Streamlining the process for formal peer review of patients with haematologic malignancies has brought significant results for patient care, haematologists report.

And the implementation of a streamlined, formal framework for multi-disciplinary (MDT) meetings has also seen a major increase in “clinicians’ satisfaction”, says Associate Professor Judith Trotman, Senior Staff Specialist and Director, Clinical Research Unit at the Concord Hospital’s Haematology Department.

“It has become the most well-attended meeting in the whole department,” she told the limbic.

“The meetings wouldn’t be a success if people didn’t see it as good use of their time.”

Associate Professor Trotman and her colleagues have published a paper online in the Internal Medicine Journal, which details the development of a process for formal peer review of patients with haematologic malignancies.

They also audited resulting changes made to management recommendations of the treating physician.

The protocol for the MDT meetings was developed to integrate clinical peer review with weekly pathology and radiology meetings. A key part of the process was the inclusion of an electronic patient-specific proforma, which was completed prior to the meeting.

This is effectively a template for the review of the patient presentation, discussion of the proposed management, and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record and a copy sent to the GP.

“MDT meetings can vary considerably in their organisational structure, membership, focus and decision making processes,” the authors wrote.

“Prior to 2010, Haematology MDT meeting in our institution was a sporadic fortnightly meeting held in addition to the weekly departmental review of inpatient care.

“Pathology and radiology were reviewed in separate weekly meetings. These meetings were poorly documented and inadequate for optimal integrated peer review and delivery of evidence-based cancer care.”

Professor Trotman said creating the time for completing the proformas and attending “yet another meeting” was an initial hurdle that was overcome by a sustained commitment to collaboration.

Even just finding a satisfactory time of the week to ensure attendance of a truly multidisciplinary team, required initial compromises now long forgotten.

She said that by streamlining the logistics, and using technology to allow all MDT members to review a concise and logically presented summary of patient data, with staging and prognostic factor menus tailored to their specific malignancy, physicians and health professionals were able to make the most of the meetings.

“Ours wasn’t a process that happened overnight, we have had to work hard at it,” she said. “I think certainly streamlining the logistics over the initial months was crucial.”

Likewise she said the patient-specific proforma was integral to the success of the system.

“If you expect a dozen of your colleagues to give rapid but quality peer review you must provide them relevant data in a concise and comprehensive way,” Professor Trotman said.

“Similarly if you expect the treating physician to complete and submit a patient proforma it must be with as few keystrokes and as many tick options as possible.”

The authors of the paper revealed that the “robust weekly MDT meetings for peer review of the management of patients with haematological malignancies” had led to 20% of patient management plans being altered to optimise patient care.

This was a direct consequence of peer review at the MDT, and while Professor Trotman said most changes were more ‘minor tweaking’ of management plans such as additional investigations or supportive cares, even such minor recommendations assist greatly in ensuring nothing was missed in delivering quality patient care.

She said that with change being the only constant in haematology her department would continue to develop and audit the program.

She said other departments had already shown interest in the model. But she stressed that it may not be possible to directly extrapolate the program used at her department into any other department.

“I couldn’t possibly suggest what the ideal MDT is because it has to be adapted to the individual needs of the department and the hospital,” she said.