Effect of digital tumor board solutions on “failure-to-discuss” rates for patient cases during tumor boards.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 308-308 ◽  
Author(s):  
Donna Fowler ◽  
Lincoln R Sheets ◽  
Matthew S Prime ◽  
Chaohui Guo ◽  
Athanasios Siadimas ◽  
...  
Keyword(s):  
Clinical Care ◽  
Interdisciplinary Approach ◽  
Clinical Information ◽  
Clinical Decision ◽  
Tumor Board ◽  
Tumor Boards ◽  
Rate Of Failure ◽  
Implementation Data ◽  
The Impact

308 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Efficient conduction of MTBs is importantfor optimal patient management. It is, however, often observed that prepared patient cases are not discussed during tumor boards due to limited time or incomplete information, which could cause delaytocaredecisions and/or the initiation of treatments. It remains unknown whether digital technologies canreduce the rate of failure to discuss during MTBs. Methods: A prospective cohort study was undertaken to evaluate the preparation & conduction of MTBs pre- & post-implementation of the NAVIFY Tumor Board (NTB) solution at Missouri University Health Care (MU), including the Ear, Nose & Throat (ENT) MTB. The NTB is a cloud-based workflow product, integrated with the hospital EMR, that aggregates and displays relevant clinical information. NTB was introduced to theMUENT MTB on Oct 10, 2018. Results: Pre-NTB implementation, data was collected from 42 ENT MTBs. A total of 551 patient cases were prepared for MTBs, but only 423 patient cases were discussed. This was an average “failure-to-discuss” rate of 19.4% per meeting (SD = 15.6%). After NTB implementation, data was collected from 7 MTBs where a total of 70 patient cases were prepared and discussed. There were no instances of failure to discuss, and as such, was significantlyreduced after the implementation of NTB (Mann-Whitney U test, p = 0.0004). The average number of patient cases discussed per meeting pre- and post-NTB implementation did not change (Mann-Whitney U test, p > 0.1) and meeting duration was the same. Conclusions: Introduction of the NTB did not change the weekly number of cases discussed, but did significantly reduce the failure to discuss rates for ENT MTB cases. Reducing failure to discuss rates could decrease the overall time to clinical decision and the initiation of treatment, which could potentially improve patient outcomes. Additional studies are needed to examine the impact of digital solutions on the quality of clinical care.

scholarly journals Measuring the Impact of Academic Cancer Network Development on Clinical Integration, Quality of Care, and Patient Satisfaction

2018 ◽  
Vol 14 (12) ◽  
pp. e823-e833 ◽  
Author(s):  
Anne C. Chiang ◽  
Jessica Lake ◽  
Naralys Sinanis ◽  
Debra Brandt ◽  
Jane Kanowitz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Clinical Care ◽  
Care Center ◽  
Tumor Board ◽  
Clinical Trial Accrual ◽  
Oncology Practice ◽  
The Impact

Purpose: Many US academic centers have acquired community practices to expand their clinical care and research footprint. The objective of this assessment was to determine whether the acquisition and integration of community oncology practices by Yale/Smilow Cancer Hospital improved outcomes in quality of care, disease team integration, clinical trial accrual, and patient satisfaction at network practice sites. Methods: We evaluated quality of care by testing the hypothesis that core Quality Oncology Practice Initiative measures at network sites that were acquired in 2012 were significantly different after their 2016 integration into the network. Clinical and research integration were measured using the number of tumor board case presentations and total accruals in clinical trials. We used Press-Ganey scores to measure patient satisfaction pre- and postintegration. Results: Mean Quality Oncology Practice Initiative scores at Smilow Care Centers were significantly higher in 2016 than in 2012 for core measures related to improvement in tumor staging ( z = 1.33; P < .05), signed consent and documentation plans for antineoplastic treatment ( z = 2.69; P < .01; and z = 2.36; P < .05, respectively), and appropriately quantifying and addressing pain during office visits ( z = 2.95; P < .05; and z = 3.1; P < .01, respectively). A total of 493 cases were presented by care center physicians at the tumor board in 2017 compared with 45 presented in 2013. Compared with 2012, Smilow Care Center clinical trial accrual increased from 25 to 170 patients in 2017. Last, patient satisfaction has remained at greater than the 90th percentile pre- and postintegration. Conclusion: The process of integration facilitates the ability to standardize cancer practice and provides a platform for quality improvement.

