Impact of regional multi-disciplinary team on the management of complex urogynaecology conditions

Abstract

Introduction and hypothesisFollowing the publication of the National Institute for Health and Care Excellence guidelines on the management of pelvic floor dysfunction, articles speculating on the benefits and costs of local and regional multi-disciplinary teams (MDTs) have been in circulation. To date, there has been no formal assessment of the impact of a regional MDT on the management of women with complex urogynaecological conditions.MethodsThroughout the existence of the West of Scotland (WoS) Regional Urogynaecology MDT, from May 2010 to December 2015, 60 patients with complex Urogynaecology conditions were discussed. Data were collected on presenting condition, pre- and post-MDT management plans, and treatment outcomes.ResultsThe average age was 52.6 years (range 21–91 years). All meetings had at least 1 urogynaecologist, 1 gynaecologist, 1 reconstructive female urologists, 1 urodynamicist and, on average, 3 continence nurses, 4 physiotherapists, as well as 1 clinical librarian to conduct a literature search and 1 secretary for administrative support. The majority of the referrals dealt with urinary incontinence (n=34) and 8 patients presented with mesh complications alongside other pelvic floor disorders. The MDT made changes to the original referrer’s management plan in at least 25 (41.7%) patient presentations. Twenty-two out of all the patients discussed (36.7%) were reported as cured or improved in their condition following the MDT-recommended management.ConclusionThe WoS Regional Urogynaecology MDT had a positive impact on the management of women presenting with complex condition(s). Cross-sharing of resources between hospitals within the region provided a wider range of management plans, better tailored to each individual.