Abstract
BackgroundHead and neck cancers are fast growing tumours that are complex to diagnose and treat. Multidisciplinary input into organization and logistics is critical to start treatment without delay. A multidisciplinary first-day consultation (MFDC) was introduced to reduce throughput times for patients suffering from head and neck cancer in the care pathway. In this mixed method study we evaluated the effects of introducing the MFDC on throughput times, number of patient hospital visits and compliance to the Dutch standard to start treatment within 30 calendar-days.MethodsData regarding ‘days needed for referral’, ‘days needed for diagnostic procedures’, ‘days to start first treatment’, and ‘number of hospital visits’ (process indicators) were retrieved from the medical records and analysed before and after implementation of the MFDC (before implementation: 2007 (n = 21), and after 2008 (n = 20), 2010 (n = 24) and 2013 (n = 24)). We used semi-structured interviews with medical specialists to explore a sample of outliers.ResultsComparing 2007 and 2008 data (before and after MFDC implementation), days needed for diagnostic procedures and to start first treatment reduced with 8 days, the number of hospital visits reduced with 1.5 visit on average. The percentage of new patients treated within the Dutch standard of 30 calendar-days after intake increased from 52 to 83%.The reduction in days needed for diagnostic procedures was sustainable. Days needed to start treatment increased in 2013. Semi-structured interviews revealed that this delay could be attributed to new treatment modalities, patients needed more time to carefully consider their treatment options or professionals needed extra preparation time for organisation of more complex treatment due to early communication on diagnostic procedures to be performed.ConclusionsA MFDC is efficient and benefits patients. We showed that the MFDC implementation in the care pathway had a positive effect on efficiency in the care pathway. As a consequence, the extra efforts of four specialist disciplines, a nurse practitioner, and a coordinating nurse seeing the patient together during intake, were justified. Start treatment times increased as a result of new treatment modalities that needed more time for preparation.
Highlights
Head and neck cancers are fast growing tumours that are complex to diagnose and treat
We found no significant differences between the pre multidisciplinary first-day consultation (MFDC) group and the post MFDC group in patient and tumour characteristics
Throughput times for the diagnostic procedures and start treatment decreased significantly, with an average of eight days, after the implementation of the MFDC through the extra effort of the four specialist disciplines while no increase in personnel capacity was possible in the care pathway
Summary
Head and neck cancers are fast growing tumours that are complex to diagnose and treat. The tumours in the head or neck region (nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx) are fast growing tumours This means that a long interval between the moment of referral and the start of the primary treatment (surgery, radiotherapy and/or chemotherapy) can lead to upstaging of the tumour with less chance on cure [1]. In the meantime the involved supportive paramedical specialists, such as the dental team (special care dentist, oral hygienist), speech therapists, dieticians, and medical social workers, were consulted prior to the multidisciplinary meeting. This meeting was the first opportunity for a multidisciplinary discussion in the care pathway about treatment, based on written history, physical examination, laboratory data, and imaging.
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