PATIENT CARE: Putting Patients First

 

Dr. Hagop Kantarjian, Chief of the leukemia section, examines patient Lorraine Lalumandier of Baton Rouge, Louisiana, in the Hematology Center, as nurse Rona Dorn provides support.

 

 

Every three weeks, Ralph and Mary Champagne travel more than 300 miles from their home in Louisiana to M. D. Anderson.

 

While the trek is long and tiresome, they look forward to the trip each time. First and foremost, because they know the interleukin-2 treatments Ralph's been receiving to treat melanoma of the spinal fluid are keeping him alive. Secondly, it's because they get to see old friends.

 

For the Champagnes, M. D. Anderson is more than just a "great" cancer hospital. It's also a place where life-long friendships are made.

 

The moment they came to M. D. Anderson, they were surrounded by so many caring people who reached out to them in their time of despair with love and support. They were amazed, and grateful, to feel such warmth, the couple says. Now when they come here, they come "home" to friends.

 

From Sister Alice Potts - whom they call their "Angel" - to the nurses, physicians, support staff and volunteers, the Champagnes have experienced what makes M. D. Anderson unique - the people.

 

How to best serve patients and accommodate their special needs was the overriding focus of M. D. Anderson's faculty and staff this past fiscal year. A major milestone in patient care was achieved when all 10 of the multidisciplinary care centers were officially open and fully operational in their new locations, with the Nellie B. Connally Breast Center opening in fall 1997.

 

The care centers are designed to offer medical, surgical and radiation consultations, follow-up services and multidisciplinary treatment planning for specific disease sites in a single location. Where possible, diagnostic services are located in or near designated centers. For instance, the newly opened Julie and Ben Rogers Breast Diagnostic Clinic is located adjacent to the Breast Center, providing a wide range of important breast diagnostic services.

 

In step with changing times and ways of delivering care, M. D. Anderson established the Academy of Training and Systems Improvement to offer focused employee training and provide improvements in inefficient systems that compromised customer service.

 

According to Sherry Martin, associate vice president for training and systems improvement, "as each new center was implemented, every job in the center was abolished and new job descriptions were drafted in order to enable staff to make decisions at the point of service."

 

To meet the increased demands of their new roles, staff are required to complete structured education programs that will provide them with the necessary interpersonal, managerial, problem-solving, computer and technical skills to be "effective, contributing members of their teams," Martin says.

 

Improving systems and processes also are critical. Throughout the cancer center, leaders agree that for staff to perform their jobs efficiently, systems must be functioning properly. During the past year, existing processes were evaluated, opportunities identified for improvement and corrective action plans implemented.

 

Significant improvements made included:

 

· Streamlining the patient billing system, which now combines all charges incurred and makes hospital invoices easier to understand.

 

· Establishment of a new Patient Referral Office, featuring an improved telephone system that has significantly reduced hold times and the drop call rate from more than 10 percent of incoming calls to less than two percent.

 

· Development of a drop off/pick up service in Garage 10, which reduces congestion in front of the R. Lee Clark Clinic and connects patients to the Charles A. LeMaistre Clinic.

 

· Implementation of a voucher program, whereby coupons for free meals in the hospital cafeteria and valet parking are issued by clinic personnel to patients who have been inconvenienced.

 

· A pilot program aimed at providing patients with restaurant-like service and fresh-cooked meals on request.

 

Multidisciplinary treatment approaches and innovative surgical, radiation and drug therapies continued to provide the curative formula for thousands of cancer patients.

 

In the area of disease management, for instance, more than 2,000 patients were enrolled in one of the 72 existing collaborative care pathways last year. Since 1995, 4,000 patients have been enrolled.

 

Disease management uses the three modalities of surgery, medicine and radiation to provide oncology care management from prevention to therapies to illness resolution. A pathway is a multidisciplinary document that describes the expected events and interventions in an episode of care.

 

In addition, 17 practice guidelines were in use during the fiscal year. A guideline gives an overview of a disease process and treatment approaches.

 

With 9,000 procedures performed over the past year, surgery remains the cornerstone of cancer treatment. Many surgical techniques that are more exacting underwent important clinical testing in 1996-97.

 

Some examples are: lymph node mapping for melanoma, breast, and squamous carcinoma of the penis and urethra; stereotactic biopsy for detection of breast abnormalities; hypothermic isolated limb profusion using biochemotherapy for melanoma and sarcoma; radiofrequency ablation of liver tumors; and tumor reduction surgery followed by stem cell rescue therapy for ovarian cancer.

 

In addition, neurosurgeons began using functional mapping, a non-invasive preoperative planning technique that utilizes advances in magnetic resonance imaging, to aid in the resection of brain tumors. Reconstructive surgeons continued to advance the science of tissue engineering (the science of creating new body structures from the patient's own cells) with colleagues at Rice University. They are also embarking on a similar effort with the University Hospital in Freiburg, Germany.

 

Two key developments in radiation oncology focused on a new device and treatment plan that allow the clinical and physics team to maximize their ability to deliver radiation to the treatment site while minimizing the dose delivered to healthy tissue. An internally developed and patented miniature multileaf collimator used in stereotactic radiosurgery and radiotherapy allows for fewer treatments than conventional radiotherapy. The COPPERPlan, a three-dimensional treatment planning system, supports treatment protocols in prostate and lung cancer and development of new technologies for improved breast cancer treatments.

 

A number of new anti-cancer agents that underwent extensive clinical trials at M. D. Anderson were FDA-approved during 1996-97. They include drugs for the treatment of fungal infections and pancreatic, breast, esophageal and metastatic colorectal and ovarian cancers.

 

The year also saw increased activity in preparation for the opening of the Albert B. and Margaret M. Alkek Hospital in 1998.

 

According to David Bowlin, director of major buildings programs, more than 100 people have been working behind the scenes to ensure that the activation process goes smoothly from the time the contractor turns over the building for testing and furnishing to the time staff and patients move in.

 

The opening of the Alkek will complete the third piece of an expansion and renovation project which will add one million square feet of space and services to M. D. Anderson's arsenal in the war against cancer - all designed with the patient in mind as the faculty and staff seek the best possible outcome for each of them.

 

Facts on Patient Care

The figures below demonstrate tremendous activity in a number of patient care areas during fiscal year 1996-97.

 

340,290

Outpatient Visits

 

18,400

New Patients Registered

 

32,166

Surgical Hours

 

64,441

External Beam Radiation Treatments Performed

 

210,000

Outpatient Prescriptions

 

69, 271

Cytology Specimens Processed

 

125,827

Units of Blood and Blood Components Transfused

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