scholarly journals P094: A computerized provider order entry strategy to improve the quality of clinical information on neuroimaging requisitions from the emergency department: an interim analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S90-S90
Author(s):  
K. Lin ◽  
S. K. Dowling ◽  
K. Yiu ◽  
D. Wang ◽  
S. van Gaal ◽  
...  
Keyword(s):  
Clinical Information ◽  
Relative Increase ◽  
Free Text ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Implementation Period ◽  
Implementation Data ◽  
The Impact ◽  
Order Set

Introduction: Clinical context is critical for accurate radiologic interpretation of neuroimaging investigations. The aim of this study was to determine the impact of a change in the Emergency Department (ED) computerized provider order entry (CPOE) interface on the quality of clinical information conveyed in ED neuroimaging requisitions for suspected stroke patients. Methods: Four local EDs utilizing a common CPOE ED Stroke order set were studied before and after the introduction of a mandatory blank free text field requiring clinical information for the radiologist before a computed tomography angiography (CTA) request could be submitted. Prior to this modification, the indication (acute stroke) was pre-filled in the CTA request for convenience with the option of providing additional information at the discretion of the ordering physician. ED physicians were informed of the change as well as the rationale for its implementation. A retrospective pre (90 days) post (30 days) analysis was conducted across four local EDs to evaluate the impact of the CPOE user interface change on the quality of clinical information provided on neuroimaging orders. Patients aged 18 with CTA head and/or neck orders submitted from the order set were included. Patients were excluded if the CTA order was submitted outside of the ED Stroke order set, if order entry was by non-physician personnel, or if the order was modified by the diagnostic imaging department after ED submission. Clinical information from CTA orders were scored as complete, partial, or absent/uninformative based on a standardized rubric of critical elements, including: description of neurological deficit(s), lateralization, and timing of symptom onset or duration. Results were analyzed using chi square analysis. Results: Pre-implementation data from Oct 1, 2015 Jan 1, 2016 (N=652) was compared to post-implementation data from Nov 1 30, 2016 (N=227). The proportion of complete, partial, and absent/uninformative clinical histories were: 45.3%, 31.4%, and 23.3% in the pre-implementation period and 62.6%, 37.4%, and 0% in the post-implementation period respectively. There was a 38.2% relative increase in complete clinical histories, a 19.1% relative increase in partial clinical histories, and a 100% reduction in absent/uninformative clinical histories (p<0.001). Conclusion: The introduction of a mandatory free text field significantly increased the overall quality of clinical information provided on ED neuroimaging orders. This CPOE strategy has the potential to improve diagnostic accuracy and reduce unnecessary delays to imaging interpretation caused by lack of clinical information.

The impact of a digital solution on case discussion time at tumor boards.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18028-e18028
Author(s):  
Donna Fowler ◽  
Lincoln R Sheets ◽  
Matthew S Prime ◽  
Athanasios Siadimas ◽  
Yariv Z Levy ◽  
...  
Keyword(s):  
Decision Making ◽  
Interdisciplinary Approach ◽  
Tumor Board ◽  
P Value ◽  
Case Discussion ◽  
Patient Case ◽  
Tumor Boards ◽  
Significant Difference ◽  
Case Discussions ◽  
The Impact

e18028 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Information factors such as, multiple data sources, incomplete or missing information and teleconferencing failures, have been identified as issues contributing to variability in MTB conduction and impact. Little is known about how digital tumor board solutions can optimize MTB meeting conduction. Methods: A prospective IRB approved cohort study was undertaken to evaluate the time for patient case discussions,before and after the implementation of the NAVIFY Tumor Board (NTB) solution, at University of Missouri Health Care. Data was collected using a digital time-tracking application. The NTB manual version was implemented via a phased roll-out (Breast May 18, 2018; Gastrointestinal (GI) Jul 11, 2018; ENT Oct 30, 2018 – no manual version phase). Subsequently, the integrated version was introduced (Oct 4, 2018) whereby automated electronic medical record (EMR) data extraction was enabled. Results: Patient case discussion time was recorded at 138 MTBs (1109 patient cases) during 2018 (Breast 40 MTB; 236cases / GI 49 MTB; 389 cases / ENT 49 MTBs; 484 cases). Case discussion time significantly reduced at the Breast MTB (6.6mins to 5.3 mins; p-value = 0.01). Case discussion time at ENT MTB and GI MTB showed no significant change (Table 1). Time variance in case discussions significantly decreased post-NTB implementation at the Breast MTB (p-value = 0.008). For the GI & ENT MTBs, there was no significant difference post-NTB implementation (GI p-value =0.199; ENT p-value = 0.511), however, variance was already sma Conclusions: Introduction of the NTB reduced the time spent discussing cases for the Breast MTB, but showed no change forGI MTB and ENT MTB. Interestingly, case discussion times converged to between 5.5 - 6.5 minutesirrespective of the MTB type. Furthermore, variance decreased or was already small, for all MTB types. Both observations suggest that NTB standardized the case discussion process, perhaps because it created a common format for case presentation. A common workflow tool for MTB meeting conduction could ensure availability of all required data, increase efficiency of therapy decision-making, and lead to higher throughput of cases resulting in shorter time-to-treatment.

