Introduction Infective endocarditis is a complex area of cardiology, with a highly variable clinical history and frequent atypical presentations. Despite advances in management it remains associated with a high mortality and severe complications. Most patients are diagnosed and managed outside cardiothoracic centres, either for medical management only, or prior to surgical treatment. These patients may still benefit from a co-ordinated approach to their care, and early input from a surgical team.ESC guidelines recommend the formation of an endocarditis team in reference centres to manage complex cases and advise on non-complicated cases in other centres. This multidisciplinary approach has been shown to significantly reduce 1 year mortality. We created an endocarditis team within a non-surgical centre, with remote input from a Cardiothoracic Surgeon, to aim to improve levels of patient care and outcomes.
Methods A weekly multidisciplinary meeting (MDM) for review of patients with presumed endocarditis was created. Attendees were invited from cardiology, microbiology, elderly care and acute medicine, with cardiothoracic input from the regional surgical centre. Meetings were held via Microsoft Teams to allow input between the hospital sites involved. Imaging studies could be viewed by all. Attendance was open to the cardiology directorate including junior doctors, cardiac physiologists and nurses for on-going education and multidisciplinary input.
An electronic referral form ensured documentation of patient history, Duke score, imaging and microbiology investigations and current treatment. This was updated weekly with outcomes and recommendations from the MDM and appeared on the electronic patient record.
After 3 months, a questionnaire was circulated to assess attendees’ feelings about the meeting and areas for improvement.
Results Over 3 months, 16 patients were referred to the meeting for review. Eleven were treated as endocarditis; after review the remaining 5 were felt to have an alternative diagnosis. Five patients were transferred for surgery or device explant. Others were either not suitable for surgical intervention or did not require surgery. In 11 (68%) cases the MDM added to the patient management plan or changed diagnosis.Meetings had an average of 18 attendees across specialties and grades (figure 1). The majority felt very satisfied with the workings of the MDM (figure 2). Positive aspects highlighted included the multidisciplinary input and educational aspects of the MDM. The meeting was felt to improve knowledge of, and confidence in, management of the condition (table 1). Comments for changes or improvements were predominantly related to time (2) and duration (3) of the meeting.
Conclusion We have successfully introduced an effective, well-attended, weekly MDM for the management of endocarditis, resulting in increased confidence in patient management, and the ability to coordinate investigation and on-going care for these patients.
Conflict of Interest na
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.