Virtual Multidisciplinary Team Research Articles

Virtual Multidisciplinary Team Meetings: A Tool to Increase Radiology Access in Global Health Settings

Virtual Multidisciplinary Team Meetings: A Tool to Increase Radiology Access in Global Health Settings

Virtual Multi-disciplinary Team (vMDT) platform improves workflows and productivity within the heart failure pathway for patients in the UK National Health Service (NHS)

Abstract Background We implemented a virtual MDT platform as a technical solution to assist a heart failure MDT. vMDT would enable the team to document discussions and create actions for individual team members that were visible and transparent and thus ensuring rapid completion relating to patient care plans. Patients cases processed via this pathway in comparison to traditional approaches were able to access treatment optimisation and newer heart failure therapies more rapidly. Data from the vMDT platform helped plan for wider transformation. Purpose Integrating care between general practice (GP), community and hospital specialists is the current focus for the National Health Service (NHS) in the UK. An integrated approach necessitated better communication and sharing of information between MDTs. We decided that it was necessary to have the digital infrastructure to deliver this approach. Method The vMDT system harnessed information relevant to the patients heart failure and presented it to MDT members to view and contribute to the patients treatment plan, before, during and after a scheduled MDT meeting. Following the meeting the platform would instantly communicate actions to members of the professional team, ensuring transparency and rapid completion of actions. Processes were simplified, meaning that patients could be referred onwards at the click of a button. The patients could be referred into this pathway by a GP when patients continued to have symptoms. Pathway was made available to GP clinics covering a 200,000 patient population. Led by the commissioning transformation team, who managed the project alongside the GP cardiovascular lead, community heart failure nurse lead, and Hospital heart failure specialist nurse leads. Clinical pharmacists linked to the GP clinics were included and were the ones who would prepare, upload and present the heart failure cases. Results 98% (150 processed over 10 months) of patients referred along this pathway could be managed effectively. 5% would otherwise have been lost to follow up. 100% of actions created through this pathway were completed. 62% had their treatment optimised. Clinician satisfaction improved. Conclusion Virtual MDTs are the rave but there needs to be digital infrastructure to support this novel way of working, especially if we are to scale this up. A digital platform needs to have the safeguards for information security but also needs to align to an improved workflow for the health professionals working within the service. In future we would like to look at whether addition of decision support can further improve productivity and outcomes relating to optimisation of therapy for heart failure patients.

P397 Using the science of health care improvement to implement a virtual cystic fibrosis clinic alongside the traditional face-to-face model post-COVID pandemic

The Blackpool Adult Cystic Fibrosis service (BACFS) is a small service with a young patient population in the North of England. In 2020 COVID restrictions imposed a virtual approach to CF care. Clinic attendance improved to 100% at times. Patient feedback was positive with nearly 70% finding the experience “excellent,” 90% wanting option of virtual care as it saved time, travel, and money. By converting 75% of outpatients to digital it may save 8,486 miles travel per year. We therefore aim to offer a structured Virtual CF multidisciplinary team (V-MDT) clinic whilst meeting the same key service performance indicators as a face-to-face clinic.

Changing from face-to-face to virtual meetings due to the COVID-19 pandemic: protocol for a mixed-methods study exploring the impact on cancer multidisciplinary team (MDT) meetings

IntroductionIn the UK, the National Cancer Plan (2000) requires every cancer patient’s care to be reviewed by a multidisciplinary team (MDT). Since the introduction of these guidelines, MDTs have faced...

Patient satisfaction with a virtual multidisciplinary team balance clinic: a pilot study

Background/Aims The COVID-19 pandemic led to many services being conducted remotely, including ear, nose and throat services. Although much in-person activity has now resumed, some services are still being provided remotely. This pilot study explored patients' satisfaction with the virtual multidisciplinary team balance clinics established at the authors' practice, looking at the feasibility of continuing this model of service delivery in the future. Methods Self-administered questionnaires were posted to the 56 patients who had received a virtual consultation with the service between March and September 2020, of which 22 were returned. The questionnaire presented respondents with 14 items, with which they rated their agreement on a 6-point Likert scale. Correlations between the final item (which measured overall satisfaction) and the other items were analysed using Spearman's rho. Results Overall, respondents were satisfied with the virtual consultations. Respondents either agreed or strongly agreed with 13 of the 14 items; the only exception was ‘I obtained better access to healthcare services by use of telemedicine’. Most respondents were happy with the quality of communication and valued the time saved on travel, although one pointed out that this may not be an appropriate mode of service delivery for patients who are deaf. Conclusions Virtual clinics can be an acceptable adjunct to traditional clinical consultations in an ear, nose and throat outpatient department for balance disorders and should be continued in future.

