Multidisciplinary team meetings in prosthetic joint infection management: A qualitative study

Jennifer Broom; Alex Broom; Katherine Kenny; Pamela Konecny; Jeffrey J Post

doi:10.1016/j.idh.2023.01.002

Multidisciplinary team meetings in prosthetic joint infection management: A qualitative study

Infect Dis Health. 2023 Aug;28(3):145-150. doi: 10.1016/j.idh.2023.01.002. Epub 2023 Feb 12.

Authors

Jennifer Broom¹, Alex Broom², Katherine Kenny³, Pamela Konecny⁴, Jeffrey J Post⁵

Affiliations

¹ Infection Research Network Sunshine Coast, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD, Australia; University of Queensland, Brisbane, QLD, Australia. Electronic address: jennifer.broom@health.qld.gov.au.
² Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, NSW, Australia. Electronic address: alex.broom@sydney.edu.au.
³ Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, NSW, Australia. Electronic address: Katherine.kenny@sydney.edu.au.
⁴ Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, Sydney, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia. Electronic address: pam.konecny@health.nsw.gov.au.
⁵ Department of Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia; School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia. Electronic address: jeffrey.post@health.nsw.gov.au.

PMID: 36788048
DOI: 10.1016/j.idh.2023.01.002

Abstract

Background: Prosthetic joint infections (PJIs) cause substantial morbidity to patients and are extremely challenging for clinicians. Their management can include multiple operations, antibiotics, and prolonged hospital admissions. Multidisciplinary team meetings (MDTM) are increasingly used for collaborative decision-making around the management of PJIs, but thus far there has been no examination of the role of MDTM in decisions and management. This study aimed to examine interactions in a PJI MDTM to identify the dynamics in decision-making, and inter-specialty relationships more broadly.

Methods: Twelve MDTMs over 7 months at an Australian tertiary referral hospital were video recorded, transcribed, and thematic analysis was performed.

Results: Thematic analysis revealed four key areas of collaborative discussion 1. Achieving Inter-specialty Balance: The role of the multidisciplinary team discussion in providing balance between specialty views, and traversing the barriers between specialty interactions. 2. Negotiating Grey zones: there was frequent discussion of the limits of tests, interpretation of symptoms, and the limits of proposed operative strategies, and the resultant tensions of balancing ideal care vs pragmatic decision-making, and divergent goals of care. 3. Tailoring Treatment: identification of individual patient factors (both physiological and behavioural) and risks into collaborative decision-making. 4. Affording Failure: creating affordances in communication to openly discuss 'failure' to eliminate infection and likely negative outcomes.

Conclusions: MDTM in the management of prosthetic joint infections serve multiple functions including: achieving interdisciplinary balance; effective grey zone management, tailoring reconfigured care; and most critically, recognition of 'failure' to eliminate infection, a communicative affordance most likely leading to better care.

Keywords: Multidisciplinary team meeting; Prosthetic joint infection; Qualitative research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents*
Australia
Communication*
Humans
Patient Care Team
Qualitative Research

Substances

Anti-Bacterial Agents