A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations
| Autor: | Alejandra Vilanova-Sanchez, Devin R Halleran, Carlos A. Reck-Burneo, Alessandra C. Gasior, Laura Weaver, Meghan Fisher, Andrea Wagner, Onnalisa Nash, Kristina Booth, Kaleigh Peters, Charae Williams, Sarah Mayer Brown, Peter Lu, Molly Fuchs, Karen Diefenbach, Jeffrey R Leonard, Geri Hewitt, Kate McCracken, Carlo Di Lorenzo, Richard J. Wood, Marc A. Levitt |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Gastrointestinal Diseases Health Personnel Bowel management Disease 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach 030225 pediatrics Medicine Humans Child Patient Care Team business.industry General surgery General Medicine Evidence-based medicine medicine.disease Cloacal exstrophy Ulcerative colitis Colorectal surgery 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Functional constipation Surgery Female business Digestive System Abnormalities |
| Zdroj: | Journal of pediatric surgery. 54(3) |
| ISSN: | 1531-5037 |
| Popis: | Introduction Patients with anorectal malformations (ARM), Hirschsprung disease (HD), and colonic motility disorders often require care from specialists across a variety of fields, including colorectal surgery, urology, gynecology, and GI motility. We sought to describe the process of creating a collaborative process for the care of these complex patients. Methods We developed a model of a devoted center for these conditions that includes physicians, psychologists, social workers, nurses, and advanced practice nurses. Our weekly planning strategy includes a meeting with representatives of all specialties to review all patients prior to evaluation in our multidisciplinary clinic, followed by combined exams under anesthesia or surgical intervention as needed. Results There are 31 people working directly in the Center at present. From the Center's start in 2014 until 2017, 1258 patients were cared for from all 50 United States and 62 countries. 360 patients had an ARM (110 had a cloacal malformation, 11 had cloacal exstrophy), 223 presented with HD, 71 had a spinal malformation or injury causing neurogenic bowel, 321 had severe functional constipation or colonic dysmotility, and 162 had other diagnoses including familial polyposis, Crohn's disease, or ulcerative colitis. We have had 170 multidisciplinary meetings, 170 multispecialty outpatient, and 52 nurse practitioner clinics. In our bowel management program we have seen a total of 514 patients in 36 sessions. Conclusion This is the first report describing the design of a multidisciplinary team approach for patients with colorectal and complex pelvic malformations. We found that approaching these patients in a collaborative way allows for combined medical and surgical decisions with many providers simultaneously, facilitates therapy, and can potentially improve patient outcomes. We hope that this model will help establish new-devoted centers in other locations to encourage centralized care for these rare malformations. Level of evidence IV. |
| Databáze: | OpenAIRE |
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