A multidisciplinary approach to optimising the virtual management of haemophilia: a roundtable meeting of UK experts

Abstract The necessity of a multidisciplinary team (MDT) approach in haemophilia care is well recognised globally, with international guidelines advocating this. Prior to the coronavirus disease 2019 pandemic, virtual MDT haemophilia care was gaining support worldwide. However, the pandemic necessitated the rapid implementation of innovative virtual solutions to ensure continued access to multidisciplinary care. A multidisciplinary panel of healthcare professionals who specialise in haemophilia care in the United Kingdom gathered to discuss the following: the current landscape of haemophilia MDT care and best practices, the benefits, challenges, and opportunities for virtual MDT care, managing bleeds remotely, virtual paediatric care, and the future of virtual MDT care. The consensus was that virtual MDT care is widely used, however formats vary depending on the healthcare setting, available resources, MDT preferences, and local policy. Advisors agreed that virtual MDT care has several benefits, such as improved convenience/choice for their patients and wider patient reach. However, many patient-specific and logistical challenges exist. Hybrid care models may provide an opportunity to overcome these challenges. The decision on how bleeds are managed (virtually versus face-to-face) depends on provider preference, the patient-provider relationship, and the patient’s disease severity, history, and ability to self-manage. As such, this should be assessed on a case-by-case basis. Virtual tracking tools cannot be solely relied upon for MDT decisionmaking as patient accuracy cannot be ascertained. The MDT composition for paediatric care should be tailored to the patients’ and their parents’/caregivers’ needs. Lastly, hybridised care will likely be adopted for future haemophilia management and will facilitate the advancement of MDT care.

Pharmacist-led multidisciplinary approach in preventing strokes in people with atrial fibrillation

Abstract Background/Introduction Targets set by Public Health England (PHE) state that 90% of patients with atrial fibrillation (AF) are expected to receive anticoagulation by 2029. In 2019/2020, across three London boroughs serving a population of 770,000, the percentage of AF patients at high risk of stroke (CHA2DS2VASc>2) anticoagulated was below the target set by PHE. In addition, optimisation of risk factors can significantly reduce the risk of cardiovascular disease and associated mortality in these patients. Purpose To provide specialist input from a cardiovascular pharmacist to prevent AF-related strokes through improvement of anticoagulation rates and optimisation of cardiovascular risk factors in patients with AF across three London boroughs over one year, as well as minimising bleed risk in patients on dual antithrombotic therapy. Methods A specialist cardiovascular pharmacist was commissioned to identify high-risk AF patients (CHA2DS2VASc>2) by working with primary care clinicians. Utilising “proactive care frameworks” created by UCLPartners and Clinical Effectiveness Group Queen Mary University of London, patients were stratified and prioritised for review. Patients not on anticoagulation were deemed to be at highest risk, requiring an urgent review to assess suitability for anticoagulation. A virtual multidisciplinary team (MDT) would review any complex patients and agree an action plan. Patients on dual antithrombotic therapy were also assessed to determine if antiplatelet therapy was indicated to minimise risk of major bleeding. All AF patients were reviewed for suitability of statin initiation to optimise cardiovascular risk prevention. Results At baseline, 86% (7581/8582) of AF patients with a CHA2DS2VASc>2 across the three boroughs were anticoagulated. 1001 patients were reviewed by a specialist pharmacist, with 84% (841/1001) of patients having a CHA2DS2VASc between 2–5, and 28% (280/1001) on antiplatelet monotherapy. Analysis at 12 months following intervention reported that 95% (7888/8280) of AF patients with a CHA2DS2VASc>2 were suitably anticoagulated, an improvement of 9%. 6% (61/1001) of patients were switched from antiplatelets and 25% (246/1001) were newly initiated on anticoagulation. 13% (130/1001) of patients required specialist MDT input to determine appropriateness for anticoagulation initiation. There was also a reduction in dual anticoagulation and antiplatelet therapy from 429 to 252 patients (41% reduction). Lastly of those reviewed, 2609 patients received a recommendation to start a statin for either primary (n=1981) or secondary prevention (n=628). Conclusion(s) Provision of a specialist cardiovascular pharmacist supported a multidisciplinary workforce to significantly improve and optimise cardiovascular risk, and reduce the risk of stroke in this high-risk population for people with AF across all three boroughs. By extrapolating these results nationally, 3600 strokes could be averted over 18 months. Funding Acknowledgement Type of funding sources: None.

