The highly complex nature of hematology disorders and cancer care in children requires a well-coordinated, multidisciplinary team approach.
Children’s Mercy takes a holistic approach looking at the whole child to ensure that each child is meeting with every professional resource needed to manage the disease.
Every patient is assigned a case manager, usually an advanced practice nurse or physician’s assistant, teamed with a social worker and hematology/oncology specialist who oversees each child’s case from diagnosis through follow-up care.
The child has the same team throughout their entire treatment.
Gerald M. Woods, MD is here to discuss hematology disorders and cancer care in children.
Selected Podcast
Continuity of Care Through an Oncology Case Management Model
Featured Speaker:
Learn more about Dr. Woods
Gerald M. Woods, MD
Dr. Woods is the Division Director of Hematology/Oncology and Bone Marrow Transplant at Children’s Mercy Kansas City and serves as Section Chief of Hematology, and director of the Sickle Cell Program. Dr. Woods is also a professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. Dr. Woods received his medical degree from Duke University Medical Center. He completed his residency in Pediatrics at Children’s Mercy and returned to Duke for his fellowship in Pediatric Hematology/Oncology. Dr. Woods has been with Children’s Mercy now for more than 30 years.Learn more about Dr. Woods
Transcription:
Continuity of Care Through an Oncology Case Management Model
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I'm Dr. Michael Smith and our topic is continuity of care through a hematology /oncology case management model. My guest is Dr. Gerald Woods. Dr. Woods is the Division Director of Hematology, Oncology and Bone Marrow Transplant at Children's Mercy Kansas City. He also serves as the Section Chief of Hematology and Director of the Sickle Cell Program. Dr. Woods, welcome to the show.
Dr. Gerald Woods (Guest): Thank you, Dr. Smith.
Dr. Michael Smith: So, cancer and blood disorders are serious and, obviously, treatment is often complex. At Children's Mercy, you have a somewhat unique case management team approach for patients. Tell me about that team approach.
Dr. Gerald Woods: Okay and I'll try to do it in a short fashion. So, I do think we have a unique program, which I am very proud of and it's something that we've done for many, many years – over 20 years--shortly after I got here. What we try to do is, we assign each one of our patients a primary hematologist – pediatric hematologist/oncologist--a primary advanced practice nurse, and a primary social worker. So, from the time of their diagnosis until the time of their transitioning into adult care, they have the same primary team that kind of knows what's going on in and out. So, instead of handoffs where one team will see them in the clinic one time and another doctor or nurse will see them the next visit – and we can't always have the same person every time--but for the most part, they are used to seeing this mini-team, core group of people. We have a huge group, over 25 docs, 30 APNs, and everybody knows our protocols and when we're not here, they can cover for us. But, the families and the patients feel the continuity and the consistency which we think is very good--much better and a very good model.
Dr. Smith: And why is it important to have consistency in these teams?
Dr. Woods: I think it creates one, less confusion. Two, I think it promotes more confidence and then, there's more of a connection between the patient, family and healthcare providers. What I mean by that is, say if we saw them one month and a treatment plan was established and they came back a month later and saw a different physician or nurse who might have a little different twist on how to adjust chemotherapy or when to transfuse or when to have them come back. It's kind of unsettling in that they were told one thing the previous time and now the plan has changed a bit on the subsequent visit. I think that it just promotes more consistency, continuity and better and safer care.
Dr. Smith: Right, right. So, I noticed when I was reviewing your case management team approach that you use nurses or physician's assistants as case managers rather than a physician. Why is that?
Dr. Woods: I think the advanced practice nurses or we have a few physician's assistants. We have many more advanced practice nurses. They are more available, so they are more accessible to the patient and family and the advanced practice nurse or the physician’s assistant knows how to get us. We may be on rounds; we may be in a meeting but they can take the call so the patient and patient’s family, hopefully, won't have to wait as long to make contact and then, often we’ll have to get back with them but they're able to field their calls in a more efficient manner. Our advanced practice nurses are great. We work so closely with them. They are very familiar with what our practice would be like and it is individualized from doc to doc. We don't all do everything the same way, but the nurses and social workers who work most closely with us kind of know how we're going to react, how we're going to respond, so they're able to interpret things for the families. They get information quicker than if they had to wait for us all the time.
