Streamlining the management of patients with problematic wounds: must a multidisciplinary team formulate all patient...

The importance of the management of patients with problem wounds by multidisciplinary teams (MDTs) is uniformly emphasized. The aim of this study was to examine the impact of the review of individual cases by MDT on the management plan proposed by the Surgical Wound Care Specialist (SWCS).

Trained "field" nurse specialists assessed problem wound patients in ambulatory care settings followed by the evaluation by the SWCS. The initial management plan (IMP), including a statement regarding the probability of the plan change by the MDT, was formulated by a SWCS based on evaluation of electronically transmitted patient record (including photographs) by a "field" nurse, followed by direct face-to-face evaluation by the same SWCS. Subsequently, the MDT reviewed individual cases formulating the final management plan (FMP). Over a 24-month period (2005-2006) the MDT reviewed clinical data for 124 new patients and a collective decision about the FMP was made.

As the result of the MDT discussion, 3 of the 124 cases had clinical management changes (clinically important disagreement) and 5 trivial assessment changes. All cases were identified (among 4 others) by SWCS as potential "change cases" before the MDT meeting.

The MDT review made no difference in the case management plan in 93.6%, with significant changes recommended only in 2.4% of cases. In consideration of a potential management plan change the SWCS correctly identified cases requiring discussion, which indicates that a selective rather than blanket approach would be effective. This has the potential to expedite patient care and to reduce costs without affecting patient care.