team of physicians at Froedtert & the Medical College of
review a medical image together.
As health care
becomes increasingly complex, a team-based approach is becoming a
widely accepted practice to deliver patient care. Several health care
organizations in the Milwaukee area recently shared with M Magazine
how they are embracing team-based care to improve quality and promote
efficiency in all fields of health care.
A diagnosis of
breast cancer can be stressful and overwhelming. But knowing what to
expect and having a team of medical professionals to rely on can
provide a sense of relief.
That was the
impetus for Columbia St. Mary’s Breast Cancer Multi-Disciplinary
Clinic, which opened in 2009. "The unknown makes people
crazy," says Dr. Alysandra Lal, a surgical oncologist with
Columbia St. Mary’s.
But taking a
multidisciplinary approach to breast cancer care has helped lessen
patients’ anxiety. "Having a team of people gives
comfort," says Deb Theine, a nurse navigator with the Breast
Cancer Multi-Disciplinary Clinic.
As a nurse
navigator, Theine is the first point of contact for patients following
their cancer diagnosis. She explains the diagnosis and coordinates
appointments with doctors, specialists and support staff like social
workers and genetic counselors. "It’s nice for patients not to
have to try to navigate the system themselves," says Lal.
"It takes a lot off their plate."
role extends far beyond coordinating doctor appointments and surgery
schedules. She also helps remove barriers to care, such as managing
paperwork, communicating with insurance companies, and helping
patients understand their treatment and care options. "It’s a
comprehensive approach," she says. "Nothing falls through
clinics are held every Tuesday at Columbia St. Mary’s Ozaukee campus
and every Wednesday at the hospital’s Milwaukee campus. Prior to
seeing patients, the clinic team gathers to review patient cases and
devise treatment plans.
members meet individually with each patient so she knows her exact
course of treatment. The weekly clinics typically run two to three
hours with several patients going through at once.
past, patients had to run around to multiple appointments over several
days," says Theine.
have been diagnosed at other health care systems may also go through
Columbia St. Mary’s multidisciplinary clinic for a second opinion.
multidisciplinary approach has made Columbia St. Mary’s a leader in
breast cancer care, Lal says it remains a work in progress. Recently,
the focus has turned to better supporting patients post-treatment.
"We do this
full court press and when treatment is over there’s a bit of a
letdown," she says.
Now the clinic
is looking into setting up follow-up appointments with a psychologist
and other support staff to help patients stay the course on their
post-cancer life. "We want to help launch them forward into the
next phase of life," explains Lal.
care can improve health outcomes and lower health care costs by
enhancing preventive care and improving the management of chronic
diseases. That’s the idea behind the patient-centered medical home (PCMH)
model — a more personalized health care approach that has been
steadily gaining popularity among health care networks nationwide.
patient care delivery model is changing," says Dr. Ron Fickel, a
physician and chief medical informatics officer for ProHealth Care.
"Today, there is more talk about population health
that historically, identifying patients’ medical needs has been more
episodic, which at times delays people getting the right care at the
right time. Now the focus has shifted to making sure all patients who
go through ProHealth Care’s primary care network get the same level
To better meet
the needs of its patients, ProHealth began implementing the medical
home model in its primary care clinics 18 months ago. As part of the
approach, the doctor or doctors at each clinic are responsible for
leading a team of care managers and health educators to ensure
patients — particularly those with chronic illnesses like diabetes
and heart disease — receive key tests, take medication as directed,
and have access to tools and resources to stay well.
primary care clinic teams are working together to consistently
coordinate patient care," says Fickel. "The idea is to build
medical home model, ProHealth Care’s primary care clinics serve as
the hub for coordinating patients’ overall care, from preventative
services, to acute care to managing complex illnesses. The approach is
designed to help root out serious diseases or health problems before
earlier we’re able to intervene, the much better ability we have to
treat patients, which results in better outcomes," explains
continuity of care can also help lower costs over the long term,
particularly for those patients with serious health problems who
account for much of health care spending.
electronic patient records are another critical component of the
medical home model. The ability to quickly access patient profiles,
including test results and health histories, is a vital tool for
physicians as they track and manage the health of their patients.
