Evaluating the value of multidisciplinary reviews to get to the root causes of C. difficile infection

An interesting paper has been published evaluating the cost and value of multidisciplinary team (MDT) meetings to investigate C. difficile cases. The study counts the cost of C. difficile MDTs (somewhere between £25k and £50k over two years), and concludes that they had limited value in delivering additional learning or quality improvement. But I beg to differ…!

The premise was simple: to understand how much a bi-monthly C. difficile MDT review meeting cost in terms of staff time. The authors included both the time to attend the meetings, and the time to prepare before and write reports afterwards. This returned costs in the range of £25k to £50k associated with meetings to review 84 cases of C. difficile over two years. The authors then deducted the averted fines from the hospital’s commissioners attributed to IPC-related reductions in C. difficile to come up with a net loss of between £4k and £31k.

Two main reflections on this study:

  • The authors conclude that ‘Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations.’ Really? Can this be true? No additional learning from 84 cases of C. difficile over two years? This is certainly not our experience.
  • The staff time is an opportunity cost, and not actual expenditure. These were not staff employed specifically for the purposes of a bi-monthly review of C.  difficile cases. So the question is, could there have been a better use of time for these staff members? Getting together to review the root causes of a high-profile cause of healthcare-associated infection seems like a pretty good use of time to me!

I like the study – it’s always good to add cost and value evaluation to IPC-related activity. But I don’t like the conclusions, and worry that this may erode / damage established and effective MDTs to review C. difficile and other causes of HCAI. So, I hope this blog brings some balance to the discussion.

Image: hopkinsmedicine.org

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