ADHD - MDT Process Flow

PROCESS OVERVIEW

ADHD MDT process flow

PEER MDT COMPETENCIES

Use the guidance below to book the correct MDT.

IMPORTANT INFO

MDT GUIDANCE

Select the statement that best describes your situation, to be directed to the correct MDT type.

Strong evidence to support outcome and some differentials that are within staff team knowledge.

New to Healios and/or haven't been met MDT competencies

NO

Evidence is mixed and/or multiple differentials orthere are safeguarding concerns.

Evidence is highly complex.

YES

PROCESS OVERVIEW

Peer MDT (old)

PEER MDT COMPETENCIES

Consensus reached by clinicians?

NO

Note: If the peer MDT has identified additional complexities or safeguarding concerns then go straight to team manager MDT.

YES

Go straight to team manager MDT

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PROCESS OVERVIEW

Team manager MDT

PEER MDT COMPETENCIES

Consensus reached by clinicians?

NO

YES

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PROCESS OVERVIEW

Complex MDT

Consensus reached by clinicians?

NO

YES

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PROCESS OVERVIEW

Escalation options for team leads

PEER MDT COMPETENCIES

Gather info and review Review gathered information (if required/completed)

Review gathered information (if required/completed)

Complex case MDT with clinical lead

Consensus reached by clinicians?

NO

after exploring all viable escalation options a consensus has not been reached.

YES

after exploring one or more escalation options a consensus has been reached.

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PROCESS OVERVIEW

Consensus reached

When a consensus has been reached, follow the QC guidance and publish.

Follow QC guidance

Publish: follow contract requirements

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PROCESS OVERVIEW

Consensus not reached

If a consensus cannot be reached or evidence is inconclusive, select one of the options below.

Discuss with TL/CL/AM and/or local team to ensure correct information is summarised in the report re next steps

Clinical difference of opinion

Hand case back to local team for review

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PROCESS OVERVIEW

Consensus not reached

If a consensus cannot be reached or evidence is inconclusive, select one of the options below.

Discuss with TL/CL/AM and/or local team to ensure correct information is summarised in the report re next steps

Clinical difference of opinion

Hand case back to local team for review

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Process overview

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Please note that any important differential or sensitive information that has been considered during diagnostic formulation should be pasted from the report and included in the MDT progress note. If an outcome is agreed, the referring team lead should then tick the relevant DSM-5 criteria, write the summary in the summary box and ensure the report saves. They should then copy across the MDT summary to a progress note and complete the diagnosis tab to formally record the outcome of the assessment. The assessing clinician should add any additional recommendations, finalise the report and convert the completed DSM-5 mapping tool to PDF format and upload it to the clients panacea account as an attachment; within 24 hrs of the MDT (or next working day).

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PROCEED

Team Lead MDTs/Suport

When a case is escalated to a TL, the assessing clinician should book the case into an empty MDT slot, providing the Panacea code as a hyperlink, and a rationale/hypothesis. If the TL MDT follows a peer review or MDT, the reviewing clinician should also be invited to attend and the assessing clinician should also include their previous discussion documented in the MDT progress note.

Diagnostic outcome agreed

1. The history clinician should complete the MDT summary, summary box and add a formal diagnosis to the diagnosis tab. Please note that any important differential or sensitive information that has been considered during diagnostic formulation should be pasted from the report and included in the MDT progress note.
2. The history clinician should document the review in a progress note.
3. The history clinician should finalise their report and convert the completed DSM-5 mapping tool to PDF format and upload it to the client's panacea account as an attachment.
4. If both of the assessing clinicians are QC exempt, they should self approve the report. If one of the assessing clinician is not QC exempt they should press complete to request team manager QC.
5. Within 24 hrs (or next working day) of the report being approved the history clinician should telephone the family to advise them that they have shared the report, and offer the opportunity for a further feedback session. The feedback session should be arranged within 7 days.

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PROCEED

Complex case MDT with clinical leads

Team leads can book MDTs with clinical leads for a complex MDT. Specific slots for these will not appear in their calendars. The assessing clinicians should also be invited. If not all members of the MDT can attend, it may be appropriate for clinicians to share views via email. These meetings are for cases with particular complexity or when there are unresolvable differences of opinion amongst the assessing team and/or the case would benefit from a fresh perspective.

Clinical difference of opinion

In these instances, there are a number of approaches to resolve cases and reach a consensus assuming all possible additional information has been gathered and previous MDTs completed.

• The final decision could be based on the consensus of the MDT, including the clinical lead.
• A case could be presented (independent of team lead) at the group supervision meeting to help reach a neutral, unbiased consensus.

Reasons for escalation

If following a team manager MDT, a consensus cannot be reached or the outcome is inconclusive (e.g. due to mixed evidence) then the escalation process can be followed.

