What is an MDT?
An MDT is a multidisciplinary team. A team of health care workers who are members of different disciplines, each providing specific services to the patient. The team members independently treat various issues a patient may have, focusing on the issues in which they specialise
The activities of the team are brought together using a care plan. This co-ordinates their services and gets the team working together towards a specific set of goals. Sometimes the person has a key worker, who becomes the main point of contact for the person.
The benefits of having an MDT are that patients have access to a range of different specialists who can work together to provide the best possible care. It also helps to improve communication between different members of the healthcare team and can make sure that everyone is working towards the same goal.
If you are part of an MDT, it is important to remember that each team member has their own area of expertise. Respect each other’s opinions and work together to provide the best possible care for the patient.
Finally, the methods and quality of communcation that is needed for effective handover should also be implemented within multidisciplinary teams.
Why do we need an MDT?
An MDT is required in order to provide the best possible care for patients. By having a team of specialists with different knowledge and skillsets working together, we can address all of the patient’s needs in a coordinated and holistic manner. This is particularly important in complex cases where a single specialist may not have all the knowledge required to make an accurate diagnosis or provide appropriate treatment.
An MDT can also help to avoid potential conflict between specialists who may have different opinions on the best course of treatment for a patient. By working as a team, all members of the MDT can share their ideas and come to a consensus that is in the best interests of the patient.
NHS Core Development Elements of MDT Working
The below elements form the key aspects of MDTs within the NHS in the UK.
Continuum
The continuum sets out descriptions of different types of care delivery teams functioning and describes how these change as multidisciplinary team working deepens and extends throughout the team.
Common Principles
To be effective, every team needs core principles that to adhere their functions, practice and delivery together.
Commissioning
Focusing on innovative & effective use and distribution of funds to commission services for a multidisciplinary team.
Who attends MDT meetings?
The following is an example of core members of an MDT that are required to attend meetings every week or fortnight. This will naturally change between specialities and specific patient cases.
- Consultants
- Specialist Registrars
- Radiologists
- Histopathologists
- Oncologists
- Advanced Nurse Practitioners
- MDT Coordinator
Other members of the MDT may not necessarily attend meetings, but are available to provide advice to the MDT and additional care to patients. In the case of oncology team, further team members could include:
- Specialist Palliative Care Service
- Surgical Services
- Blood and Marrow Transplant (BMT) Service
- Immunologists
- Clinical Psychologist/Psychiatrist
- Occupational Therapist
- Dietitian
- Physiotherapist
- Cancer Pharmacist
- Teenage and Young Adult Cancer Service
Multidisciplinary team member roles
Doctors
Doctors are an essential part of an mdt, as they are responsible for diagnosing and treating the patient’s illness or injury. They work with other members of the team to develop a treatment plan that meets the patient’s needs. Doctors can also provide leadership and guidance to the rest of the team, and ensure that the mdt is working effectively towards the best possible outcomes for the patient.
Nurses
Nurses are potentially more exposed to a patient’s emotional and psychosocial needs whilst providing care to the patient. They work with other members of the team to ensure that the MDT is providing holistic care to the patient. Nurses can also provide leadership and guidance to the rest of the team, and ensure that the MDT is working effectively towards the best possible outcomes for the patient.
Occupational therapists
Occupational therapists are responsible for helping patients to regain their independence and participate in everyday activities. They work with patients who have physical or mental disabilities, and help them to adapt to their new situation. OTs can provide support in areas such as:
- Rehabilitation
- Adapting home environments
- Helping with activities of daily living
- Working on goals related to employment, education, or leisure
Social workers
Social workers are responsible for helping patients to cope with the emotional and social problems that can accompany a long-term illness or disability. They provide support and guidance to patients and their families, and can help them to access services such as financial assistance or counselling. Social workers can also help to arrange care for the patient when they are no longer able to live at home.
What is a care coordinator?
A care coordinator is an NHS professional who co-ordinates the care of patients within multidisciplinary teams. They ensure that all the different members of the team are working together towards the same goal and that the patient has a key worker who becomes their main point of contact. Care coordinators play an important role in ensuring that patients receive the best possible care.
An effective MDT framework
Developed by the Organisational Development Support team at Bradford, Airedale, Wharfedale and Craven, the purpose of the framework is to create a clear and consistent model of what good looks like for effective MDTs.
It includes the following indicators of effectiveness:
1. Execution of the task (clarity of purpose, outcomes, process)
2. MDT structure and membership
3. Meeting management
4. Roles and functions
5. Integrated Care Processes
6. Debate and discussion
7. Trust within the team
8. Individual/collective agreement
9. Acceptance of accountability
10. Attention to results
Unidisciplinary vs Transdicliplinary
Unidisciplinary teams are those in which all members share a single discipline. This can be a strength, as everyone is on the same page with regards to understanding the patient’s condition. However, it can also be a weakness, as members may not have the expertise to provide holistic care.
Transdisciplinary teams are those in which members from different disciplines work together. This can be a strength, as members can share their knowledge and expertise to provide holistic care. However, it can also be a weakness, as members may not always agree on the best course of action for the patient.
While MDTs are in their foundation made up of multiple inputs, it is incorrect to say that the transdisciplinary teams are the desired state to aim for. As an example, complex psychiatric patients with social concerns would benefit from a wide range of disciplines while an acutely unwell surgical patient may benefit most from the input of one or two specialities.
The 4 models within the MDT continuum model are the following:
1. Unidisciplinary team
2. Multidisciplinary team (core team)
3. Transdisciplinary team
4. Multidisciplinary team with patient at the centre
The key difference between 3 and the distribution found in 2 and 4 is the breakdown of formal roles in transdisciplinary teams. The roles within the team are redesigned to make the optimum use of team skills and knowledge. Assessments may be carried out by different disciplines working together with insights from one discipline informing the assessments of another; the ‘whole will be greater than the sum of the parts’.
How to improve multidisciplinary teams
The primary driver of MDT function is to ensure that all team members are properly trained in their respective fields. This can be done through continuing education and regular meetings where everyone can share their knowledge and expertise.
MDT success is predicated on the quality of communication. This includes not only being able to communicate effectively with one another, but also with the patient and their family. Maintaining a homogenous approach to discussion and recording of outcomes is also vital.
Both of these concerns can today be supported by the use of digital tools such as CAREFUL.
Finally, it is important to create an environment that is supportive and collaborative. Team members should feel comfortable sharing their ideas and asking for help when they need it.
Breakdown of this good working environment led to disasters such as the failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The Francis report makes 290 recommendations which can be read in summary [here.]
Care planning for effective patient outcomes
One of the best ways to improve patient outcomes with care planning is to make sure that everyone on the team is working towards the same goal. This can be done by creating a care plan that outlines the specific goals of the team, and by making sure that all team members are aware of the plan.
Another way to improve patient outcomes is to ensure that communication between team members is effective. This can be done by using clear and concise communication methods, and by making sure that everyone has access to the same information.
Finally, it is important to remember that each team member has their own area of expertise. Respect each other’s opinions and work together to provide the best possible care for the patient.
Patient centered care
Patient centered care is a way of providing care that puts the patient at the centre of all decisions. It involves taking into account the patient’s wishes and preferences, and ensuring that they are involved in all aspects of their care.
This is an important ethic to bring into the MDT meeting as the patient is not present and crucial decisions are constantly being weighed and evaluated.
By providing patient centered care, healthcare professionals are able to build a relationship of trust with the patient, which can help to improve medical and patient experience outcomes.
It is also important for patients to feel like they are in control of their own care, and that they have a say in what happens. A lack of perceived control and autonomy increases the risk of feelings of hopelessness and depression.