scholarly journals OP0277-PARE METABERN, THE EUROPEAN REFERENCE NETWORK FOR RARE HEREDITARY DISEASES: STRUCTURE, OBJECTIVES, METABOLIC RMDS AND THE ROLES OF EUROPEAN PATIENT ADVOCACY GROUPS (EPAGS)

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 168.2-168
Author(s):  
L. Wagner ◽  
S. Sestini ◽  
C. Brown ◽  
A. Finglas ◽  
R. Francisco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Social Science ◽  
Metabolic Pathways ◽  
Metabolic Disorders ◽  
Clinical Care ◽  
Single Point ◽  
Link Type ◽  
The Impact

Background:Inborn metabolic disorders (IMDs) currently encompass more than 1,500 diseases with new ones still to be identified1. Each of them is characterised by a genetic defect affecting a metabolic pathway. Only few of them have curative treatments, that target the respective metabolic pathway. Commonly, treatment examples include diet, substrate reduction therapies, enzyme replacement therapies, gene therapy and biologicals, enabling IMD-patient now to survive to adulthood. About 30 % of all IMDs involve the musculoskeletal system and are here referred to as rare metabolic RMDs. Generally, IMDs are very heterogenous with respect to symptoms and severity, often being systemic and affecting more children than adults. Thus, challenges include certified advanced training of adult metabolic experts, standardised transition plans, social support and development of therapies for diseases that do not have any cure yet.Objectives:Introduction of MetabERN, its structure and objectives, highlighting on the unique features and challenges of metabolic RMDs and describing the involvement of patient representation in MetabERN.Methods:MetabERN is stratified in 7 subnetworks (SNW) according to the respective metabolic pathways and 9 work packages (WP), including administration, dissemination, guidelines, virtual counselling framework, research/clinical trials, continuity of care, education and patient involvement. The patient board involves a steering committee and single point of contacts for each subnetwork and work package, respectively2. Projects include identifying the need of implementing social science to assess the psycho-socio-economic burden of IMDs, webinars on IMDs and their transition as well as surveys on the impact of COVID-193 on IMD-patients and health care providers (HCPs), social assistance for IMD-patients and analysing the transition landscape within Europe.Results:The MetabERN structure enables bundling of expertise, capacity building and knowledge transfer for faster diagnosis and better health care. Rare metabolic RMDs are present in all SNWs that require unique treatments according to their metabolic pathways. Implementation of social science to assess the psycho-socio-economic burden of IMDs is still underused. Involvement of patient representatives is essential for a holistic healthcare not only focusing on clinical care, but also on the quality of life for IMD-patients. Surveys identified unmet needs of patient care, patients having little information on national support systems and structural deficits of healthcare systems to ensure HCP can provide adequate clinical care during transition phases. These results are collected by MetabERN and forwarded to the Directorate-General for Health and Food Safety (DG SANTE) of the European Commission (EC) to be addressed further.Conclusion:MetabERN offers an infrastructure of virtual healthcare for patients with IMDs. Thus, in collaboration with ERN ReCONNET, MetabERN can assist in identifying rare metabolic disorders of RMDs to shorten the odyssey of diagnosis and advise on their respective therapies. On the other hand, MetabERN can benefit from EULAR’s longstanding experience regarding issues affecting the quality of life, all RMD patients are facing, such as pain, stiffness, fatigue, rehabilitation, maintaining work and disability claims.References:[1]IEMbase - Inborn Errors of Metabolism Knowledgebase http://www.iembase.org/ (accessed Jan 29, 2021).[2]MetabERN: European Refence Network for Hereditary Metabolic Disorders https://metab.ern-net.eu/ (accessed Jan 29, 2021).[3]Lampe, C.; Dionisi-Vici, C.; Bellettato, C. M.; Paneghetti, L.; van Lingen, C.; Bond, S.; Brown, C.; Finglas, A.; Francisco, R.; Sestini, S.; Heard, J. M.; Scarpa, M.; MetabERN collaboration group. The Impact of COVID-19 on Rare Metabolic Patients and Healthcare Providers: Results from Two MetabERN Surveys. Orphanet J. Rare Dis.2020, 15 (1), 341. https://doi.org/10.1186/s13023-020-01619-x.Acknowledgements:The authors thank the MetabERN collaboration group, the single point of contacts (SPOC) of the MetabERN patient board and the Transition Project Working Group (TPWG)Disclosure of Interests:None declared

