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

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.