P071 Defining the aims of multi-disciplinary team driven care within an inflammatory bowel disease service provision - Results from a Delphi consensus-building methodology
P. Morar*1,2, N. Sevdalis2, J. Warusavitarne1,2, J. Green3, A. Hart1,2C. Edwards4, O. Faiz1,2
1St Mark's Hospital, Colorectal Surgery & IBD Unit, London, United Kingdom, 2Imperial College London, Surgery and Cancer, London, United Kingdom, 3University College Hospitals, Urology and Cancer, London, United Kingdom, 4Torbay Hospital, Gastroenterology, Torbay, United Kingdom
Multidisciplinary Team (MDT) driven care is arising intuitively within the Inflammatory Bowel Disease (IBD) setting. There are no clear evidence-based definitions of what the aims of the IBD MDT should be. Providing a standardised framework, with clearly defined aims that characterise the purpose of the IBD MDT, may enhance its capacity to establish effective quality improvement. The objective of this study was to obtain a definition of the aims of the IBD MDT, through expert-based consensus.
This was a prospective, qualitative study using a Delphi formal consensus-building methodology. An eligibility criterion was established to ensure panel members had recognised expertise in the field of IBD. The online survey contained stems, developed on the basis of themes that emerged from prior semi-structured interviews with IBD experts. Participants were asked to rank each stem with a Likert scale (1= not relevant to 5= highly relevant). Likert ratings were represented as mean scores. Consensus was defined with a standard deviation (SD) < 1. Stems with a mean score of ≥4 were included into the primary aim, and those <4 were included into the secondary aim.
A multidisciplinary sample of 24 experts were recruited. The mean number of years of experience in the field of IBD was 11. Stems that described the aims of the IBD MDT [mean; SD] (from highest to lowest relevance) were to provide multidisciplinary input for the patient's care plan [4.9; 0.3], deliver the best possible care for the patient [4.8; 0.5], provide shared experience and expertise [4.8; 0.5], improve patient outcome [4.7; 0.6], advance patient care [4.7; 0.6], provide a basis of support and shared decision making [4.6; 0.7], obtain a consensus on the patient's management plan [4.5; 0.7], provide a forum for research and education [3.9; 0.9], reduce emergency surgical procedures [3.6; 0.9], and provide a safety net so patients are not missed [3.6; 1.1]
“Figure 1 Error bar graph representing the aims of the IBD MDT - Mean scores for each stem are represented in the centre of each bar with the bar width representing the 95% confidence interval limits.”
The IBD MDT should primarily aim to deliver the best possible care for the patient, improve patient outcome and advance patient care by obtaining multidisciplinary input and consensus on the patient's management plan through a basis that provides support, shared experience, expertise and decision-making. Secondary aims are to reduce emergency surgery and provide a forum for research and education. This definition provides a focus for key specialists, enhancing the MDT as a tool that delivers a high quality IBD service provision. Further validation is required prior to implementation into standards.