P67 PIMS-TS MDT – where do we go from here?

Introduction/BackgroundFollowing first reports of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) in April 2020, services have rapidly been developed to manage these patients. In our tertiary paediatric rheumatology service a daily virtual PIMS-TS multidisciplinary (MDT) team meeting was set up in January 2021. This meeting facilitates discussions between the tertiary centre (routinely including paediatric rheumatology and infectious diseases/immunology teams) and general paediatric teams in district general hospitals (DGHs) and within our centre. The aim of this project was to evaluate the service and understand general paediatric opinion in order to consider the future direction of the meeting.Description/MethodWe looked at a one month period after meetings were initiated and compared it with a one month period a year later (February 2021 and February 2022) to define patient numbers and outcomes. Alongside this we constructed an online survey aimed at general paediatricians to determine opinion of the current structure of the MDT and how it may be developed in the future. The survey was sent to general paediatricians within our own centre and in the eleven DGHs falling within our region. Results were analysed descriptively.Discussion/ResultsDuring February 2021, 19 new referrals were discussed within the PIMS-TS MDT; each referral was discussed for a median of 5 days (interquartile range (IQR) 3–6 days). Of these, 11/19 (58%) had a final primary diagnosis of PIMS-TS and 5/19 (26%) patients were transferred for tertiary care (of whom 4/5 (80%) had PIMS-TS). In February 2022, 14 new referrals were discussed for a median of 2.5 days (IQR 2–5.75 days). Of these, 3/14 (21%) had a final diagnosis of PIMS-TS and 2/14 (14%) were transferred for tertiary care (of whom neither had PIMS-TS).We received responses from 20 general paediatricians covering 9/11 (82%) DGHs within our region plus our own centre. Most clinicians had discussed up to 6 patients in the meeting (9/20 (45%) 1-3 patients; 9/20 (45%) 4-6 patients; 2/20 (10%) >6 patients). All clinicians felt the MDT helped facilitate appropriate diagnostic work-up and treatment decisions. 18/20 (90%) felt that the meeting helped avoid unnecessary tertiary paediatric transfers. Interestingly, 9/20 (45%) felt that a routine PIMS-TS MDT meant they were more likely to discuss a patient with rheumatology (1/20 (5%) less likely). All clinicians felt the meeting improved care for patients and most felt it increased their confidence in looking after patients with PIMS-TS (19/20, 95%) and was useful for continuing professional development/training experience (19/20, 95%).Considering the future direction of the meeting, all clinicians felt it should be continued but most (16/20, 80%) felt it should be aimed at a wider patient group. 11/20 (55%) felt a later time of day would be more convenient (currently 11am). Over half (11/20, 55%) thought it should be combined with a currently separate meeting for acute COVID-19 patients (7/20 (35%) don’t know; 2/20 (10%) no). A minority (4/20, 20%) reported difficulty accessing the meeting.Key learning points/ConclusionAs the initial phase of the pandemic draws to a close and numbers of PIMS-TS cases decline this is important data to reflect on how services can go forward into the next phase. While numbers of PIMS-TS cases reduced, the meeting was still well-used and evolved to include patients with other diagnoses. The survey confirms that most general paediatricians believe it improves patient care and would like the meeting to continue but that review of the format may be helpful. Particular considerations are to broaden the scope of the meeting beyond PIMS-TS, revise the timing and consider how to improve ease of access to the meeting for all.Further work will focus on evaluating patient numbers and diagnoses over the full period of the PIMS-TS MDT and adapting the format of the current MDT in response to the feedback received.