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Clinical Pharmacists ◽  
Randomized Controlled ◽  
The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

scholarly journals Lessons Learned From an Early Hotspot During the COVID-19 Pandemic

2021 ◽  
pp. 000313482199475
Author(s):  
Brett M. Chapman ◽  
George M. Fuhrman
Keyword(s):  
Decision Making ◽  
Surgical Education ◽  
Clinical Care ◽  
Well Being ◽  
Educational Environment ◽  
Lessons Learned ◽  
Residency Programs ◽  
Surgical Residency ◽  
The Impact

The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.

scholarly journals Digital Tumor Board Solutions Have Significant Impact on Case Preparation

2020 ◽  
pp. 757-768
Author(s):  
Richard D. Hammer ◽  
Donna Fowler ◽  
Lincoln R. Sheets ◽  
Athanasios Siadimas ◽  
Chaohui Guo ◽  
...  
Keyword(s):  
Care Center ◽  
Tumor Board ◽  
Preparation Time ◽  
Implementation Phase ◽  
Health Care Center ◽  
Multiple User ◽  
Tumor Boards ◽  
User Groups ◽  
The Impact ◽  
Nose And Throat

PURPOSE Multidisciplinary tumor boards (TBs) are the gold standard for decision-making in cancer care. Variability in preparation, conduction, and impact is widely reported. The benefit of digital technologies to support TBs is unknown. This study evaluated the impact of the NAVIFY Tumor Board solution (NTB) on TB preparation time across multiple user groups in 4 cancer categories: breast, GI, head and neck (ie, ear, nose, and throat, or ENT), and hematopathology. METHODS This prospective study evaluated TB preparation time in multiple phases pre- and post-NTB implementation at an academic health care center. TB preparation times were recorded for multiple weeks using a digital time tracker. RESULTS Preparation times for 59 breast, 61 GI, 36 ENT, and 71 hematopathology cancer TBs comparing a pre-NTB phase to 3 phases of NTB implementation were evaluated between February 2018 and July 2019. NTB resulted in significant reductions in overall preparation time (30%) across 3 TBs pre-NTB compared with the final post-NTB implementation phase. In the breast TB, NTB reduced overall preparation time by 28%, with a 76% decrease in standard deviation (SD). In the GI TB, a 23% reduction in average preparation time was observed for all users, with a 48% decrease in SD. In the ENT TB, a 33% reduction in average preparation time was observed for all users, with a 73% decrease in SD. The hematopathology TB, which was the cocreation partner and initial adopter of the solution, showed variable results. CONCLUSION This study showed a significant impact of a digital solution on time preparation for TBs across multiple users and different TBs, reflecting the generalizability of the NTB. Adoption of such a solution could improve the efficiency of TBs and have a direct economic impact on hospitals.

Experiences of nursing in older care facilities in New Zealand

2010 ◽  
Vol 34 (1) ◽  
pp. 11 ◽  
Author(s):  
Jenny Carryer ◽  
Chiquita O. Hansen ◽  
Judy A. Blakey
Keyword(s):  
New Zealand ◽  
Older People ◽  
Registered Nurses ◽  
Residential Care ◽  
Nurse Practitioners ◽  
Clinical Care ◽  
Nursing Services ◽  
The Impact ◽  
Care For Older People

To examine issues related to the working life of registered nurses in residential care for older people in New Zealand, 48 registered nurses completed surveys (n = 28) or participated in discussions (n = 26) regarding their work roles, continuing education and interactions with specialist nurse services when providing care for older people living with chronic illnesses. This nursing workforce is characterised by ageing, relative isolation, reduced confidence and few opportunities for induction of new graduates. Registered nurses reported their struggle to deliver the appropriate quality of care to residents as acuity increases, general practitioner availability decreases and the opportunities for increasing their knowledge and competence remain limited. The provision of nursing services in residential care for older people is an area of growing concern to many Western countries. Nurse practitioners offer opportunities to improve the quality of residential care. What is known about the topic?The lack of registered nurses generally and the more critical shortage in residential care is well known. What does this paper add?This paper explains the impact on the current and future viability and the quality of registered nurse services in an area of service where acuity continues to rise and the demand for nursing services is increasing. What are the implications for practitioners?Nurses in older care settings often express a sense of isolation and note limited career development despite their passion for serving the frail older person. The establishment of nurse practitioner (gerontology) roles offers the potential for improved quality of clinical care for residents and clinical champions for development of nursing services.

