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Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital
C Rolland-Debord1, A Canellas2, P Choinier2
1Service des explorations fonctionnelles de la respiration de l'exercice et de la dyspnée, hôpital Tenon, Sorbonne université, AP-HP, Paris, France.
Insights
Daily multidisciplinary team (MDT) meetings for COVID-19 improved patient care by standardizing treatment and increasing trial enrollment. These COVID-19 MDT meetings ensured adherence to best practices during the pandemic.
Area of Science:
- Infectious Diseases
- Public Health
- Critical Care Medicine
Background:
- The COVID-19 pandemic necessitated rapid adaptation of healthcare practices.
- Standardized treatment protocols were lacking in the early stages of the pandemic.
- Multidisciplinary team (MDT) meetings emerged as a crucial tool for managing complex COVID-19 cases.
Purpose of the Study:
- To describe the implementation of daily MDT meetings for COVID-19 patients.
- To evaluate the impact of these MDT meetings on clinical practice and patient outcomes.
- To assess adherence to MDT meeting protocols.
Main Methods:
- A retrospective review of hospitalized COVID-19 patients from March 31 to April 15, 2020.
- Inclusion criteria for MDT presentation: confirmed/suspected COVID-19 requiring hospitalization and non-standard treatment.
- Comparison of treatment and outcomes between patients presented at MDT meetings and those not, supplemented by a staff survey.
Main Results:
- Of 318 COVID-19 patients, 91 met MDT criteria; 50 were presented at meetings.
- MDT-presented patients had higher rates of complementary exploration and cohort inclusion (P=0.03, P=0.0007).
- Patients not presented at MDT meetings received more hydrocortisone hemisuccinate (P=0.007), and technical issues limited MDT participation.
Conclusions:
- MDT meetings established a unified standard of care for COVID-19.
- These meetings helped avoid unproven treatments and facilitated patient enrollment in clinical trials.
- Despite challenges, MDT meetings proved valuable in managing the pandemic's complexities.
Objectives:
In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice.
Methods:
All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey.
Results:
In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues.
Conclusions:
Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.
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