MDT information

Multidisciplinary Team Meeting This information has been provided to give healthcare professionals better knowledge of how MDT Meetings operate within the West London network

Types of cases

The format of the cases that are discussed at the MDT, they fall into two categories, the first being any recent adverse events that have been reported since the last meeting. This is a requirement from the commissioning quality dashboard set-up to report adverse events and record adverse events, discuss them at MDT to enter them onto the National Haemoglobinopathy Register (NHR). The adverse event cases don't need to be very lengthy in terms of the discussion

TERMS OF REFERENCE

Purpose

The purpose of the HCC MDT is to provide multi professional input for adults and children with Sickle Cell disease served by the West London HCC

Responsibilities

Process of Referral

The HCC Network Manager (or deputy) will forward out invitations for the scheduled HCC MDT in advance of the meeting. Included in the invitation will be case referral forms and adverse event report form for the MDT and criteria for referral, referrals to the MDT will be submitted at latest the day before the MDT to allow time for the coordinator to collect the case and circulate the cases in advance to the attendees. A reminder/call for cases will be sent out to clinicians two weeks in advance of the HCC MDT occuring. Patient identifiers should be anonymised. Referrals will be collated, anonymised if further required and a patient list created. The HCC Network Manager (or deputy) will respond to referral email with confirmation that patient is on the list.

Any issues with referrals to be clarified with lead clinician and referring team (e.g. doesn't meet the criteria, information not clear). Referrals that don't meet the criteria will be returned to clinician with a request for clarification. It is incumbent on the clinicians referring that they collect all necessary medical information (scans, results, notes etc.) in advance of presenting the case at the meeting.

The Meeting is chaired by the West London HCC MDT Lead or nominated deputy.

Cases are presented by the referring clinician.

Collecting the outcomes

The West London HCC MDT Lead records the case outcomes of the discussion, the outcomes will then be circulated within one week post the MDT to all the MDT attendees by the Network Manager (or deputy).

The Network manager will send the outcome of the MDT discussion to the referring consultant for confirmation. Once confirmed and validated via email exchange the outcomes will then be stored in the MDT folders of the HCC network server, which has restricted access and sent to the MDT attendees.

The number of patients discussed at MDTs and the numbers referred onto the NHP will also be recorded. Information on deaths
and patients referred for Gene therapies and stem cell transplant
will be collected for NHSE data requirements.
3. Criteria for patient Referrals

Criteria for patient referrals

It is suggested the following cases should be referred to the MDT:

• Management of complex transfusion issues (inc. Hyperhaemolysis)
• Difficult chelation issues
• Complex Psychology/Safeguarding concerns
• Candidates for bone marrow transplant/gene therapy referral
• Peri-operative managment
• Unplanned PICU/ICU admissions
• Missed Children from the newborn screening programme
• Management of Multi-organ failure and Fat embolism syndrome
• Complex transition issues
• Renal Transplant Planning
• Severe Covid-19 complications and potential PIMS-TS cases
• Potential trial/Novel therapy candidates
• Pregnancy complications
• Death

Considerations should be made as to the following:

• Consideration of stem cell transplantation
• Plan to commence long term transfusion/change from simple or manual exchange transfusion to automated transfusion
• Lack of response to hydroxycarbamide
• Other chronic/acute complications e.g.:
- Renal dysfunction
- Neurological disease (e.g. stroke, TIA)
- Urological complications
- Respiratory disease
- Pulmonary hypertension
- Obstetric complications
- Orthopaedic disease

Significant complications (known previously on the NHR as adverse events) to be submitted to the MDT for discussion will be derived from the following catergories (please see appendix 1 for full list)

• Cardiorespiratory complications, including:
- Pulmonary hypertension
- Severe acute chest syndrome
- Pulmonary embolism

• Multi Organ Failure, including; Fat embolism syndrome

• Genitourinarycomplications, including:
- Acute renal failure
- Severe Priapism
- Sickle Nephropathy

• Orthopaedic complications, including:
- Osteomyelitis/ Septic arthritis
- Severe AVN associated with significant functional limitation
- Recurrent leg ulcers

• Extramedullary haemopoiesis

• Neurological disorders, including:
- Stroke
- Silent cerebral infarcts
- Visual Loss
- Moya Moya

• Hepatobiliary complications:
- Sickle hepatopathy
- Cirrhosis of liver
- Pancreatitis

• Endocrinopathy due to iron overload or opiod use

• Obstetric/ gynaecological complications, including Intrauterine death

• Severe bacterial or viral infection

• Cancer

• ITU admission

• Severe transfusion reaction including hyperhaemolysis

• Death

 

Membership

The MDT HCC members will comprise:

• West London HCC MDT Lead or nominated deputy

• West London HCC Consultants (including a representative of each of the SHT paediatric and adult services. SHT services- Imperial College Healthcare NHS Trust, London North West University Healthcare NHS Trust, St George's University Hospitals NHS Foundation Trust )

• West London HCC Nursing Staff both Community and Hospital based

• West London HCC Psychology Staff

• West London HCC Junior Doctors

• West London HCC Network Manager

• Members of the SPAH and Welsh Haematology teams linked with the West London HCC

Other members from West London professional bodies, administrative specialists and other clinical specialists may be identified and invited as appropriate.