Pharmacist-led multidisciplinary approach in preventing strokes in people with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction In England, 90% of patients with atrial fibrillation (AF) are expected to receive anticoagulation as part of targets set by Public Health England by 2029. In 2019/2020, across three London boroughs serving a population of 770,000, the percentage of AF patients at high risk of stroke (CHA2DS2VASc>2) anticoagulated was 87%, 83% and 84%. This placed two of the three localities in the bottom 10% compared to others in England. In addition, optimising cholesterol and lifestyle choices can significantly reduce the risk of cardiovascular disease and associated mortality in these patients. Purpose To prevent AF-related strokes by improving anticoagulation rates and optimising cardiovascular risk factors in patients with AF in all general practices across three London boroughs over one year, and to minimise risk of bleeding in patients on concurrent anticoagulation and antiplatelet therapy. Methods A specialist cardiovascular pharmacist was commissioned to systemically identify high-risk AF patients (CHA2DS2VASc>2) by working with primary care clinicians, including up-skilling of primary care pharmacists. Through utilisation of ‘proactive care frameworks’ created by the Clinical Effectiveness Group Queen Mary University of London and UCL Partners, patients were able to be stratified and prioritised for review. AF patients not on anticoagulation or on antiplatelet monotherapy were deemed to be at highest risk, and these patients were reviewed to assess suitability for anticoagulation. Subsequently, patients on concurrent anticoagulation and antiplatelets were assessed to determine if dual antithrombotic prescribing was still indicated to minimise risk of major bleeding. Lastly, to optimise cardiovascular risk prevention, all AF patients were reviewed for suitability of statin initiation for primary or secondary prevention. A virtual multidisciplinary team was convened for complex patients, which included a cardiologist, haematologist, general practitioner and pharmacist to review and agree an action plan. Results An interim analysis at 9 months reported that 94% (6745/7145) of patients with a CHA2DS2VASc>2 across the three boroughs were suitably anticoagulated, an improvement of 6% on the initial 88% (6585/7391). There was a reduction in concurrent anticoagulation and antiplatelet therapy from 381 to 262 patients (31.2% reduction) following specialist review. Lastly 2285 patients were reviewed with a recommendation to start a statin for either primary (n=1783) or secondary prevention (n=502). Conclusion(s) Provision of a specialist cardiovascular pharmacist supported a multidisciplinary workforce with significant improvement in anticoagulation rates across all three boroughs, reducing the risk of stroke in this high-risk population. In addition, we were able to reduce the risk of bleeding in this cohort of patients by stopping inappropriate antiplatelet therapy, and reduced the risk of cardiovascular disease through statin initiation.

Virtual cancer multidisciplinary team meetings: outcomes of a two-phased survey from a tertiary NHS hospital

Background/Aim Multidisciplinary team meetings have been an integral part of comprehensive cancer services in the UK for over 20 years. The COVID-19 pandemic led to the adoption of virtual platforms to allow these meetings to continue with minimal in-person contact. This study assessed multidisciplinary team members’ perspectives regarding the efficacy of the virtual platform, with the view of continuing this mode of delivery in the post-pandemic world. Methods A two-phased survey study was conducted among all members of the cancer multidisciplinary team in one UK hospital. Respondents completed a four-part questionnaire 6 months (n=108) and 1 year (n=120) after the implementation of the virtual platform in March 2020 to determine their perceptions of its effectiveness and safety. Results There was a statistically significant (P<0.05) improvement between the 6-month and 1-year survey responses in terms of overall satisfaction with the virtual platform, ease of use and efficiency of collective decision making using the virtual format. After 1 year, 80.5% of respondents preferred either continuing to use the virtual platform exclusively or switching to a hybrid model. Conclusions Staff experiences of using a virtual platform for cancer multidisciplinary team meetings may improve over time, with many respondents preferring this mode of delivery. Virtual meetings can provide greater flexibility and allow wider participation, potentially including specialists from across the globe.

