title: Reducing referral-to-treatment waiting times in cancer patients using a multidisciplinary database.
abstract: BACKGROUND
  Modern delivery of cancer care through patient-centred multidisciplinary teams (MDT) has improved survival. This approach, however, requires effective on-going co-ordination between multiple specialties and resources and can present formidable organisational challenges. The aim of this study was to improve the efficiency of the MDT process for head and neck cancer.
  
  
  METHODS
  A systems analysis of the MDT process was undertaken to identify bottlenecks delaying treatment planning. The MDT process was then audited. A revised process was developed and an Intranet-based data management solution was designed and implemented. The MDT process was re-evaluated to complete the audit cycle.
  
  
  RESULTS
  We designed and implemented a trust-wide menu-driven database with interfaces for registering and tracking patients, and automated worklists for pathology and radiology. We audited our MDT for 11 and 10 weeks before and following the introduction of the database, with 226 and 187 patients being discussed during each period. The database significantly improved cross-specialtity co-ordination, leading to a highly significant reduction in the number of patients whose treatment planning was delayed due to unavailability of adjunctive investigations (P < 0.001). This improved the overall efficiency of the MDT by 60%.
  
  
  CONCLUSIONS
  The NHS Cancer Plan aspires to reduce the referral-to-treatment time to 1 month. We have shown that a simple, trust-wide database reduces treatment planning delays in a sizeable proportion of head and neck cancer patients with minimal resource implications. This approach could easily be applied in other MDT meetings.
authors.affiliation: Department of Ear Nose and Throat Surgery, Charing Cross Hospital, London, UK. RN@cantab.net
authors.forename: S A R
authors.initials: SA
authors.lastname: Nouraei
authors.forename: J
authors.initials: J
authors.lastname: Philpott
authors.forename: S M
authors.initials: SM
authors.lastname: Nouraei
authors.forename: D C K
authors.initials: DC
authors.lastname: Maude
authors.forename: G S
authors.initials: GS
authors.lastname: Sandhu
authors.forename: A
authors.initials: A
authors.lastname: Sandison
authors.forename: P M
authors.initials: PM
authors.lastname: Clarke
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D008485:Medical Audit; D009369:Neoplasms / Q000628:therapy*; D010348:Patient Care Team; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013813:Therapy, Computer-Assisted / Q000379:methods; D014850:Waiting Lists