P400 Setting standards for multi-disciplinary team driven care in inflammatory bowel disease service provision - an expert consensus on key specialists to be involved
P. Morar*1, N. Sevdalis2, J. Warusavitarne1, J. Green3, A. Hart1, C. Edwards4, O. Faiz1
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 which specialties should be key IBD MDT members. Providing a standardised framework, with a clear definition of key members, may enhance its capacity to establish effective quality improvement. This study aims to obtain a definition the key specialties that should be members of the IBD MDT, through expert-based consensus.
This was a prospective, qualitative study using an online survey. An eligibility criterion was established to ensure panel members had recognised expertise in the field of IBD. Consensus was defined by an agreement of greater than 70% across panelists. The definition of a 'core member' was a regular attendee with contractual IBD MDT responsibilities and an 'extended member' was an attendee invited only by a core member without contractual IBD MDT responsibilities. Dichotomous responses were represented in proportions.
In total, 24 participants were recruited into the expert panel. Consensus for being a core member was demonstrated for radiologists [24/24], gastroenterologists [24/24], colorectal surgeons [24/24], IBD nurse specialists [24/24], histopathologists [21/24] and the MDT co-ordinator [21/24]. Consensus for being an extended member was demonstrated for paediatricians [17/24], research fellows [17/24] and psychologists [22/24].
“Figure 1 - Bar chart demonstrating consensus (> 70% agreement) for core members and extended members of the IBD MDT.”
Heterogeneity (<70% agreement) in opinion was present on the role of the consultant endoscopy specialist, junior doctors, the dietician, the pharmacist, the outpatient nurse, the consultant dermatologist, the consultant rheumatologist and the IBD patient.
“Figure 2 - Bar chart representing heterogeneity in opinion (< 70% agreement) for specialists in the IBD MDT”
The core members of the IBD MDT, with contractual recognition of IBD MDT responsibilities, should be radiologists, gastroenterologists, colorectal surgeons, IBD nurse specialists, histopathologists and the MDT co-ordinator. The extended members should be paediatricians, research fellows and psychologists. Defining key specialists as IBD MDT members is necessary to reduce variation in care standards. An evidence-based recognition through expert consensus can aid contractual definition of IBD MDT responsibilities for core members. Further validation and specialist role definition are required prior to implementation into standards.