1058 ESTABLISHING A VIRTUAL MULTIDISCIPLINARY TEAM MEETING FOR CARE HOME RESIDENTS IN NEWCASTLE-UPON-TYNE

Abstract Introduction Care home (CH) residents are frail with complex physical and mental health needs. Healthcare provided is often by different organisations and fragmented. Optimising quality of life and reducing avoidable hospital attendance is crucial. The Newcastle Specialist Care Home Support Team (SCHST) provides care for 2,482 residents across 55 Newcastle CHs. Between April 2019–2020, there were 2,428 unplanned hospital attendances in this cohort. SCHST looked to establish multidisciplinary team (MDT) meetings to streamline care by collaboration and integrating pre-existing services. We aimed to establish weekly virtual MDT meetings to facilitate coordinated care for CH residents, reduce unplanned hospital attendances and improve communications between services, reducing need for additional referrals. Method Members identified to comprise the MDT included SCHST staff, Geriatricians, Old Age Psychiatrists, Pharmacists and GPs. Weekly meetings via Microsoft Teams were established, with the SCHST undertaking initial assessments of those referred. Management plans were formulated and actioned with feedback to GPs, CH staff and relatives. Residents were either discharged, planned for MDT re-review, or planned for in-person CH review. Interventions include medications optimisation, CH staff education, psychiatric and comprehensive geriatric assessments. Results From April-Nov 2021, 77 residents were referred to MDT. The number of reviews ranged from 1–6 (median = 2). All residents received an initial assessment by SCHST, with only 18 requiring in-person geriatrician input. Analysis of 22 residents showed fewer unplanned admissions in the 6 months following MDT review, compared to 6 months before. (Pre-MDT median 2 (range 0–6); post-MDT 0 (0–9); p < 0.05). Conclusion Preliminary data suggest that the virtual Care Home MDT may reduce the number of unplanned hospital admissions of care home residents, with less than one quarter requiring face-to-face geriatrician reviews. The CH MDT has shown to provide effective delivery of care, whilst reducing workload and improving efficiency, through collaborative interdisciplinary working.

LINC-15. Sustaining multidisciplinary care of children with central nervous system tumors during the COVID-19 pandemic

INTRODUCTION: A multidisciplinary team (MDT) approach is essential for quality cancer care. Since 2019, we have conducted regular MDT meetings to discuss pediatric patients with central nervous system (CNS) tumors at the Philippine General Hospital. Because of COVID-19, an abrupt transition from in-person to virtual meetings became necessary. METHODS: We reviewed the proceedings of MDT meetings for pediatric CNS tumors from March 2020–December 2021. We identified the strategies and adaptations of our pediatric neuro-oncology group, and outlined recommendations for other institutions in low- and middle-income countries. RESULTS: Our pediatric neuro-oncology group conducted 18 virtual MDT meetings during the study period. Meetings were scheduled every last Tuesday of the month, with pediatric oncologists, neurologists, neurosurgeons, radiation oncologists, radiologists, and neuropathologists regularly attending. We invited other specialists as needed. In total, we had 135 case discussions for 79 unique patients, or about 8 patients per meeting. These included both inpatients (74%) and outpatients (26%). Ten patients received prior treatment elsewhere. At the time of the meeting, 86% were postoperative, 8% were preoperative, and 6% did not require surgery. Most (60%) had malignant CNS tumors and 15% had disseminated/leptomeningeal disease. Histopathologic diagnosis was obtained for 62 patients (79%). Concerns addressed were: formulating a treatment plan (88%), surveillance strategy (10%), and diagnostic workup (5%). DISCUSSION: Several factors contributed to the ease of online transition: (1) motivated care providers including a patient navigator, (2) fixed schedule, (3) institutional Zoom account for securing data privacy, and (4) availability of picture archiving and communication system (PACS) for neuroimaging. Challenges included: (1) delays due to internet connectivity, (2) Zoom fatigue and online distractions, and (3) risk for miscommunication or misunderstanding. Commitment of the entire neuro-oncology team is essential to ensure the delivery of best possible care for pediatric patients with CNS tumors.

Virtual Endocrinology Care Emphasizing Data-Driven Insights and Continuous Engagement and Its Impact on Glycemic Outcomes in Patients With Uncontrolled Diabetes: A Real-world Retrospective Case Series.

BackgroundSteady Health’s novel virtual care model incorporates continuous glucose monitoring (CGM) and a multidisciplinary approach to timely person-centered diabetes care.ObjectiveThis real-world retrospective case series explores the early glycemic outcomes of its patients with uncontrolled diabetes.MethodsAll patients of Steady Health who had an initial time in range (TIR) below 70% from their first 4 weeks of available CGM data and who had completed onboarding by February 2021 were included in this analysis. We compared the change in TIR, time below range, and average blood glucose from their first 4 weeks with their latest 4 weeks of available CGM data. Hemoglobin A1c (HbA1c) values at baseline and at the end of the study were also compared. Patients completed a questionnaire assessing their satisfaction with Steady Health’s intervention.ResultsA total of 53 patients (n=35, 66% with type 1 diabetes; n=44, 83% treated with insulin) were included in this analysis. This cohort had a median baseline TIR of 53.0% (IQR 40.9%, 61.7%) and saw a median change in TIR of +16.6% (IQR +6.0%, +27.9%; P<.001) over a median duration of care of 11 months, amounting to nearly 4 more hours spent between 70 to 180 mg/dL a day. Of the 27 patients who had both baseline and follow-up HbA1c results, their median baseline HbA1c was 8.6% (IQR 7.5%, 11.4%; 70 mmol/mol), while their median change in HbA1c was –1.2% (IQR –2.6%, –0.2%; P=.001). Importantly, these glycemic improvements were achieved with a median decrease in the time below range by –0.3% (IQR –1.1%, 0.0%; P<.001), regardless of whether patients were started on an automated insulin delivery system. A total of 40 (75.5%) patients improved TIR by ≥5%, and 27 (50.9%) achieved TIR≥70% by the end of the study. Glycemic improvements were greatest among patients with the lowest baseline TIR and those who collaborated most intensively with Steady Health’s clinicians. A total of 25 of these patients responded to a questionnaire assessing levels of satisfaction with their care, and all of them agreed that Steady Health had a positive impact on their diabetes management.ConclusionsOur findings suggest that patients with uncontrolled diabetes can achieve significant glycemic improvements by working with a virtual multidisciplinary care team that uses CGM to provide continuous clinical feedback and support.

Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021

IntroductionLung cancer is the leading cause of cancer death in Australia and has the highest cancer burden. Numerous reports describe variations in lung cancer care and outcomes across Australia. There...

Fifteen-minute consultation: An approach to the management of PIMS-TS in a district general hospital

The COVID-19 pandemic has caused significant disease across the globe but children seem to be much less affected than adults. Coincidentally with the first wave of the pandemic, a cluster...

1619P Transition to a virtual cancer multidisciplinary team meeting during the COVID-19 pandemic: Experience from a regional Irish Cancer Centre

The COVID-19 pandemic has dramatically changed how healthcare services are provided. In order to comply with public health recommendations, the multidisciplinary team (MDT) network of the South East Cancer Centre at University Hospital Waterford made a transition to a virtual meeting format. The centre coordinates a network of eight individual cancer MDTs with three satellite hospitals. Following adaptation to virtual format, remote participants now join by videoconference, telephone call, or by phone application.

Advent of the virtual multidisciplinary team meeting: do remote meetings work?

The multidisciplinary team (MDT) is key to the management and decision-making process for head and neck cancer. The sudden shift to virtual meetings due to the COVID-19 pandemic has been arguably the most dramatic change since inception of the MDT, and we know of no studies that have evaluated the head and neck MDT since this change in working. A preliminary questionnaire was designed and trialled, based on guidance on MDT qualities and measurable outcomes as per published national guidelines. A questionnaire was then distributed to all head and neck MDTs in the UK. We obtained 97 individual responses, from 27 units. Our results indicated that most clinicians (70.1%) felt that decision making was unchanged. Most (84.5%) also felt that technology resources were satisfactory and that some aspects of communication (viewing of images and slides) were as good or improved (76.3%). However, there were notable deficiencies with remote working. In particular, the majority of respondents perceived that engagement (43.9%), teamworking (69.1%), and training (47.7%) were worse since they moved to remote meetings. Our study suggests mixed opinions of virtual meetings. Our results demonstrate that despite remote working, head and neck MDT participants feel that they have largely been able to perform in most indicators. However, we should consider solutions to the perceived deficiencies in engagement, training, teamworking, and communication. To our knowledge, this is the first study to evaluate virtual head and neck MDT meetings, and the largest study of virtual MDTs and remote working within healthcare.

COVID-19 and cancer care: Embedding high-value changes into practice.

