1. The MDT Process: BSUH and WSHT (Worthing) M.F. Caruana (on behalf of all the team)

2. Good starting point. Good starting point. No information on: No information on: Morbidity Morbidity Efficiency Efficiency Cost. Cost. Sustainability. Sustainability.

3. Objectives: Objectives: Inclusive MDT process. Inclusive MDT process. All patients put forward for elective AAA treatment. All patients put forward for elective AAA treatment. All relevant HC workers. All relevant HC workers. Sufficient detail Sufficient detail Anatomy considered at work station. Anatomy considered at work station. Sufficient information about patients physiology and condition. Sufficient information about patients physiology and condition. Proper documentation and patient tracking. Proper documentation and patient tracking. Need for MDT coordinator. Need for MDT coordinator. Patient communication safeguarded. Patient communication safeguarded. Practical, sustainable and equitable (pts and carers). Practical, sustainable and equitable (pts and carers). Acceptable to all as centralization proceeds. Acceptable to all as centralization proceeds.

4. Currently: BSUH and Worthing (WSHT) working as one unit. Centralization into BSUH next major shift. Centralization into BSUH next major shift.

5. Where are we and what can we do better ? Simple audits Simple audits 20 AAAs recently treated at BSUH. 20 AAAs recently treated at BSUH. Last 20 AAAs worked up in Worthing for Rx in BSUH. Last 20 AAAs worked up in Worthing for Rx in BSUH. Issues identified. Issues identified. From above. From above. From personal experience. From personal experience. Anaesthetists, surgeons, Specialist nurse etc. Anaesthetists, surgeons, Specialist nurse etc. Solutions proposed. Solutions proposed.

6. Issues identified: Worthing patients: Worthing patients: Separate work-up pathway involving SPAM/CPX clinic Separate work-up pathway involving SPAM/CPX clinic Mean 8 week wait for appointment. Mean 8 week wait for appointment. Sometimes pt sent for MIBI scan by surgeon. Sometimes pt sent for MIBI scan by surgeon. Not led by current vascular anaesthetist. Not led by current vascular anaesthetist. Some pts also referred to BSUH pre-assessment: Some pts also referred to BSUH pre-assessment: Unnecessary journeys identified. Unnecessary journeys identified. All pts presented at MDM but not all information available. All pts presented at MDM but not all information available. Paper barrier between two trusts. Paper barrier between two trusts. Important information not always available. Important information not always available.

7. Issues identified: BSUH patients: BSUH patients: Fairly standard work-up includes Echo and MIBI scan Fairly standard work-up includes Echo and MIBI scan Not all pts go through current MDM. Not all pts go through current MDM. Not all pts go through vascular anaesthetic led pre-assessment clinic. (clinic currently not formally funded). Not all pts go through vascular anaesthetic led pre-assessment clinic. (clinic currently not formally funded). Difficult to track some patients. Difficult to track some patients. Significant delay with some patients. Significant delay with some patients.

8. Common issues: No documentation of early pre-op consent for NVD. No documentation of early pre-op consent for NVD. No documentation of any written information given. No documentation of any written information given. Widely varying complexity. Widely varying complexity. Delays from work-up to Rx Delays from work-up to Rx Referral to cardiology. Referral to cardiology. Capacity issues masked by inefficient work-up. Capacity issues masked by inefficient work-up.

9. Proposed solutions: Early vascular anaesthetic involvement. 1) Secure funding for BSUH VA led clinic sessions (Done). 2) WSHT model will depend on the centralization process. Simple integrated care pathway. 1) Common to all patients irrespective of Trust. 2) Started at first anaesthetic assessment. 3) Triggers proper communication.

10. Proposed solutions: Appointment of MDT coordinator. (Done) 1) Patient tracking 2) Data collection 3) Audit. Separate aortic MDM. 1) CTs reviewed at work station with sizing at same sitting. 2) Anaesthetic report present at the meeting.

13. The next steps: The next steps: Pilot the above. Pilot the above. Marry it into an ICP. Marry it into an ICP. Get all above in place. Get all above in place. Simplify and standardize rest of paperwork. Simplify and standardize rest of paperwork. Better information sheets. Better information sheets. Better coordination and data collection. Better coordination and data collection. Simplify the patient journey. Simplify the patient journey.