Dr. Smith: Right. So, you have so many people involved in the care, how do you manage to keep the teams the same or as close to the same as you can throughout the year, throughout the care for an individual patient? How exactly do you handle the team and keeping everybody there?
Dr. Woods: Yes. It does make it a more complex schedule and what we do is, I would say, each doc with APN and social worker have 2 or maybe 3 half-day clinics per week and they're on set days. So, Monday afternoon, Thursday morning--whenever it is--and there are times when we're doing in-patient rounds or we're on our way to a medical meeting or on vacation that we won't have the clinic but those set clinics are when the patients come back to be seen. So, that's one way that we can have consistency. To be able to do that does require more resources and we wouldn't be able to do it without the support of our administration meaning it takes, I think, a few more docs. It takes many more advanced practice nurses and many more social workers to do what we're doing. Everyone is housed in our division meaning the social workers aren't out of the Department of Social Work. They're in our division. All of our APNs are in our division. All of our docs are in our division. So, we're able to work more closely together.
Dr. Smith: Right. You mentioned Dr. Woods that you've had or have practiced in this type of case management team approach for about 20 years. So, the million dollar question is what is the response of patients to this model?
Dr. Woods: I think they love it and they do get attached and we get attached to the patient and families. And in many ways--and I've said this before--I think we become a part of their extended family. They are so familiar with us and I think it makes for a happier clinic visit for the patient. They look forward to seeing us, we look forward to seeing them. They know who they're going to see. We kind of know their quirks. We can joke with each other and even with communication, not only with the patient but with the parents, too, because they're very actively involved. It's just an easier type of communication and a higher level of trust. The other way we're able to pull this off, too, is we have our own clinic, as many divisions of hematology/oncology/transplants do. So, all of our patients are seen in one out-patient setting and we have the same set of clinic nurses, so there's continuity there. We have our own in-patient unit which maybe all divisions of hematology/oncology don't have. I think most do now and, once again, it's the same core set of nurses, so there are consistent providers throughout the continuum: in-patient, out-patient care and when they phone in, they're talking to the same people.
Dr. Smith: And, you know, this type of model, this type of case management model, what you're doing at Children's Mercy Kansas City really sounds like it could be the standard of practice for hematology/oncology throughout the country. Are other universities and community hospitals, are they following this type of model when it comes to patient care?
Dr. Woods: I haven't heard of too many doing it. In fact, sometimes when we have visiting professors or outside visitors they marvel at what we're doing and I think that the reason that others aren't doing it is it does require increased resources. I mean, administration has to be supportive of hiring a few more doctors, a few more advanced practice nurses. I mean, the bottom line is important in any organization or institution but even sacrificing RBUs or what seems to be the standard productivity. To do this, I would say that it takes more people, more resources and a higher investment from administration of the hospital and maybe a not as big of a bottom line.
Dr. Smith: Right. With all of this that’s going on in this team approach and how successful it's been, in addition to that, you also have a pediatric hematologist/oncologist in the hospital 24/7, right? Why is that so important compared to just having somebody on call?
Dr. Woods: So, I think it's another unique aspect for us, although I would say from my discussions nationally, most divisions of hematology/oncology, and bone marrow transplant have had to do this. With the cutback in resident work hours and with maybe a greater emphasis on teaching and less on work product from the resident, there are subsets of patients that the residents aren't as comfortable caring for. For us, for example, bone marrow transplant patients which are very, very complex, chemotherapy patients, general pediatric residents feel like they aren't going to take care of that type of patients when they graduate and they don't round on them regularly through the day. So, there were negotiations with our residents and our education department where they would take calls on those stations at night but they were getting increasingly uncomfortable. So, we had to look at a different model, particularly, with their work hours and their level of comfort at night. So, once again with the support of administration, we said we think the best way to provide safer, highest quality care would be hire pediatric hematology/oncology trained physicians to be available at night. We just extended that this year, July 2015, where around the clock, there's always an attending pediatric hematologist/oncologist on site in the hospital. It's safer care. It's higher quality care because they've been trained to do this. There are less handoffs. There's better communication. Once again, from a cost efficient standpoint, it's not a money maker. It's focusing on other aspects of care which I think is very important in pediatric hematology/oncology patients.