Quorum and expected attendance

The quorum for any meeting of the MDT shall be at least 8 members of the clinical teams

Key Membership should include:

- Adult Consultant from Imperial College Healthcare NHS Trust
- Paediatric Consultant from Imperial College Healthcare NHS Trust
- Adult Consutltant from London North West University Healthcare NHS Trust
- Paediatric Consultant from London North West University Healthcare NHS Trust
- Adult Consultant from St George's University Hospitals NHS Foundation Trust
- Paediatric Consultant from St George's University Hospitals NHS Foundation Trust

Frequency of Meetings

The MDT will be held every Month alternating between Wednesdays at 1pm and Fridays at 2pm

With an additional meeting to discuss significant complications/adverse events every 3 months, this will be scheduled for 2 hours

Agenda and Reporting

- HCC Network Manager with dicussion (or nominated deputy) will prepare the patient list and prepare and/or collate any additional documents for discussion or approval at the meeting.

- Outcomes list will be taken for each meeting and a list of all cases that have been reviewed at the MDT will be agglomerated and held by the HCC network manager and team in relation to any data requests from NHSE

- A 5 minute section of the HCC MDT will be given over to an update on Clinical trails open within the HCC and to enable equitable access to clinical trails for patients


To satisfy the NHS England data requirements as follows information will need to be picked up from the cases going throught the HCC MDT:

• Number of cases referred to the NHP
• Proportion of significant complications (as defined by National Haemoglobinopathy Registry) that are discussed at the HCC morbidity / mortality meetings
• Proportion of patient deaths discussed at HCC morbidity/mortality meetings
• Proportion of patients referred for gene therapy and haematopoeitic stem cell transplantation

The MDT will have separate sessions to cover significant complications/adverse event reporting this will occur once every 3 months

Review of Terms of Reference

The Terms of Reference of the HCC MDT will be reviewed annually and approved by the West London HCC Network Manager leads and by all core members of the HCC MDT Sub group and noted at the HCC Steering Group.

 

Significant complications/Adverse events listed on the NHR

Cardiorespiratory:

Pneumonia
Acute chest syndrome
Angina
Cardiac arrhythmia
Pulmonary hypertension
Myocardial infarction
Asthma
Deep vein thrombosis
Restrictive lung disease
Fat embolism syndrome
Obstructive lung disease
Other thrombotic complication related to central catheter
Pulmonary embolism
Superior venocaval obstruction secondary to previous central lines

 

Genitourinary:

Acute renal failure
Renal stones
Haematuria
Glomerulonephritis
Chronic renal failure stage 1-5 CKD listed and has different eGFR from less than 15 to greater to 90
Hydronephrosis
Renal replacement therapy
Nephrotic syndrome
Papillary necrosis
Priapism
Renal mass/tumour

 

Orthopaedic:

Fracture
Acute osteomyelitis
Chronic osteomyelitis
Septic arthritis
AVN
Osteoporosis
Degenerative disc disease
Leg ulcer
Extramedullary haemopoiesis

 

Neurological disorders:

Ischaemic stroke
Silent cerebral infarcts
Seizure without diagnosis of epilepsy
Haemorrhagic stroke
Central venous thrombosis
Epilepsy
Spinal cord compression
Visual loss
Retinopathy stages I - V listed separately
Moya Moya
Chronic pain

 

Haematological:

Acute haemolytic event not related to blood transfusion
Agranulocytosis
Disseminated intravascular coagulation
Neutropenia
Pure red cell aplasia
Acute vaso occlusive crisis

 

Hepatobiliary:

Liver failure
Intrahepatic cholestasis
Cholestasis
Biliary colic
Ascending cholangitis
Acute pancreatitis
Pancreatic exocrine insufficiency
Cirrhosis of liver
Fibrosis of liver
Fatty liver disease
Hepatocellular carcinoma
Acute infective hepatitis
Hepatic mass

 

Endocrine:

Insulin dependent diabetes
Non-insulin dependent diabetes
Diet controlled diabetes
Hypothyroidism
Hypoparathyroidism
Adrenal insufficiency
Hypogonadotropic hypogonadism
Other endocrine complication

 

Obstetric/ gynaecological:

Intrauterine death
Recurrent miscarriage

 

Bacterial infection:

Pneumococcus
Salmonella sp.
Klebsiella sp.
Coagulase neg staphylococcus]mycoplasma
Bacterial infectious disease (other)

 

Viral infection:

Influenza
COVID 19
Parvovirus
Hep a
Hep b
Hep c
Hep e
Other viral illness

 

Other:

Cancer

Other complication not listed above

Death

Contacting the MDT Coordinators and Advice line

Please contact the email address wlhcc.mdtadvice@nhs.net if you are a healthcare professional with a case you would like to discuss, the team will aim to get back to you within 3 working days, please look to call or email the network management team if you need an emergency MDT to discuss a case.

Operation of the MDT

The Network Manager sends the invitations for the MDT and the request for cases in advance and sends out the link to join the virtual MDT (this is held via MS Teams). AL chairs the MDT. One of the members of the MDT, currently AL, will record the outcomes and we try to send out the outcomes of the clinical discussions within seven days following the MDT.