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Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital - 11/06/21

Doi : 10.1016/j.resmer.2021.100828 
C. Rolland-Debord a, A. Canellas b, P. Choinier b, A. Milon c, I. Debrix d, E. Blin b, N. Belaube e, S. Mattioni f, F. Millet b, M. Nadal e, C. Petit-Hoang g, P. Rigaud b, J.S. Rech f, M. Siguier e, D. Sroussi b, M. Denis e, C. Amiel h, M. Fartoukh i, S. Georgin-Lavialle f, L. Lassel e, A. Parrot b, J. Cadranel b,
a Service des explorations fonctionnelles de la respiration de l’exercice et de la dyspnée, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
b Department of pneumology and thoracic oncology, centre constitutif maladies pulmonaires rares, hôpital Tenon, GRC no 04, Theranoscan Sorbonne université, AP–HP, Paris, France 
c Department of radiology, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
d Department of pharmacy, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
e Department of infectious and tropical diseases, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
f Department of internal medicine, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
g Department of nephrology, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
h Department of virology, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 
i Intensive care unit, hôpital Tenon, Sorbonne université, AP–HP, Paris, France 

Corresponding author. Department of pneumology, hôpital Tenon, 4, rue de la Chine, 75970 Paris, France.Department of pneumology, hôpital Tenon4, rue de la ChineParis75970France

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Abstract

Objectives

In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice.

Methods

All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey.

Results

In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues.

Conclusions

Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.

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Keywords : COVID-19, Multidisciplinary meetings, Standard of care, Prospective cohorts, Therapeutic trials


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