Delayed decisions: The patient safety risk hidden inside MDTs

Multi-Disciplinary Teams (MDTs) were at the core of the 2000 NHS Cancer Plan and have become a cornerstone of treatment planning. Once hailed as the “gold standard” for cancer management, though, MDTs are now under strain. Over the years, the number of referrals have gone up drastically and meeting times have increased to up to four hours, while the volume of cases has rocketed to up to 90 per session, with a third of these cases being rolled over from the week before. That means the time spent on each patient has shortened.

Cancer Research UK reports that discussions per patient usually last less than two minutes, and it’s no surprise that those towards the end of the meeting are shorter and of worse quality due to participant fatigue.[1] Far too often, patients are pushed back to a later MDT due to lack of data to discuss their case. Administrative issues negatively impact patient safety by causing delays in patients’ treatment. Hospitals now devise various measures to streamline cases to avoid unnecessary discussion – including the use of AI to sort cases out that don’t need formal discussion from the more complex ones, which need multi-disciplinary input.

In its new Cancer Plan for England, the NHS sets out a 10-year strategy to combat rising cancer incidence in an ageing population with the objective of ensuring that three in four cancer patients survive for five years or more by 2035.[2] As part of its new plan, the NHS Cancer Plan has commissioned the Royal College of Radiologists (RCR) with a formal review of opportunities to modernise MDTs. The report is due in the summer of 2026.

The data problem inside MDTs

Better data management and sharing are key to improving MDTs. If critical data is missing at the time of discussion, patients cannot be properly assessed.

Today, clinicians typically complete a referral in a digital file, email it to the MDT or tumour board, who then manually copy every field into a spreadsheet to create a list of new cases to discuss. While some teams build bespoke templates to give clinicians the ability to add patients and relevant information, these also have limitations. Custom paper forms are not tailored to each specialty, and they often do not reflect the true complexity of each case. To bridge this data gap, research has shown that many teams use the MDT to input information live, sacrificing even more decision-making space.

Freeing up decision-making time

There is a clear need for automation in a service that requires so much manual input. While current manual MDT patient lists are paper based, some MDT coordinators may prioritise the discussion of more complex cases first, but most do not and simply create the list in order of receipt. What happens when the right specialist is not able to attend? The case gets rolled over.

What we require are systems where asynchronous input from specialists who can look at the case in detail at their own pace before the MDT meeting and to contribute their opinion without being present. This one feature alone could speed up decision-making and improve patient outcomes.

Bridging format and key information gaps

Simple solutions such as an automated MDT list builder that asks the important questions and allows freeform text or voice dictation to be inserted into a form would improve information sharing, overcoming the limitations of templated paper forms. Similarly, pre-generated summaries or systems that flag missing and incomplete test results can radically improve MDT efficiency.

There are at least two other areas where MDTs are lacking. On one front, standardised forms and inputs cannot adequately represent the voice of the patients, to highlight personal preferences such as a refusal of surgery. Providing a space to record patient input is key to improving adherence to treatment and maintaining engagement, especially over long periods of treatment.

On the other, current systems are not storing information from MDTs in a digital format to enable real world audit of clinical practice. A typical teaching hospital might discuss 3,000 cases of breast cancer each year, and yet there is no discernible output of simple data such as patient outcomes, or re-evaluation of breast cancer prognosis tools. In fact, there is so much data going to waste, it would be hard to identify the impact of certain interventions even if we wanted to, as it would require a manual trawling of patient records.

A pragmatic approach

Many hospitals have tried to achieve the required improvements through automation and integration of their Electronic Patient Record (EPR) systems, but the constraints in that area have proven insurmountable. Overhauling existing systems demands significant capital investment, lengthy implementation timescales, and a level of internal resource that most Trusts simply do not have.

Further, accurate co-morbidity, past medical history, and current medications tend to live in GP records, not hospital systems, leaving an enormous information gap. Most EPRs also remain rigid in what formats they can accept, typically limited to PDF imports, which places an immediate cap on what can be shared.

A more pragmatic approach is to work around these limitations. Products where clinicians copy and paste images of reports, upload blood test results, or even share short video clips can put the right information in front of the right people without requiring extensive technical integration. This kind of flexibility could also be very relevant to Neighbourhood MDTs, as it finally begins to bridge the longstanding divide between Primary and Secondary care, Acute Services, Community Provision, Mental Health, and Social Care.

MDTs remain one of the most powerful frameworks in cancer care, but their potential is being eroded by a lack of support systems. Modernising the underlying infrastructure that helps MDTs run smoothly does not require an expensive EPR replacement programme. It requires flexible tools that work with the clinical reality on the ground, joining up data across care settings and giving clinicians the complete picture they need to make decisions confidently and quickly.

The RCR review this summer offers a timely stimulus to focus on the systems required to return MDTs to their original vision.

References

[1] Cancer Research UK, Meeting the Patient’s needs [PDF].

[2] Gov.co.uk, The National Cancer Plan for England: delivering world class cancer care.

About the author

A Professor of Medicine at UCL, an experienced clinician working in the Royal Free London as a hepatologist, acute physician, and a clinical pharmacologist, Professor Kevin Moore is also an author of the Oxford Handbook of Acute Medicine with ~ 200,000 sold copies. As a clinician, he has experienced the many frustrations of manual workflows, which lead to patients becoming lost in the system, either in referral or long-term follow-up. During the COVID-19 pandemic, the problems faced by the many patients under long-term surveillance became acutely manifest, leading him to tackle the technological challenges impacting patient safety head-on by co-founding Salutare.