LOUISVILLE If you mention “support system” in the company of gynecologists, their first thought may be of pelvic organ prolapse repair rather than a program that unites services for women. At Norton Suburban Hospital, both definitions apply. The organization has made a recent push to reorganize their existing women’s services and standardize clinical care in the hopes of expanding their presence as a regional resource in women’s health.
Norton Healthcare is currently in the midst of a significant renovation of Norton Suburban Hospital, transforming it into the future Norton Women’s and Kosair Children’s Hospital, which is scheduled to open fall 2014. Having a solid foundation in women’s health, both at its downtown Louisville campus and at Norton Suburban, the physical renovation gave the health system the opportunity to reevaluate and realign its women’s health services to better serve patients.
Female pelvic health is a top priority for Norton Healthcare. In 2013, Norton Suburban Hospital sought and received designation as a Center of Excellence in Minimally Invasive Gynecology (COEMIG™) by the AAGL-Advancing Minimally Invasive Gynecology Worldwide. They are currently the only facility in Kentucky to hold that designation.
Jonathan Reinstine, MD, an OB/GYN with Associates in Obstetrics & Gynecology, is the medical director of the Pelvic Health Program and the COEMIG program at Norton. Having been in Louisville for 32 years and having performed laparoscopic hysterectomies for 25 years, he says Norton has always practiced advanced minimally invasive surgery. However, the COEMIG designation lends further credibility to the program, while fostering quality improvement and safety, providing high clinical benchmarks, reducing health care costs, and raising public awareness. Both the facility, including all aspects of surgical care – pre-operative, post-operative, nursing, laboratory, emergency, radiology, etc. – and the surgeons are certified. COEMIG certification is a three-year cycle.
Navigation and Teamwork
Reinstine estimates 25 to 30 percent of women suffer from pelvic health issues and says the key to treatment is considering multiple organ systems. While Norton had a variety of specialists and services already in place, “Our goal was bringing them together,” he says.
To facilitate assembling the pieces of the puzzle, Norton hired Melissa Ulfe, RN, as nurse navigator. Ulfe managed the COEMIG application process and helped establish clinical pathways to meet COEMIG requirements. Ulfe has 20 years’ experience as an RN and five years as a patient navigator, first with breast cancer patients and now in pelvic health.
The pelvic health team includes specialists in gynecology, urogynecology, pediatric and adolescent gynecology, urology, allergy, colorectal surgery, interventional radiology, anesthesiology, physical therapy, and mental health. The team is a mix of Norton Healthcare-employed specialists and independent practitioners. “Our goal was to get the best folks that we could, regardless of affiliation,” says Reinstine. The team holds a monthly pelvic health conference that is open house-wide for the presentation and consultation of difficult cases and updates on new technologies.
Physical therapy for pelvic floor disorders is one of the more unique aspects of the program. Commonly, patients do not realize physical therapy is even an option for female pelvic problems. Norton utilizes Dunn Physical Therapy, an independent PT practice specializing in these issues. [See related article on Dunn Physical Therapy on page 25.]
A Higher Level of Sophistication
Like most gynecologic surgeons, those with Norton’s pelvic health program treat a high volume of uterine fibroids, endometriosis, pelvic organ prolapse, urinary incontinence, and gynecological malignancies. Reinstine says there is increasing attention on chronic pelvic pain, utilizing the multidisciplinary approach and physical therapy for treatment. The surgeries and treatments surgeons use have not changed with COEMIG certification, but the surgeons must follow specific standards and demonstrate proficiency and volume.
The cohesiveness created in pursuit of the designation is providing easy interaction and regular consultation among physicians on difficult cases. “We are doing a lot of the things that get done on a daily basis but at a higher level of sophistication,” says Reinstine.
Norton Suburban Hospital does have the da Vinci Surgical System® and the capability to do single-site hysterectomies robotically. Though Reinstine contends, “One of the big things now is to find that proper value position for robotics with increasing cost-consciousness.”
Another benefit that has emerged is the standardization of care. “One of the things that’s very helpful is reducing variation. If, as a group of surgeons, we can practice pretty consistently, that helps the nursing staff and the operating room staff be prepared. Patients are getting a very consistent message, and the process runs very smoothly,” says Reinstine.
A critical component of the COEMIG requirements is education, which includes patient education, nursing and ancillary staff education, and physician education.
In addition to organizing resources for COEMIG, Ulfe helps educate patients on disease processes and treatments and how to navigate the complex health care system. “What I like to tell the lay person is [nurse navigators] are like the GPS in your car. We are here to get you through the health care system,” says Ulfe. She also has insider information – she has a list, not only of all the specialists, but one that includes details on what each physician’s passion and niche is. “If I get calls, I know what doctors specialize in and can funnel patients in the right direction,” says Ulfe.
Nursing and ancillary staff meet quarterly for updates and in-services.
Physicians receive a plethora of education during their formal training, but not as much attention is given to “education for physicians of today,” says Reinstine. “Missy’s gotten us certified for category one CMEs. Not only are we educating but we are helping others keep their certification up.” He believes the CME program will be a resource for all OB/GYN-related specialists in the region.
For Reinstine, it’s not about competition but about support. “I want [the program] to be a resource. I’m interested in enhancing what other physicians do in their own practices,” he says.
COEMIG certification allows us to do the things that get done on a daily basis with a higher level of sophistication and coordination.