have been over 25 million
    confirmed cases and 847,000
    deaths worldwide from COVID-
    19
                                        Figure 1: New Cases of COVID-19 In World Countries
                                        [Internet]. Johns Hopkins Coronavirus Resource Centre

Materials and methods
•   There are 13 MDMs that take place in our hospital on a weekly basis.
    Further subspecialist MDMs such as maternal medicine and
    congenital heart disease take place on a 2 weekly basis.
•   With the diversion of many in hospital services towards the COVID
    response, reduced numbers of patients were referred for discussion.
    All patients referred were discussed.
•   We analysed the numbers of patients referred for discussion over a 3
    month period of March-May 2019 and 2020 to assess the effect of the
    pandemic on this aspect of patient care.
•   We examined the measures put in place to adhere to infection
    control guidelines and ensure staff safety.

Results
•   The capacity for case review from a radiological perspective was
    unchanged, however there were fewer cases submitted for MDM
    discussion in March, April and May 2020 compared to the same
    period in 2019.
•   A modest reduction in referrals of 4% was seen in March, although this
    likely preceded the effect of COVID-19 as the first case was confirmed
    in Ireland at the end of February.
•   While the numbers were lower across all 3 months, a greater reduction
    was seen in April (20%) and May (17%), during the height of the
    pandemic response.
•   During the period of April and May 2019 a total of 1,470 patients were
    discussed at MDM. 1,194 patients were discussed over the same
    period in 2020, a reduction of approximately 19%.

Figure 2: Cases referred for MDM discussion April -
       Results                  May 2019 vs 2020
     MDM VASCULAR
                                                                                  The total of MDM cases
     MDM UROLOGY                                                                  discussed per month in 2019
       MDM Thyroid                                                                were
MDM THORACIC AORTA                                                                •   March: 710
   MDM RESPIRATORY                                                                • April: 715
  MDM PELVIC FLOOR                                                                • May: 746
    MDM ONCOLOGY

    MDM OBS/GYNAE

   MDM NEUROLOGY

       MDM STROKE                                                                 In 2020 the total numbers
   MDM MRI CARDIAC                                                                discussed per month were
 MDM HAEMATOLOGY                                                                  • March: 680
 MDM GYNAECOLOGY                                                                  • April: 572
           MDM GI                                                                 • May: 622
          MDM ENT

       MDM BREAST

                     0    50      100        150      200     250     300   350

                         MDM mnumbers 2019         MDM numbers 2020

Results

•   Some conferences, such as the pelvic floor, thoracic aorta and
    obstetrics MDMs, did not refer any patients for discussion.
•   The Breast, GI and respiratory MDMs, which have the largest
    monthly caseloads, saw reductions of 11%, 15% and 28%
    respectively.
•   The biggest decreases were seen in Cardiac MRI (77%), stroke
    (58%) and vascular (38%)
•   2 areas demonstrated a paradoxical increase – ENT (26%) and
    haematology (6%)
•   Another study similarly reported an overall decrease in cases
    discussed and a greater decrease between the 1st and 2nd half of
    April 2019-2020 vs the month of March 2019-2020 (23 and 33% vs
    8%) [6].

Protection of Staff
•   MDMs normally do not put limits on the numbers of team members in
    attendance. The largest of these conferences may have up to 40 staff
    present.
•   Social distancing in this context was an impossibility
•   In accordance with guidelines from HSE, NPHET and the department of
    health, the NCCP have recommended that staff physically present at
    these meetings should be limited to decision makers and key support staff.
•   Staff physically present in the conference room is now limited to a
    maximum of 15. Seating is arranged to accommodate social distancing
    measures
•   Video-conferencing software (Pixip) has been utilised in compliance with
    GDPR to allow other team members attend from external locations if
    required.
•   The conference is also streamed to two hospital lecture theatres, with a
    maximum capacity of 300, allowing for appropriate social distancing
    should other team members wish to attend.
•   Hand gel is provided and the use of face masks is encouraged

Protection of staff

A picture of the conference room,              A closeup of the monitors in use in the
demonstrating the chairs laid out to adhere    conference room. On the left is a view of
to social distancing requirements.             the room, when in use cases would be
Note the chairs against the wall in the left   shown here. On the right is a view of the
of the room, these would have previously       lecture theatre in the Mater which
been out and in use.                           conferences are now being streamed to.

Conclusion
    The COVID-19 pandemic has created a challenging environment
     for multidisciplinary team meetings, a key element of patient care.
     The implementation of measures in line with infection control advice
     has allowed them to safely continue in a new format.

References
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       Coronavirus Disease (COVID-19) Era. American Journal of Roentgenology. 2020;:1-3.
3.     HSE Library Guides: Covid-19 HSE Clinical Guidance and Evidence: Multidisciplinary Team Meetings [Internet].
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       https://hse.drsteevenslibrary.ie/c.php?g=679077&p=4850274
4.     New Cases of COVID-19 In World Countries [Internet]. Johns Hopkins Coronavirus Resource Center. 2020 [cited 3
       June 2020]. Available from: https://coronavirus.jhu.edu/data/new-cases
5.     COVID-19 Information [Internet]. Health Protection Surveillance Centre. 2020 [cited 3 June 2020]. Available from:
       https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland/
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