Multidisciplinary first-day consultation accelerates diagnostic procedures and throughput times of patients in a head-and-neck cancer care pathway, a mixed method study

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.

Prosthodontic rehabilitation of head and neck cancer patients—Challenges and new developments

“…Multidisciplinary first-day consultation intents to shorten time between diagnosis and treatment of oral cancer (van Huizen et al, 2018).…”

“…Multidisciplinary first‐day consultation intents to shorten time between diagnosis and treatment of oral cancer (van Huizen et al., 2018). Maxillofacial prosthodontics should be included in the multidisciplinary first‐day consultation.…”

Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation

“…The efficiency of the MDTs is important for decision-making and care pathway management. The centre’s MDT regarding diagnostics and treatment involves more than nine disciplines (details presented elsewhere) 13. The teams of centre and partner meet face-to-face three times a year, where governance, guidelines and research projects are discussed.…”

Estimation of Time Factors in Radiotherapy for Head and Neck Cancer with Auto-regressive Integrated Moving Average Model After Dashboard Launching

“…Toustrup et al revealed that a fast track strategy with a full-time case manager, multidisciplinary tumor board, and higher priority for head and neck cancer examination slots could dramatically shorten the time between the initial visit and the start of curative treatment, from 57 to 29 days [25]. Van Huizen et al found that multidisciplinary rst-day consultation might shorten the days needed for diagnostic procedures and the days to the start of the rst treatment in patients with head and neck cancer [26]. They concluded that the introduction of a multidisciplinary rst-day consultation, including specialists of different departments and the use of coordinating nurses, could improve treatment quality.…”