A blueprint for multidisciplinary fast track gastrointestinal oncology care

In this thesis, we have evaluated the implementation of two key concepts of the Gastro Intestinal oncology Center Amsterdam (GIOCA): multidisciplinary teams (MDT) and the fast delivery of care in fast track clinics (FTC).
The first part of this thesis investigates the value of multidisciplinary teams. The added value of MDTs was assessed by comparing the diagnosis formulated by the MDTs with the diagnosis formulated by the referring physician. MDTs accurately identified patients without a malignant diagnosis, avoiding overtreatment. Patients are more likely to receive a correct diagnosis if a physician with personal knowledge of the patient is present at the MDT-meeting. The number of patients discussed or the duration of the MDT meeting didn’t influence the chance of a correct diagnosis.
In the second part of this thesis, patient satisfaction and healthcare professional’s work satisfaction with fast track care were investigated. Patients were very satisfied with the received care. Irrespective of the actual waiting time, patients considered it too long when it exceeded their expectation of the waiting time. There seems to be a positive correlation between patient satisfaction and the job satisfaction of healthcare workers.
The third part of this thesis describes the organizational aspects of the GIOCA and evaluates its transferability by implementing of this concept in a different university hospital. GIOCA was implemented horizontally across different vertical divisions within the hospital. Thereafter the GIOCA-concept was implemented in a different university hospital. After implementation both the referral time and the waiting time were significantly reduced.