e18685 Background: Health systems pressures during the COVID-19 pandemic have driven adoption of innovative models of cancer care which optimise resources and protect patients and staff. High-value changes should be identified and retained to improve resilience of cancer care. Methods: Cancer Australia reviewed the literature and consulted with oncology health professionals, cancer control experts and consumers to examine elements of cancer care that changed during the pandemic. Strategies that support high-value care and improve cancer outcomes were identified. Results: The pandemic highlighted models of care which minimise risk of infection for cancer patients, whilst optimising outcomes. Of the numerous cancer care elements that we examined, this abstract focuses on key enhancements in digital health and treatment practices. Digital health helped maintain quality and continuity of cancer care during the pandemic. Use of telehealth (for clinical and supportive care), e-prescribing, and e-ordering of investigations increased, supported by national health system funding. Shared care between care settings was facilitated by rapid uptake of telehealth, e-health records, virtual multidisciplinary team meetings and secure messaging. Treatment modifications included hypofractionated radiotherapy, transitioning to oral chemotherapy where possible, and home-based palliative care. Lower thresholds adopted for use of G-CSF with chemotherapy to reduce risk of febrile neutropenia, aimed to decrease hospital admission rates. It is important to address barriers to uptake of these high value changes. For digital health, variations in patient access to telehealth and digital health literacy can be reduced through technical and coordination support (tailored to people with diverse needs and backgrounds), with telehealth consultations offered in safe, accessible clinical or community settings. Administrative and technical burdens in health service settings can be mitigated through sustainable IT infrastructure, standardised processes for appointments, and improving staff digital health capabilities. Patient anxiety regarding changes in care plans can be mitigated through transparent, accessible, and culturally appropriate communication, documentation and shared decision-making. Clinician uncertainty in calculating risks and benefits in treatment modifications can be addressed through evidence-based standardised care procedures and risk-stratification protocols. Conclusions: Many modifications to cancer care made during the pandemic can have long-term benefits and should become standard care, including enhancements in digital health and treatment practices. Strategies have been identified which enable these changes and address barriers to uptake at the system-, service-, practitioner-, and patient-level. Efforts to embed high value changes are required across the cancer control sector.

261 Using Technology to Improve Inpatient Surgical Lists

Abstract Introduction Every day in our surgical department; prior to our quality improvement project, Junior Doctors spent on average 3.26 clinical hours maintaining 5 surgical inpatient lists of different specialities with accessibility of lists rated as “neutral” based on a 5-point scale from difficult to easy. Our hospital previously had lists stored locally on designated computers causing recurrent difficulties in accessing and editing these lists. Method We used surveys sent to clinicians to collect data. Cycle 1: Surgical Assessment Units list on Microsoft Teams Cycle 2: Addition of surgical specialities and wards lists onto Microsoft Teams. Cycle 3 (current): expand the use of Microsoft Teams to other specialities. Results Utilising technology led to a 25% reduction in time spent on maintaining inpatient lists, to 2.46 hours a day, and an improvement in the accessibility of lists to “easy”. Across a year, this saves over 220 hours clinician hours which can be used towards patient care and training. Furthermore, use of Microsoft Teams has improved communication and patient care, in the form of virtual regional Multi-Disciplinary Team meetings and research projects. Conclusions Microsoft Teams is currently free to all NHS organisations in England so there is potential for these efficiency savings to be replicated nationwide.

Will virtual multidisciplinary team meetings become the norm for musculoskeletal oncology care following the COVID-19 pandemic? - experience from a tertiary sarcoma centre

BackgroundLike with all cancers, multidisciplinary team (MDT) meetings are the norm in bone and soft tissue tumour (BST) management too. Problem in attendance of specialists due to geographical location is the one of the key barriers to effective functioning of MDTs. To overcome this problem, virtual MDTs involving videoconferencing or telemedicine have been proposed, but however this has been seldom used and tested. The COVID-19 pandemic forced the implementation of virtual MDTs in the Oxford sarcoma service in order to maintain normal service provision. We conducted a survey among the participants to evaluate its efficacy.MethodsAn online questionnaire comprising of 24 questions organised into 4 sections was circulated among all participants of the MDT after completion of 8 virtual MDTs. Opinions were sought comparing virtual MDTs to the conventional face-to-face MDTs on various aspects. A total of 36 responses were received and were evaluated.Results72.8% were satisfied with the depth of discussion in virtual MDTs and 83.3% felt that the decision-making in diagnosis had not changed following the switch from face-to-face MDTs. About 86% reported to have all essential patient data was available to make decisions and 88.9% were satisfied with the time for discussion of patient issues over virtual platform. Three-fourths of the participants were satisfied (36.1% - highly satisfied; 38.9% - moderately satisfied) with virtual MDTs and 55.6% of them were happy to attend MDTs only by the virtual platform in the future. Regarding future, 77.8% of the participants opined that virtual MDTs would be the future of cancer care and an overwhelming majority (91.7%) felt that the present exercise would serve as a precursor to global MDTs involving specialists from abroad in the future.ConclusionOur study shows that the forced switch to virtual MDTs in sarcoma care following the unprecedented COVID-19 pandemic to be a viable and effective alternative to conventional face-to-face MDTs. With effective and efficient software in place, virtual MDTs would also facilitate in forming extended MDTs in seeking opinions on complex cases from specialists abroad and can expand cancer care globally.