The multidisciplinary team (MDT) at St. James's Hospital experienced significant increases in workload due to the implementation of PACS, electronic patient records, and an increase in patient referrals. To accommodate the workload, the MDT increased meeting time from 1 to 1.5 hours and was able to discuss 24 patients per hour compared to 14 previously. They coped through strategies like grouping similar cases, prioritizing, and incorporating electronic record keeping into their meetings. However, this reduced time spent reviewing images and clinical summaries for each patient.

1. MULTIDISCIPLINARY TEAM (MDT)
EXPERIENCE IN THE
INCORPORATION OF PACS AND
REAL-TIME ELECRONIC RECORD-
KEEPING AT MEETINGS
B. Kane1, M. Morrough, H. Al Chalabi, S. O’Keeffe, B.
Dunne, M. J. Kennedy, D. Hollywood, T. Boyle, E. Connolly,
R. McDermott, K. O’Byrne, F. Lynam, S. Luz
1IRCSET Research Fellow

2. Overview
• Background
• Development
• Response
• Conclusion

3. Method
• Survey
• Interviews
• Observation
• Work process Data

4. Background - Change
• PACS
• Electronic Patient Record implementation
• Designation as Referral Centre
• Guidelines – MDT Meetings
• Increased Number of Patients
• Public Awareness

5. Team Profile - 2011
ROLE Number
Clinicians 9
Radiologist 1
Pathologist 3
Vocal Non-Vocal
Oncologist 6
13 (46%) 15 (54%)
Nurse 6
Physiotherapist 1
Data/Audit Manager 1
Administration staff 1
Total 28

6. Team Profile - Clinicians
ROLE Number
Consultant 8
Specialist Registrar 3
Registrar 5
Intern 2
Total 18

7. Team Profile - Experience
Experience
Frequency
(Years)
<1 2
1-3 8
4 - 10 12
11 - 20 3
> 20 2
Not given 1
Total 28

8. Team Profile – MDTs and MDTMs
MDTs to MDTMs Number
which per week
Number
member 1 12
belongs
2 4
1 19
3 6
3 6 5 1
10 3 1-2 3
2-3 2
Total 28
Total 28

9. Data - Workload
Month of
Increase
November 2005* 2010
%
22 working days
Patient Cases - 206 255
Patient Case 58 237 309
Discussions (Mean 14) (Mean 48) (243)
*In 2005: In 2010:
One MDTM cancelled 28 patients discussed more than once.
No. Individuals not noted Three of these were discussed 3 times

10. How
has increase been
accomplished?
350
300 2010
250
200
150
100
50
0
1 2 3
-50
-100
2003 2005

11. Increase accommodated
More TIME
Instead of 8.00am to 9.00am
Now meet 07.45am to almost 09.45am
Represents increase from
14 per hour in 2005
to
24 per hour 2010
= 71% increase in number of discussion

12. Coping Strategies
Grouping
Prioritising
Increased Formalisation
Incorporate Electronic Record Keeping

13. Electronic Record-Keeping

14. Electronic Record-Keeping

15. Other Consequences
Less Clinical summary
Reduced time spent on radiology images
Mammogram, US, MR
Pathology pictures rarely shown
Less discussion, less participation

16. Acknowlegements
• Breast Team at St James’s Hospital
• IRCSET Research Fellowship
• St James’s Hospital Board