to know the patient we can design a care pathway that meets their
needs," says Fickel. "We’re better able to identify
patients who are behind on care."
the MedicalCollege of Wisconsin
the Medical College of Wisconsin has found that a team-based approach
can be equally effective for treating chronic health conditions.
individual practices, Dr. William Rilling, an interventional
radiologist, and Dr. David Poetker, an otolaryngologist, both
encountered patients with Hereditary Hemorrhagic Telangiectasia (HHT),
a genetic disorder characterized by malformed blood vessels that lack
the structure and durability required to prevent bleeding.
disease varies in symptoms, the two doctors often referred patients to
one another — Poetker treating patients with heavy nosebleeds and
Rilling treating those with arteriovenous malformations (AVMs) in
two doctors agreed that establishing a local HHT program made sense.
They enlisted Dr. Robert Krippendorf, an internal medicine specialist
with a background in chronic disease management, to serve as the HHT
program’s medical director.
with HHT have medical needs that need to be expedited as quickly as
possible," says Rilling. Today, Froedtert & the MCW’s HHT
program is one of just 17 specialized treatment centers nationwide,
and the only program of its kind in Wisconsin. In 2012, the
International HHT Foundation recognized the program as a Center of
multidisciplinary team of 15 to 20 specialists, Froedtert & the
MCW’s HHT program is able to offer a full spectrum of coordinated
care. The team also includes a genetic counselor who can explain the
implications of HHT and test family members at risk for the genetic
people in place who can handle the entire continuum of the disease is
important because the symptoms are extremely variable," says
Rilling. Symptoms can range from frequent nosebleeds to AVMs in the
lungs, brain or GI tract, which may result in hemorrhaging or death if
learn about the HHT program through cureHHT.org or are referred by
their doctor, their first point of contact is Jule Meddaugh, who
serves as the program’s liaison coordinator. Patients who have not
yet been diagnosed typically undergo genetic testing to confirm HHT.
From there, additional diagnostic tests may be ordered to detect the
presence of AVMs.
diagnosis, the HHT team helps coordinate care with the patient’s
primary care physician. Krippendorf provides patients a full report of
their test results, a summary of the HHT team’s findings and a
detailed treatment plan.
"HHT can be
very frustrating," says Krippendorf. "It makes patients feel
good to meet others who know how to pronounce their condition and know
what it is."
procedures like joint replacement and spinal surgery can be complex
and challenging, but for patients with acute medical issues like
diabetes and hypertension, there’s often an increased risk for
outcomes for its higher risk orthopedic patients, Wheaton Franciscan
added orthopedic and spine surgery to the Wisconsin Heart Hospital’s
service offerings in 2012.
partnering with the Midwest Spine and Orthopedic Hospital, the
Wisconsin Heart Hospital had focused exclusively on cardiac and
vascular care. But with a shift in health care in recent years away
from invasive cardiac procedures in favor of interventional
treatments, the hospital had become underutilized.
state-of-the-art facility has proved to be the perfect environment to
provide additional support to more medically fragile patients
undergoing orthopedic procedures, says Dr. Thomas Perlewitz, an
orthopedic surgeon with Wheaton Franciscan.
suited to those patients with more specialized medical needs," he
explains. "The hospital already had a highly trained medical
acuity staff, including cardiologists and top-notch nurse
the Midwest Spine & Orthopedic Hospital/Wisconsin Heart Hospital,
the Wauwatosa-based facility has developed an integrated program for
orthopedic care, including an evaluation process to help identify high
risk patients who might benefit from being treated in a more
the model of care MSOH/Wisconsin Heart Hospital adopted to treat high
risk patients has resulted in improved patient safety, shorter
hospital stays, fewer complications and lower health care costs.
hospital’s nursing staff is highly qualified to provide critical
care," says Perlewitz. "They’re helping patients manage
multiple health problems like diabetes, hypertension and blood
health conditions has led to expedited care and clearance for surgery
for patients who might not otherwise have been given the go-ahead.
specialty hospital environment has allowed us to deliver a more
effective continuum of care for this group of patients," says
He pointed to a
recent patient as an example of someone’s quality of life that might
have been compromised without additional support from MSOH/Wisconsin
Heart Hospital. Suffering from severe spinal stenosis, the woman
couldn’t walk more than 100 feet without having to sit down. During
the patient’s evaluation, it was revealed she also suffered from
peripheral vascular disease, which had restricted blood flow to her
legs. Following surgery to repair the women’s spine, Dr. Krisha
Kumar, an interventional cardiologist, inserted stents to reopen the
blocked arteries in her legs.
the kind of collaboration we strive for," says Perlewitz.
