Two-step Multidisciplinary Clinic (2-Step MDC) in Local Health Integration Network 4 (LHIN4) - use of MacLive Web Conferencing for Surgeon Education

Session Format Presentation
Author(s) V. Grubac, M. Cadeddu, A. Coates, S. Forbes, S. Kelly, W. Stephen, S. Tsai, M. Simunovic. Surgery/McMaster University
Session Abstract

MDCs involve review of individual patient cases and in Ontario are encouraged for all patients with colorectal cancer. At MDCs relevant specialists exchange information and achieve treatment recommendation consensus (i.e., group learning). However, in LHIN4 there are annually 850 colorectal surgery patients, and thus a colorectal MDC for every patient is logistically problematic. In response we designed the 2-Step MDC to promote learning among surgeons.

For step I of the 2-Step MDC, through email a referring surgeon completes an intake form outlining patient and tumour features and the initial treatment plan - straight to surgery or pre-operative radiation. Through a MacLive Web Conferencing platform the form and radiology tests are reviewed concurrently by the referring surgeon and a Juravinski Hospital surgeon. For step II, consensus is achieved - local surgery, radiation referral, or referral to a Juravinski surgeon. We report initial results with a focus on the ability of the 2-Step MDC to change initial management plans of referring surgeons (i.e., promote learning).

Fifteen non-Juravinski hospital surgeons referred and reviewed 40 cases from September 2011 to February 2013. Initial treatment plans were changed for 28 of 40 patients (70%) - 11 patients went straight to surgery, 6 patients were sent for radiation treatment, 1 patient was referred to a Juravinski surgeon, and 10 patients needed more investigations. Effective video and audio links required ongoing technology support.

For patients with colorectal cancer in a large region, a 2-Step MDC using a MacLive WebConferencing platform promoted learning among surgeons.
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