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PROCEED

Reasons for escalation

If an outcome is not agreed and the reviewing clinician identifies additional complexities which they feel require further exploration which is outside of their own areas of expertise, the reviewing obs clinician should contact an SME clinician or a team manager to arrange an MDT. The outcome and date of the subsequent meeting should be documented in a progress note.

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PROCEED

Clinical difference of opinion

In these instances, there are a number of approaches to resolve cases and reach a consensus assuming all possible additional information has been gathered and previous MDTs completed.

• The final decision could be based on the consensus of the MDT, including the clinical lead.
• A case could be presented (independent of team lead) at the group supervision meeting to help reach a neutral, unbiased consensus.

Reasons for escalation

If following a peer MDT, a consensus cannot be reached or the outcome is inconclusive (e.g. due to mixed evidence) then the escalation process can be followed.

GO Back

PROCEED

MDT summary must reflect the decision making and considerations of all impacting factors on an individual client’s strengths and needs.Please note that any important differential or sensitive information that has been considered during diagnostic formulation should be pasted from the report and included in the MDT progress note. If an outcome is agreed, the team lead should then tick the relevant DSM-5 criteria, write the summary in the summary box, and ensure the report saves. They should then copy across the MDT summary to a progress note and complete the diagnosis tab to formally record the outcome of the assessment. The history clinician should add any additional recommendations, finalise the report and convert the completed DSM-5 mapping tool to PDF format, then upload it to the client's panacea account as an attachment, within 24 hrs of the MDT (or next working day).

GO Back

PROCEED

Please see MDT guidance for full details on MDT preparation requirements and links to useful tools.

Handing a case back for the local team to review

Rationale and circumstance for handing back to the local team will vary and should be discussed with a team lead, clinical lead or account manager who will be able to support with the next steps and appropriate communication with the referring team and family.

Handing a case back for the local team to review

Rationale and circumstance for handing back to the local team will vary and should be discussed with a team lead, clinical lead or account manager who will be able to support with the next steps and appropriate communication with the referring team and family.

On completion of an assessment, the clinician should complete their diagnostic report and review and formulate all of the evidence gathered using the DSM-5 mapping tool to clearly document their evidence and demonstrate their formulation, found here. Please note that any important differential or sensitive information that has been included for the purpose of formulation should be clearly marked in bold within the report so this can be easily removed before the report is shared. Where possible, this should be completed within 24 hrs of the assessment in order to reduce the cognitive load of holding all of this information and to ensure that any gaps in information are identified and resolved quickly. At this stage, the assessing clinician may also highlight and time stamp interesting sections of the observation and/or report for further discussion. When a case is escalated to a team lead, the assessing clinician should book the case into an empty MDT slot, providing the Panacea code as a hyperlink and a rationale/hypothesis.

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PROCEED

Handing a case back for the local team to review

Rationale and circumstance for handing back to the local team will vary and should be discussed with a team lead, clinical lead or account manager who will be able to support with the next steps and appropriate communication with the referring team and family.

Complex Tripod MDTs

The clinicians involved in the case and a minimum of 2 ADHD Team leads will review the case. On occasion, it may be evident that a case is extremely complex from the point of assessment. In these cases, the assessing clinician should discuss complexities with their TL who will determine whether or not it is appropriate to escalate the case straight to complex MDT. Assessing clinicians should book directly into the complex MDT slots. The date and time of the complex MDT should be added to a progress note in Panacea.

Escalation to team manager MDT

If the reviewing clinicians identifie additional complexities which are outside of their skillsets, they should book a team manager MDT, where both the clinicians should attend, whenever possible. The outcome and date of the subsequent meeting should be documented in a progress note.

GO Back

PROCEED

MDT summary must reflect the decision making and considerations of all impacting factors on an individual client’s strengths and needs.Please note that any important differential or sensitive information that has been considered during diagnostic formulation should be pasted from the report and included in the MDT progress note. If an outcome is agreed, the recording clinician should then tick the relevant DSM-5 criteria, write the summary in the summary box, and ensure the report saves. They should then copy across the MDT summary to a progress note and complete the diagnosis tab to formally record the outcome of the assessment. The assessing clinician should add any additional recommendations, finalise the report and convert the completed DSM-5 mapping tool to PDF format, then upload it to the client's panacea account as an attachment, within 24 hrs of the MDT (or next working day).

GO Back

PROCEED

Handing a case back for the local team to review

Rationale and circumstance for handing back to the local team will vary and should be discussed with a team lead, clinical lead or account manager who will be able to support with the next steps and appropriate communication with the referring team and family.

Clinicians should complete their diagnostic report and review and formulate all of the evidence gathered using the DSM-5 mapping tool to clearly document their evidence and demonstrate their formulation ideally within 24 hours of the assessment.