VASGBI Project Grant
The Role of Preoperative Assessment in Effective Vascular Multidisciplinary Team Decision Making
Dr Simon Howell
Major vascular surgery is often carried out on patients who have co-existing disease including heart disease, chest disease and diabetes. Treatment options for an individual patient may include an operation, a radiological treatment such as the stenting of an artery, or medical management with no operation. The decision as to type of treatment for patients undergoing elective major vascular surgery is made by a multi-disciplinary team meeting (MDT) that brings together surgeons, radiologists and anaesthetists. This allows a full discussion the possible options. The multidisciplinary team approach to surgical planning was developed in cancer treatment and, whilst it has yielded improved treatment, there remain challenges. Studies of cancer MDTs suggest that some 15% of treatment plans made by the MDT cannot be completed, often because key information about co-existing disease and the patient's overall health was not known to the MDT. It seems likely that similar issues exist for vascular MDTs. Patients presenting for major vascular surgery undergo preoperative anaesthetic assessment and often have investigations such as echocardiography and cardiopulmonary exercise testing, but the results of these assessments may not always reach the MDT. We will conduct a study in which we identify the extent of this problem in vascular surgery, we will develop solutions within an academic decision and process mapping framework, and we will assess the impact of these solutions in a second follow up study. We will conduct this work in collaboration with the regional Academic Health Science Network (AHSN) and design solutions that can be applied in all centres. In detail, we will conduct a retrospective of study of a multicentre vascular MDT and identify the extent and causes of discordance between planned and actual treatment. We will identify cases where important medical information has not reached the MDT. We will undertake a formal process mapping exercise to identify ways to improve preoperative investigation and information flow that can be generalised to all vascular centres. We will conduct a prospective study to examine the effect of these changes on MDT process measures and concordance between planned and actual treatment. We will disseminate the results through the national network of AHSNs.