Dr. Smith: Well, Dr. Woods, I want to thank you for what you're doing and I also want to thank you for coming on the show. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information you can go to ChildrensMercy.org. That's ChildrensMercy.org. I'm Dr. Michael Smith. Have a great day.
Continuity of Care Through an Oncology Case Management Model
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I'm Dr. Michael Smith and our topic is continuity of care through a hematology /oncology case management model. My guest is Dr. Gerald Woods. Dr. Woods is the Division Director of Hematology, Oncology and Bone Marrow Transplant at Children's Mercy Kansas City. He also serves as the Section Chief of Hematology and Director of the Sickle Cell Program. Dr. Woods, welcome to the show.
Dr. Gerald Woods (Guest): Thank you, Dr. Smith.
Dr. Michael Smith: So, cancer and blood disorders are serious and, obviously, treatment is often complex. At Children's Mercy, you have a somewhat unique case management team approach for patients. Tell me about that team approach.
Dr. Gerald Woods: Okay and I'll try to do it in a short fashion. So, I do think we have a unique program, which I am very proud of and it's something that we've done for many, many years – over 20 years--shortly after I got here. What we try to do is, we assign each one of our patients a primary hematologist – pediatric hematologist/oncologist--a primary advanced practice nurse, and a primary social worker. So, from the time of their diagnosis until the time of their transitioning into adult care, they have the same primary team that kind of knows what's going on in and out. So, instead of handoffs where one team will see them in the clinic one time and another doctor or nurse will see them the next visit – and we can't always have the same person every time--but for the most part, they are used to seeing this mini-team, core group of people. We have a huge group, over 25 docs, 30 APNs, and everybody knows our protocols and when we're not here, they can cover for us. But, the families and the patients feel the continuity and the consistency which we think is very good--much better and a very good model.
Dr. Smith: And why is it important to have consistency in these teams?
Dr. Woods: I think it creates one, less confusion. Two, I think it promotes more confidence and then, there's more of a connection between the patient, family and healthcare providers. What I mean by that is, say if we saw them one month and a treatment plan was established and they came back a month later and saw a different physician or nurse who might have a little different twist on how to adjust chemotherapy or when to transfuse or when to have them come back. It's kind of unsettling in that they were told one thing the previous time and now the plan has changed a bit on the subsequent visit. I think that it just promotes more consistency, continuity and better and safer care.
Dr. Smith: Right, right. So, I noticed when I was reviewing your case management team approach that you use nurses or physician's assistants as case managers rather than a physician. Why is that?
Dr. Woods: I think the advanced practice nurses or we have a few physician's assistants. We have many more advanced practice nurses. They are more available, so they are more accessible to the patient and family and the advanced practice nurse or the physician’s assistant knows how to get us. We may be on rounds; we may be in a meeting but they can take the call so the patient and patient’s family, hopefully, won't have to wait as long to make contact and then, often we’ll have to get back with them but they're able to field their calls in a more efficient manner. Our advanced practice nurses are great. We work so closely with them. They are very familiar with what our practice would be like and it is individualized from doc to doc. We don't all do everything the same way, but the nurses and social workers who work most closely with us kind of know how we're going to react, how we're going to respond, so they're able to interpret things for the families. They get information quicker than if they had to wait for us all the time.
Dr. Smith: Right. So, you have so many people involved in the care, how do you manage to keep the teams the same or as close to the same as you can throughout the year, throughout the care for an individual patient? How exactly do you handle the team and keeping everybody there?
