Sir—We read with great interest the articles from Hudson et al. 1 and Tsou el al.,2 which outlined how an English radiology department and radiology departments in Singapore met the challenges raised by the COVID-19 pandemic. Both articles mentioned the change in the delivery of the multidisciplinary team meeting (MDM), a cornerstone of the management and coordination of patient care and an important part of a radiology department's workload. Tsou et al. describe how MDMs were curtailed or cancelled, while Hudson et al. describe how all MDMs were changed to a video-conferencing format where all parties logged in remotely. The Irish Health Services Executive (HSE) has recommended that MDMs continue, but do so in a manner safe for staff within the constraints of the individual organisation and that staff physically present at these meetings should be limited to decision makers and key support staff.3 We recently conducted a review of the effect of COVID-19 on MDM delivery in our institution. The aim of this letter is to share our experience of the measures taken to allow safe MDM provision in a challenging new environment.
There are 16 MDMs that take place in our institution, 11 of which are on a weekly basis with a further five fortnightly. The first case of COVID-19 in Ireland was reported on 29 February 2020 and the number of confirmed cases peaked in April.4 We analysed the numbers of patients referred for discussion over a 3-month period of March–May 2019 and over the same months in 2020 to assess the effect of the pandemic on this aspect of patient care. We noted the measures put in place to adhere to infection control guidelines and ensure staff safety.
The capacity for case review from a radiological perspective was unchanged and all cases referred to MDM were discussed; however, there were fewer cases submitted for MDM discussion in March, April and May 2020 compared to the same period in 2019. A modest reduction in referrals of 4% was seen in March, while a greater reduction was seen in April (20%) and May (17%). During the period of April and May 2019 a total of 1,470 patients were discussed at MDM and 1,194 patients were discussed over the same period in 2020, a reduction of approximately 19%. Three MDMs (pelvic floor, thoracic aorta, and obstetrics) did not take place over this period. The breast, gastrointestinal, and respiratory MDMs, which have the largest monthly caseloads, saw reductions of 11%, 15%, and 28%, respectively. The biggest decreases in the remainder were seen in cardiac magnetic resonance imaging (MRI) (77%), stroke (58%), and vascular surgery (38%). Two MDMs demonstrated a paradoxical increase in case referrals: ENT (26%) and haematology (6%). The change in caseload for each MDM during the period April to May 2019 compared with the same period in 2020 is shown in Fig 1 .
Figure 1.
Cases referred for MDM discussion April to May 2019 compared with 2020.
Previously the largest of these conferences could have had up to 60 staff present. Social distancing in this context was impossible. Consultation with the local infection control department and implementation of advice from government agencies has resulted in attendance in the main conference room being limited to a maximum of 15 individuals. Seating is arranged to accommodate social distancing. Video-conferencing software (Pexip, AS) has been utilised in compliance with general data protection regulation (GDPR) requirements to allow other team members attend from external locations if required. The conferences are also streamed to two large hospital lecture theatres allowing for appropriate social distancing should other team members wish to attend on site. Facemasks and hand gel are provided.
In our analysis, a modest reduction in cases submitted for MDM discussion was seen in March 2020 and a greater reduction seen in April and May compared with the same months in 2019. This reflects the diversion of hospital services towards the pandemic response. A French study recently reported a similar overall decrease in cases discussed and a greater decrease between the first and second half of April 2019–2020 versus the month of March 2019–2020 (23 and 33% versus 8%).5 The adoption of novel measures, such as video-conferencing, can allow MDMs to continue in a manner that does not compromise staff safety. The provision of MDMs in new formats is important to ensure optimal patient management is maintained.
Conflict of interest
The authors declare no conflict of interest.
References
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