Working Towards A New Best Practice
Friday 16th October 2020
Heart Valve Voice’s Gold Standard sets out specific recommendations for multidisciplinary teams (MDTs). One of the impacts of COVID-19 has been the move from in-person MDT's to a virtual format. These new virtual MDTs are a step in the right direction, as this more agile approach will allow for faster decision making, and with more input from external services.
Our Gold Standard recommendations state that all MDTs should be made up of the following core team of healthcare professionals:
- an interventional cardiologist with a specialist interest in transcatheter aortic valve implantation (TAVI)
- a cardiac surgeon with a specialist interest in TAVI and surgical aortic valve replacement (SAVR)
- an imaging cardiologist
- who specialises in echo and computerized tomography (CT)
- a general cardiologist
- a clinical nurse practitioner.
Dependent on the needs of the individual patient, an MDT should also have access to a wider team, including:
- a care of the elderly physician • a vascular surgeon
- a vascular radiologist
- a cardiac anaesthetist
- palliative care clinician.
This new form of MDTs increases access, a central part of our recommendations. This improved access to MDTs will streamline patient pathways and improve decision making. However, with this new approach, access can also broaden out, and now new sectors can be involved in key decision making. In addition to this, the virtual style lends itself better to being captured, and improve communication with the patient to ensure they understand.
President of British Cardiology Society, Professor Simon Ray, took some time to talk to our CEO Wil Woan about the Virtual MDTs and how they’re changing the patient pathway.
Wil Woan “Hi Simon, thank you for taking the time to speak to me today. I wanted to go through some of the things you talked about and what that means for valve disease patients.”
Prof Simon Ray “No problem. Thanks for asking me, Wil.
WW “During the podcast, Simon, you talk a lot about how practices have changed during the COVID-19 response and how we can learn from this moving forward. One of the things you discuss, which we’ve also heard talked about by other clinicians, is ‘Virtual Clinics” - can you tell us a little more about them?
WW "Can you tell us a little about Virtual MDTs and the impact that has had on treatment pathways?”
SR “Well, normally an MDT takes place in a meeting room at the hospital, and it’s where the health care team get together to make decisions on patients treatment pathways. Due to COVID-19, we are no longer able to meet in person, so they’re all done securely via video call. Doing it this way has had two major differences, greater frequency of MDT’s and wider involvement.
WW “By wider involvement, do you mean better interaction with external services?”
SR “Exactly. In a virtual MDT, more than one institution can be involved. This improves access to MDTs and contributes to better decision making. In addition to that, virtual MDTs allow for a more nimble process. One of the frustrations is often that if an MDT is on a Thursday and a patient presents on Friday, it can be a wait till they get a formal clinical response. Doing it virtually removes this issue as it provides the flexibility to have more frequent meetings. Rapid decision making and patient flow from these virtual MDTs is something we need to capture and cement in the guidance.
WW “I totally agree. These are new processes, and so communication to the patient is crucial. We need to develop technologies that allow MDT’s to grow. One thing I was discussing with a GP involved with Heart Valve Voice is how do we get them involved in these virtual MDTs? These connections could become a powerful resource and improve treatment pathways exponentially.”
SR “The next step with these processes is guidance and guidelines. We’re due to update the 2015 guidance on MDTs in the near future. So we need to cement these changes into them, but also look at how we develop and improve the changes we’ve made so far.”
WW "Thanks for your insight, Simon. I look forward to seeing how this new style of MDT improves the patient pathway and streamlines the treatment of heart valve disease."
This improved access to MDTs will streamline patient pathways and improve decision making. Additionally, the new approach can broaden access as new sectors can now be involved in key decision making. The virtual style lends itself to being captured as a format, and communication with patients can be improved. It is an example of a beneficial change caused by COVID-19, that must be locked in to support heart valve disease patients in the future.
This article was featured in Heart Valve Voice Magazine, which you can read for free here.