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Quality standards for cancer MDMs

Loddon MalleeStatewide - Adult

Project purpose

To conduct a statewide audit and benchmark the quality of multidisciplinary meetings (MDMs) against the Victorian MDM Quality Framework.

What we did

LMICS led this initiative for the VICS. 22 Victorian health services reviewed 85 MDMs, using auditor interviews with key stakeholders and meeting observation. The audit also involved a review of 1842 patient MDM records against MDM Quality Framework minimum data, a policy review, and administration of a survey with 1380 responses.

Output

See the Victorian Department of Health website for the project’s final report to the Department, including 10 key recommendations:

  1. That further work be undertaken to:
    • formally define medico-legal risks of MDMs associated with confidentiality, attendance records, information quality, consent, referrals, and divergent treatment recommendations
    • identify optimal management of these risks
    • communicate the extent of risks and management responsibilities to clinicians and health service executives for prioritisation of improvement activities.
  2. That health services initiate routine monitoring and reporting on the alignment across their MDMs against the framework’s standards.
  3. That health services develop or enhance terms of reference (TOR) to align with the minimum TOR content in the framework.
  4. That health services ensure the ability for all MDM participants to review all radiology and pathology data, pre-filled patient data, and live data entry for participants who join an MDM remotely and/or from another health service.
  5. That MDM members set protocols for review and presentation of patients in a way that optimises meeting efficiency without compromising clinical quality.
  6. That health services align MDM membership with that defined in the OCP (for both core and non-core disciplines) and, when clinically required:
    • have a process for inviting additional specialists and general practitioners (GPs) for specific case discussion
    • implement formal referral pathways to alternative MDMs with the specified disciplines (specialists).
  7. That health services initiate training to strengthen their collective MDM leadership.
  8. That health services explore options for improving alignment of the data that is collected for MDMs to the framework’s data collection requirements.
  9. That health services consider a statewide approach to support the development and formalisation of protocols to streamline and prioritise MDM discussions.
  10. That health services:
    • consider mapping the health services that could be referring to their MDMs within an ICS region
    • develop partnerships with other health services to optimise referral pathways within their ICS region and beyond
    • improve processes to ensure recommendations are communicated back to referrers to enable timely and appropriate treatment planning with patients.

Whilst the operational aspects of MDMs are the responsibility of health services, the VICS will continue to provide quality improvement support to services in the MDM space and, over time, help services to implement the recommendations above.

In addition to the 10 overarching recommendations, participating MDM sites identified 86 local improvement projects for implementation.