scholarly journals Clinical value of measurable residual disease testing for assessing depth, duration, and direction of response in multiple myeloma

2020 ◽  
Vol 4 (14) ◽  
pp. 3295-3301
Author(s):  
Joaquin Martinez-Lopez ◽  
Sandy W. Wong ◽  
Nina Shah ◽  
Natasha Bahri ◽  
Kaili Zhou ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Decision Making ◽  
Residual Disease ◽  
Clinical Care ◽  
Progression Free Survival ◽  
Clinical Decision ◽  
Routine Practice ◽  
Clinical Value ◽  
The Impact ◽  
Measurable Residual Disease

Abstract Few clinical studies have reported results of measurable residual disease (MRD) assessments performed as part of routine practice. Herein we present our single-institution experience assessing MRD in 234 multiple myeloma (MM) patients (newly diagnosed [NDMM = 159] and relapsed [RRMM = 75]). We describe the impact of depth, duration, and direction of response on prognosis. MRD assessments were performed by next-generation sequencing of immunoglobulin genes with a sensitivity of 10−6. Those achieving MRD negativity at 10−6, as well as 10−5, had superior median progression-free survival (PFS). In the NDMM cohort, 40% of the patients achieved MRD negativity at 10−6 and 59% at 10−5. Median PFS in the NDMM cohort was superior in those achieving MRD at 10−5 vs &lt;10−5 (PFS: 87 months vs 32 months; P &lt; .001). In the RRMM cohort, 36% achieved MRD negativity at 10−6 and 47% at 10−5. Median PFS was superior for the RRMM achieving MRD at 10−5 vs &lt;10−5 (PFS: 42 months vs 17 months; P &lt; .01). Serial MRD monitoring identified 3 categories of NDMM patients: (A) patients with ≥3 MRD 10−6 negative samples, (B) patients with detectable but continuously declining clonal numbers, and (C) patients with stable or increasing clonal number (≥1 log). PFS was superior in groups A and B vs C (median PFS not reached [NR], NR, 55 respectively; P &lt; .001). This retrospective evaluation of MRD used as part of clinical care validates MRD as an important prognostic marker in NDMM and RRMM and supports its use as an endpoint in future clinical trials as well as for clinical decision making.

Utility of a multidisciplinary tumor board in the management of pancreatic diseases.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 319-319
Author(s):  
David G. Brauer ◽  
Matthew S. Strand ◽  
Dominic E. Sanford ◽  
Maria Majella Doyle ◽  
Faris Murad ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Cancer Center ◽  
Common Diagnosis ◽  
Tumor Boards ◽  
Cancer Network ◽  
The Impact

319 Background: Multidisciplinary Tumor Boards (MTBs) are a requirement for comprehensive cancer centers and are routinely used to coordinate multidisciplinary care in oncology. Despite their widespread use, the impact of MTBs is not well characterized. We studied the outcomes of all patients presented at our pancreas MTB, with the goal of evaluating our current practices and resource utilization. Methods: Data were prospectively collected for all patients presented at a weekly pancreas-specific MTB over the 12-month period at a single-institution NCI-designated cancer center. The conference is attended by surgical, medical, and radiation oncologists, interventional gastroenterologists, pathologists, and radiologists (diagnostic and interventional). Retrospective chart review was performed at the end of the 12-month period under an IRB-approved protocol. Results: A total of 470 patient presentations were made over a 12-month period. Average age at time of presentation was 61.5 years (range 17 – 89) with 51% males. 61.7% of cases were presented by surgical oncologists and 26% by medical oncologists. 174 cases were the result of new diagnoses or referrals. 78 patients were presented more than once (average of 2.3 times). Pancreatic adenocarcinoma was the most common diagnosis (37%), followed by uncharacterized pancreatic mass (16%), and pancreatic cyst (7%). The treatment plan proposed by the presenting clinician was known or could be evaluated prior to conference in 402 cases. Presentation of a case at MTB changed the plan of management 25% (n = 100) of the time, including MTB recommendation against a planned resection in 46 cases. When the initial plan changed as a result of MTB discussion, the most common new plan was to obtain further diagnostic testing such as biopsy and/or endoscopy (n = 24). Conclusions: MTBs are required and resource-intensive but offer the opportunity to discuss a wide array of pathologies and influence management decisions in a sizable proportion of cases. Additional investigations evaluating adherence rates to MTB decisions and to published guidelines (i.e. National Comprehensive Cancer Network) will further enhance the assessment and utility of MTBs.

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