"We want to be engaged at all levels."
Like many health
care networks, Aurora Health Care has focused on implementing a
team-based approach to improve patient care at the primary care level.
Over the next year, all 120 of Aurora Health Care’s primary care
clinics will participate in the TeamSTEPPS program — a comprehensive
training curriculum developed by the Agency for Healthcare Research
and Quality (AHRQ) to improve communication and teamwork skills among
health care professionals.
Anderson, senior vice president of academic affairs, says Aurora
adopted the TeamSTEPPS program to empower staff and improve teamwork
in an effort to enhance its current patient care model.
approach has always been there, we’re just making it come to life by
creating an atmosphere that emphasizes communication," says
doctors, nurses and other staff at Aurora’s primary care clinics
will receive training and tools to better facilitate communication.
One of those tools is a daily huddle during which the clinic staff
comes together as a team to plan for the day ahead and to review what
worked or didn’t work during the previous day.
open atmosphere that allows people to bring up ideas," says
voice is also part of the daily huddle, in the form of feedback about
their experience during their clinic visit — both positive and
looking at service delivery through the eyes of our patients so we can
develop better quality outcomes," says Anderson.
approach is designed to help interdisciplinary team members work
together to enhance their knowledge and skills for a comprehensive,
patient-centered approach. Training focuses on team-building
activities that promote leadership and cross-discipline communication.
In the clinics
that have received TeamSTEPPS training already, Aurora has reported an
improvement in patients’ health care experience, as well as the
overall workplace culture.
caregivers feel more like they’re part of a group," says
Anderson. He adds that caregivers who feel more fulfilled in their
jobs ultimately deliver better patient care.
Along with the
TeamSTEPPS program, Aurora is incorporating LEAN principles to
encourage a more efficient, streamlined delivery to patient care.
is the foundation of our primary care redesign," says Anderson.
"That approach sets the culture and expectation, but we’re
pursuing other initiatives, too."
Hospital of Wisconsin
More than 5
million infants and children undergo surgery each year, ranging from
routine procedures such as tonsillectomies to complex heart-defect
repairs. Despite safety advances, though, the death and complication
rate is still higher in children than in adults.
To help, a task
force commissioned by the American College of Surgeons (ACS) has
developed a new classification system that defines the preferred
surgical environment for children.
of these recommendations is to ensure that all infants and children in
the United States receive care in a surgical environment matched to
their individual medical, emotional and social needs," said Dr.
Keith Oldham, surgeon in chief at Children’s Hospital of Wisconsin,
who served as the chairman of the national task force that developed
the new guidelines.
better results, including fewer complications and shorter hospital
stays, when newborns and children undergo surgery in hospitals with
expert resources for pediatric patients. Because of their anatomy and
growth stage, children have unique needs, including specialized
pediatric anesthesiologists, radiologists and emergency physicians.
at hospitals without a dedicated pediatric unit often don’t receive
optimal care and could face more postoperative risks, according to
Oldham. Yet close to half of pediatric surgeries take place in
adult-focused general hospitals.
The task force
identified three levels of care modeled on the national trauma center
designation system the ACS developed in the 1970s.
status, Level I, is for hospitals that perform both complex and
routine procedures on newborns and children, including those with the
most severe health conditions and birth defects. They must be staffed
24/7 by a wide range of pediatric specialists and have the
highest-level neonatal intensive care unit. Level II and III centers
must be able to stabilize and transfer critically ill children to a
hospital with higher level resources.
Hospital of Wisconsin is one of 75 health care facilities set to
participate in the initial verification process beginning in 2015.