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Offiah C, Tierney S, Egan B, Collins RD, Ryan DJ, McCarthy AJ, Smith DR, Mahon J, Boyle E, Delaney H, O 'Donohoe R, Hurley A, Walsh RA, Murphy SM, Bogdanova-Mihaylova P, O 'Dowd S, Kelly MJ, Omer T, Coughlan T, O'Neill D, Martin M, Murphy SJX, McCabe DJH. Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting. Ir J Med Sci 2023; 192:3051-3062. [PMID: 37081289 PMCID: PMC10119010 DOI: 10.1007/s11845-023-03319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/13/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND/AIMS Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM 'adherence' to such advice. METHODS This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom 'consensus management decisions' were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), 'indeterminate symptomatic status stenosis' (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / - intervention. RESULTS One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50-99% SCS patients was 12.5 days (IQR: 9-18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1-7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up. CONCLUSIONS The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death.
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Grants
- Meath Foundation, Vascular Neurology Research Foundation,
- The Adelaide Health Foundation Ireland, Enterprise Ireland-Innovation Partnership Programme
- Trinity College Dublin Innovation Bursary, The Meath Foundation, Ireland, Joint Irish Institute of Clinical Neuroscience/Merck Serono Fellowship in Neuroscience Grant, The Vascular Neurology Research Foundation Ireland, Bayer HealthCare, Ireland and Verum
- The Meath Foundation, Ireland; The Adelaide Health Foundation, Ireland; The Vascular Neurology Research Foundation Ireland; the Enterprise Ireland-Innovation Partnership Programme (co-funded by the European Regional Development Fund); and by unrestricted e
- University of Dublin, Trinity College
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Affiliation(s)
- Chika Offiah
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Sean Tierney
- Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Bridget Egan
- Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Ronán D Collins
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Daniel J Ryan
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Allan J McCarthy
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Deirdre R Smith
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - James Mahon
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Emily Boyle
- Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Holly Delaney
- Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Rory O 'Donohoe
- Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Alison Hurley
- Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Richard A Walsh
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Sinead M Murphy
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Petya Bogdanova-Mihaylova
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Sean O 'Dowd
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Mark J Kelly
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Taha Omer
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Tara Coughlan
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Mary Martin
- Dept. of Geriatric and Stroke Medicine, Naas General Hospital, Naas, Ireland
| | - Stephen J X Murphy
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Dominick J H McCabe
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
- Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
- Dept. of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK.
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Vascular Neurology Research Foundation, c/o Department of Neurology, Tallaght University Hospital /AMNCH, Tallaght, Dublin, 24, Ireland.
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