Dr. Woods: Yes. It does make it a more complex schedule and what we do is, I would say, each doc with APN and social worker have 2 or maybe 3 half-day clinics per week and they're on set days. So, Monday afternoon, Thursday morning--whenever it is--and there are times when we're doing in-patient rounds or we're on our way to a medical meeting or on vacation that we won't have the clinic but those set clinics are when the patients come back to be seen. So, that's one way that we can have consistency. To be able to do that does require more resources and we wouldn't be able to do it without the support of our administration meaning it takes, I think, a few more docs. It takes many more advanced practice nurses and many more social workers to do what we're doing. Everyone is housed in our division meaning the social workers aren't out of the Department of Social Work. They're in our division. All of our APNs are in our division. All of our docs are in our division. So, we're able to work more closely together.
Dr. Smith: Right. You mentioned Dr. Woods that you've had or have practiced in this type of case management team approach for about 20 years. So, the million dollar question is what is the response of patients to this model?
Dr. Woods: I think they love it and they do get attached and we get attached to the patient and families. And in many ways--and I've said this before--I think we become a part of their extended family. They are so familiar with us and I think it makes for a happier clinic visit for the patient. They look forward to seeing us, we look forward to seeing them. They know who they're going to see. We kind of know their quirks. We can joke with each other and even with communication, not only with the patient but with the parents, too, because they're very actively involved. It's just an easier type of communication and a higher level of trust. The other way we're able to pull this off, too, is we have our own clinic, as many divisions of hematology/oncology/transplants do. So, all of our patients are seen in one out-patient setting and we have the same set of clinic nurses, so there's continuity there. We have our own in-patient unit which maybe all divisions of hematology/oncology don't have. I think most do now and, once again, it's the same core set of nurses, so there are consistent providers throughout the continuum: in-patient, out-patient care and when they phone in, they're talking to the same people.
Dr. Smith: And, you know, this type of model, this type of case management model, what you're doing at Children's Mercy Kansas City really sounds like it could be the standard of practice for hematology/oncology throughout the country. Are other universities and community hospitals, are they following this type of model when it comes to patient care?
Dr. Woods: I haven't heard of too many doing it. In fact, sometimes when we have visiting professors or outside visitors they marvel at what we're doing and I think that the reason that others aren't doing it is it does require increased resources. I mean, administration has to be supportive of hiring a few more doctors, a few more advanced practice nurses. I mean, the bottom line is important in any organization or institution but even sacrificing RBUs or what seems to be the standard productivity. To do this, I would say that it takes more people, more resources and a higher investment from administration of the hospital and maybe a not as big of a bottom line.
Dr. Smith: Right. With all of this that’s going on in this team approach and how successful it's been, in addition to that, you also have a pediatric hematologist/oncologist in the hospital 24/7, right? Why is that so important compared to just having somebody on call?
Dr. Woods: So, I think it's another unique aspect for us, although I would say from my discussions nationally, most divisions of hematology/oncology, and bone marrow transplant have had to do this. With the cutback in resident work hours and with maybe a greater emphasis on teaching and less on work product from the resident, there are subsets of patients that the residents aren't as comfortable caring for. For us, for example, bone marrow transplant patients which are very, very complex, chemotherapy patients, general pediatric residents feel like they aren't going to take care of that type of patients when they graduate and they don't round on them regularly through the day. So, there were negotiations with our residents and our education department where they would take calls on those stations at night but they were getting increasingly uncomfortable. So, we had to look at a different model, particularly, with their work hours and their level of comfort at night. So, once again with the support of administration, we said we think the best way to provide safer, highest quality care would be hire pediatric hematology/oncology trained physicians to be available at night. We just extended that this year, July 2015, where around the clock, there's always an attending pediatric hematologist/oncologist on site in the hospital. It's safer care. It's higher quality care because they've been trained to do this. There are less handoffs. There's better communication. Once again, from a cost efficient standpoint, it's not a money maker. It's focusing on other aspects of care which I think is very important in pediatric hematology/oncology patients.
Dr. Smith: Well, Dr. Woods, I want to thank you for what you're doing and I also want to thank you for coming on the show. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information you can go to ChildrensMercy.org. That's ChildrensMercy.org. I'm Dr. Michael Smith. Have a great day.