Introduction Cardiovascular complications are one of the major causes of mortality and morbidity perioperatively. Anaesthetic assessment involving a cardiologist reduces peri-operative cardiovascular complications; however assessment in the outpatient setting can incur significant waiting times. A weekly cardiology, anaesthetic and pre-assessment multidisciplinary team (MDT) meeting was introduced with the aim of reducing the time taken to optimise patients for anaesthesia and reduce the burden on the cardiology outpatient waiting list.
Methods A weekly MDT was commenced in October 2015, discussing patients who posed a cardiovascular concern to the pre-assessment unit. Outcomes measured included time taken to be optimised for anaesthesia, need for cardiology outpatient review and investigations required. A comparison was made between those seen in pre-assessment clinic, prior to the initiation of the MDT (retrospective) and those discussed in MDT (prospective). A six month period, October-April, one year apart was studied. The data was collected from an electronic Pre-assessment system designed in our institution.
Results In the prospective period, 80 patients were discussed, with an average of 10 min being spent discussing each patient. There was a 10% reduction in number of investigation performed. The number of patients requiring formal cardiology outpatient review was significantly reduced in the prospective group (10/80) compared to the retrospective group (50/50) (p=0.0001). The time taken to optimise patients for anaesthesia was reduced by 76 days (p=0.0002) by introducing the MDT. This 49% reduction was achieved without an increase in cardiac testing.
Conclusions We have shown that the vast majority of patients deemed to require preoperative cardiac review can be dealt with efficiently through an MDT meeting, with a resulting reduction in the number of outpatient cardiology reviews and in the optimisation time for anaesthesia. The reduction of 70 patients requiring outpatient cardiology opinion equates to 11 fewer cardiology clinics in a 6 month period; the time taken per patient is shorter in the MDT setting. The 10% reduction in the number of cardiac investigations requested in the prospective group was contrary to one of our hypotheses. Four patients were entered into the aortic surveillance clinic without their anaesthesia being delayed, as valve surgery was not needed. Cardiology outpatient efficiency was improved as patients were referred with all appropriate investigations already performed. The MDT at the Royal Glamorgan Hospital has changed how the pre-assessment unit obtain a cardiology opinion with demonstrable quality improvements via collaboration between cardiologists and anaesthetists, with improved patient care.
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