Preoperative anaesthetic and cardiology MDT: Enhancing perioperative efficiency in elective non-cardiac surgery

BACKGROUND: Delays in obtaining specialist cardiology input for elective non-cardiac surgery can postpone definitive perioperative decision-making, increase short-notice cancellations and reduce theatre efficiency. In January 2021, our NHS trust introduced a weekly virtual Preoperative Anaesthetic and Cardiology Multidisciplinary Team meeting as a pathway redesign to improve access to specialist perioperative cardiovascular assessment. METHODS: We conducted a retrospective service evaluation of consecutive Preoperative Anaesthetic and Cardiology Multidisciplinary Team referrals between 1 January 2021 and 31 December 2024. Registry data were reviewed for referral indication, specialty, time from referral to first multidisciplinary team review and initial multidisciplinary team outcome. The impact on cardiology outpatient activity was estimated by comparing the Preoperative Anaesthetic and Cardiology Multidisciplinary Team pathway with the previous practice whereby non-emergency pre-assessment referrals were directed to a routine cardiology clinic. RESULTS: A total of 869 patients were reviewed; four were excluded because of incomplete records, leaving 865 analysable cases. Mean time from referral to first multidisciplinary team review was under 14 days. In a typical 1-h meeting, six to ten cases were discussed (mean 8), with a mean discussion time of approximately 8 min per patient. At first review, 64% of patients received a definitive advisory outcome: 62% were considered fit to proceed and 2% unfit for surgery. The remaining 36% required further action; 24% were triaged to cardiology clinic and 12% were managed through expedited investigation or treatment adjustment pathways. Compared with the pre-existing pathway, this represented a 76% reduction in pre-assessment referrals to a general cardiology clinic, equivalent to 657 outpatient appointments avoided over 4 years. CONCLUSIONS: A virtual anaesthetic-cardiology multidisciplinary team can provide timely specialist perioperative cardiovascular decision-making, reduce reliance on outpatient cardiology review and support elective pathway efficiency. This model is pragmatic, reproducible and may be valuable for NHS organisations seeking to streamline preoperative assessment while preserving access to specialist input for patients who need it most - a promising strategy for addressing elective surgery backlogs.