MDT cheat sheet

An MDT comprises members from at least two clinical disciplines who meet regularly, discuss shared patients, and record collective decisions with named actions.

Core governance documents are terms of reference, membership list, chair and deputy, quorum rule, decision rule, escalation route, confidentiality statement, and annual review date.

Quorum rule: a meeting can decide only when designated core disciplines are represented; absent members' views are obtained before the meeting and minuted.

Decision rule: consensus first; if unresolved, the chair records the options and escalates to the clinical director or divisional governance within an agreed timeframe.

Standing agenda: apologies, conflicts of interest, previous actions, new referrals, complex cases, safety and quality items, actions and owners.

Accountability: the team's recommendation is collective, but each registered clinician remains accountable for their own acts and omissions within their scope.

Information sharing at MDT is limited to what is necessary for direct care; patients are informed that their case will be discussed and may object.

Service-level governance reports cover attendance, case volume, time to decision, action completion, and guideline concordance.

Role clarity uses RACI: Responsible does the work, Accountable owns the outcome, Consulted gives input, Informed receives updates; each task has one accountable owner.

Scope of practice is set by registration, training, competence, employer policy, and jurisdiction; reserved acts cannot be delegated to unqualified staff.

Delegation is valid only when the delegator assesses competence, the delegate accepts, and the delegator retains accountability for the episode.

Chair responsibilities: timekeeping, inviting all disciplines to contribute, summarizing decisions, and confirming action owners and deadlines.

Coordinator responsibilities: triage referrals, circulate the minimum dataset, prepare the agenda, record decisions, and track actions between meetings.

Professional boundaries: dual relationships, personal favours, and financial interests that could bias care are declared and managed.

Escalation of competence: a clinician who lacks competence for a requested task refers to a colleague with the relevant scope rather than proceeding.

Referral criteria specify inclusion, exclusion, required investigations, consent status, and urgency category; incomplete referrals are returned to the referrer with a named contact.

Minimum dataset for presentation: demographics, diagnosis and stage, imaging and histology, comorbidities, performance status, current medication, patient goals, and the clinical question.

Case triage categories are urgent (same or next meeting), new routine, complex review, and follow-up; each category has a maximum time to discussion.

SBAR presentation: Situation, Background, Assessment, Recommendation; the presenter states the specific decision requested in the first 30 seconds.

Case circulation: written summaries are distributed at least 24 to 48 hours before the meeting; late or incomplete cases are flagged for deferral.

Presentation time-box is typically 3 to 5 minutes per case; discussion focuses on the decision requested and documented options.

Deferred cases require a named owner, the missing information, and a return date; the deferral reason is minuted.

Patient preferences, including refusal of treatment and goals of care, are recorded in the referral and read aloud at presentation.

PICO frames a searchable question: Population, Intervention, Comparator, Outcome; it precedes evidence retrieval and appraisal.

Evidence hierarchy from high to low: systematic reviews and meta-analyses, randomized controlled trials, cohort studies, case-control studies, case series, expert opinion.

GRADE rates certainty as high, moderate, low, or very low; recommendations are strong or conditional based on benefits, harms, values, and resource use.

Guideline concordance is the default; deviations require a documented patient-specific rationale and are reviewed at audit.

Shared decision-making requires discussion of options, benefits, harms, uncertainty, and patient values, with the agreed choice documented.

Care plan goals use SMART criteria: Specific, Measurable, Achievable, Relevant, Time-bound; each goal has a review date.

Multimorbidity planning weighs life expectancy, treatment burden, and patient priorities; single-disease guidelines are adapted rather than applied mechanically.

Treatment escalation plans record ceilings of care, resuscitation status, and preferred place of care, aligned with the patient's expressed goals.

SBAR and closed-loop communication are standard: the receiver repeats the message and the sender confirms accuracy.

Minutes record attendance, conflicts of interest, cases discussed, decisions, actions, named owners, deadlines, and deferrals; verbatim dialogue is not required.

Information governance principles: lawful basis, minimum necessary data, purpose limitation, accurate and timely records, retention schedule, and secure storage.

Access to MDT records is role-based and audited; sharing outside the team requires a lawful basis and patient information unless a legal exemption applies.

Patient-facing communication: copy letters to patients, use interpreters for consent, and check understanding with teach-back.

Handover between meetings uses a structured template; read-back is required for critical results and medication changes.

Incidents and near misses are reported through the local system; duty of candour requires open disclosure and apology when harm occurs.

Data minimisation in presentations: use initials or identifiers rather than full names in public or teaching settings.

Audit cycle: define standards, collect data, compare with standards, implement change, re-audit; a completed cycle requires at least one re-measurement.

Donabedian framework measures structure (staffing, facilities), process (guideline adherence, time to decision), and outcomes (survival, complications, patient-reported outcomes).

Core MDT KPIs: referral-to-discussion time, percentage of eligible cases discussed, attendance rate, action completion rate, guideline concordance, and patient experience score.

PDSA cycle: Plan predicts, Do tests on a small scale, Study measures the result, Act decides to adopt, adapt, or abandon; multiple cycles are used for improvement.

Statistical process control: run charts and control charts distinguish common-cause from special-cause variation; a shift of six or more points indicates non-random change.

Morbidity and mortality meetings review complications, deaths, and near misses, focusing on system factors and documented learning actions.

Benchmarking compares MDT performance with peer services or national standards; outliers trigger review, not automatic blame.

Patient-reported experience and outcome measures are collected at fixed intervals and reported alongside clinical KPIs.