Decision to delivery: do vascular MDT discussions achieve their intended clinical targets?

BACKGROUND Compliance between Multidisciplinary Team (MDT) decisions and the final management plan was audited before and after the introduction of electronic documentation. This study also analyzed the underlying causes and outcomes of any discrepancies.

METHODS A retrospective audit (Cycle 1) of 278 vascular MDT cases, followed by a re-audit (Cycle 2) covering 443 cases, was conducted across 24 MDT meetings between August 2021 and January 2022. Clinical management was compared with the recorded MDT decisions. Discrepancies were categorized by root cause, and associated outcomes - including mortality, limb loss, and treatment delays - were analyzed.

RESULTS Cycle 1: 39 out of 278 MDT decisions deviated from the agreed plans (14%). The main causes were pre/intraoperative surgical plan changes (33.3%) and patient unfitness (20.5%), resulting in a 33.3% three-month mortality rate and major limb amputations. Cycle 2: Implementation improved, with 48 out of 443 decisions (10.8%) deviated from the actual plans. System delays were the leading cause (31.25%), followed by clinical reassessment changes and patient unfitness equally at (20.8%). The three-month mortality rate and amputation incidence fell to 29%.

CONCLUSIONS Electronic documentation improved MDT compliance by 3.2% and reduced amputation/ 3-month mortality outcomes by 6.9%. System delays and patient unfitness continue to hinder full adherence. The rise of discrepancies in outpatients care points to unresolved divergence issues. Further refinement of documentation and reduction of system delays are essential for improving outcomes.