Streamlining the local Multiple Sclerosis Disease Modifying Therapy MDT

Write Up

In 2018, a departmental audit identified delays in commencing disease modifying therapy following the diagnosis of Multiple Sclerosis (MS). We also acknowledged delays in waiting time from initial referral to outpatient review.

To streamline this patient journey, we developed a Quality Improvement (QI) project to sequentially address each step.

To begin, we focussed on the MS DMT multi-disciplinary team (MDT) meeting. Our initial data collection analysed the MDT between August and November 2019. During this period, 15 patients (range 3 – 5 per month) were discussed at MDT with a mean waiting time of 82 days (range 45 – 136 days).

The original MS MDT consisted of 5 spaces in the monthly departmental meeting, supported by a neuroradiologist. We created an additional MDT, allowing a further 10 patients to be discussed each month. We also developed a proforma for referral to this MDT, ensuring that the relevant information such as relapse history, imaging, previous treatments, EDSS and family planning status were known.

We did encounter some challenges, namely the COVID-19 pandemic. This necessitated the MDT move to an online platform and therefore Microsoft Teams was adopted. This allowed members of the MDT to present and discuss patients remotely, including during periods of self-isolation or shielding. Indeed, the additional capacity also aided timely discussion of highly-efficacious DMT decisions based upon the most recent guidance available.

After 12 months following our original data collection, we repeated this process (see Tab.1) and identified a significant increase in the number of patients being discussed (see Fig.1) to 42 patients with a reduced delay in discussion (mean 24 days – range 3 – 98 days). Referrals were all supported by the MDT proforma and therefore essential information was always present to facilitate meaningful discussion.