Best Practices and Methodologies

Bariatric Surgery and Weight Management Programs achieve “Trifecta” with PFCC

 

Jeffrey Gusenoff, MD

Jeffrey Gusenoff, MD

Vickie March, MD

Vickie March, MD

 

This is the third in a series of guest blog posts, spotlighting how hospitals are engaging their patients to transform care delivery, using the Patient and Family Centered Care Methodology and Practice.

Magee-Womens Hospital of UPMC

Magee-Womens Hospital of UPMC

The Minimally Invasive Bariatric and General Surgery team at Magee-Womens Hospital of UPMC, performs over 1000 procedures annually. By adopting the six-step, Patient and Family Centered Care Methodology and Practice (PFCC M/P) in 2008, we have not only substantially improved the care experience for patient and families but also improved clinical outcomes and reduced costs.   

 

 

 

Step 1: Define the Care Experience for Improvement

We initially defined this PFCC Care Experience as beginning when the patient expresses interest in exploring weight loss surgery and ending after the patient’s post-surgical follow-ups. Over time, as post-surgical follow-up has evolved and as non-surgical weight management programming has been developed, the end point has changed to encompass a wide variety of weight management programs which we discuss in further detail at the end of this post. 

Step 2: Create The PFCC Guiding Council

The PFCC Guiding Council for the Bariatric Surgery and Weight-Management programs consists of: 

Administrative Co-Champions: Chief Operating Officer and Practice Manager  

Clinical Champions: Co-Directors of the program

PFCC Coordinator:  Practice Manager

 

Step 3: Define the Current State through Shadowing

Shadowing was conducted when we first adopted the PFCC M/P in 2008 and we continue to employ Shadowing periodically so that we have an ongoing understanding of “the current state.”  For our surgical programs, Shadowing segments include: the initial contact, the information session, the six-month session, clinic visits, inpatient and surgery, forms, and the Website. The beginning and end points vary, as might be expected, for the non-surgical weight management programs that we’ve launched in the last several years.

Step 4: Expand the PFCC Guiding Council into a PFCC Working Group

PFCC Working Groups are comprised of all those who impact the patient and family experience, either directly or indirectly. The Minimally Invasive Bariatric and General Surgery Working Group includes our PFCC Guiding Council members along with staff representing pharmacy, education, health management, dietitians, patient access, surgical services, imaging, lab and transport, as well as inpatient and outpatient clinicians. 

Step 5: Create a Shared Vision by Writing the Ideal Story

The PFCC Working Group created a shared vision of the ideal care story in 2008 based on Shadowing observations, letters, surveys, patient and family input, and ideas provided by care givers (anyone in the health care setting who touches the patient and family). The ideal story was written in first person from the patient and family point of view and covered the time from initial contact through post-discharge clinic visits.  Many aspects of the original ideal story have been achieved and new ideals stories have been written as re-Shadowing occurred and non-surgical weight management programs were developed. (The ideal story is too long for publication here but feel free to contact us for a copy.)

Step 6: Create PFCC Projects and Project Teams

Dozens of PFCC Projects have been completed over the past six years that include streamliningsix years that include streamlining processes, creating new patient materials and discharge packets, enhancing privacy (e.g., creating more private weighing and counseling areas), improving patient-facing forms, revising educational activities, and creating new training programs for staff.  However, we would like to highlight two PFCC Projects that have taken on a life of their own: Reducing Readmissions after Weight Loss Surgery and the UPMC BodyChangers Program.   

Reducing Readmissions

Analysis of the reasons for readmission for bariatric surgery patients identified a common thread of dehydration. Shadowing identified a need for additional patient and family education about hydration which we addressed by 1) adding hydration education to the pre-op and hospital discharge education process using further Shadowing to identify appropriate time points for each educational step, 2) developing a “quiz” to assess patient understanding regarding dehydration, 3) creating a Hydration Fact Sheet, and 4) educating staff on the “teach back” technique.

Shadowing was used throughout this project to identify the true current state and new current states, which in turn led to: 1) development of a post-discharge Bariatric Surgery Discharge Journal to log fluid intake, wound assessment, pain score, nausea assessment, signs/symptoms of dehydration, and fluid ml/ounce conversation table; 2) pilot distribution of “calibrated” water bottles post-discharge, and 3) post-discharge nursing calls to patients at home to answer questions and assess journal use. 

Published results from this initiative included metrics for patient experience, clinical outcomes and cost outcomes – what we call the PFCC Trifecta: 

Experience

Metrics

Clinical

Metrics

Cost

Metrics

  • Fewer symptoms of dehydration (e.g., nausea and pain)   
  • Reducing readmissions minimizes disruption on the path to wellness 
  • Focus on wellness 
  • Reduced readmissions in this patient population from an average of 9.5 to 1 per month in the initial 22 patient intervention group 
  • Fewer infections = fewer readmissions     
Cost reductions for reducing readmissions are significant and include not only reimbursement but the ability for the patient and family to return to pre-surgical levels of activity and work sooner

 

The improved patient education paradigm has increased: our focus on common complications, collaboration between inpatient and outpatient teams, collaboration between disciplines, and collaboration between all UPMC Bariatric Programs.  This same model is currently being used to address other common complications of bariatric surgery including wound infection, pain, vitamin deficiency, weight gain, and deep vein thrombosis and pulmonary embolism. 

UPMC BodyChangers Program

Based at Magee-Womens Hospital of UPMC and a joint venture of Life After Weight Loss and Bariatric Surgery, UPMC BodyChangers program addresses a need identified through the PFCC M/P to bring together a supportive community of like-minded individuals who want to be happy, healthy, energetic and fit by taking better care of themselves. Membership in UPMC BodyChangers includes: 

  • Educational seminars  
  • Cooking classes
  • Exercise
  • Destination education: Outings to local supermarkets, parks, trails, farmers’ markets, and other sites that promote healthy living
  • Mind Over Body: Group sessions designed to help develop strategies for permanent weight control
  • Body image/body contouring: Options for loose skin after weight loss
  • Monthly e-newsletter: Healthy recipes, program updates, and motivational material
  • Contests, competitions, incentives, prizes and freebies
  • Networking opportunities

For more information, please feel free to contact Lisa Schraeder at schraederll@upmc.edu or Pamela Greenhouse at greenhousepk@upmc.edu

Editor’s Note:  The success of the PFCC methodology and practice in these UPMC programs is also evident in videos of patients who are participating in them.

 

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Drs. Jeffrey Gusenoff and Vicki March Dr. Jeffrey Gusenoff is Co-Director of UPMC BodyChanger and the UPMC Life After Weight Loss Program. He is a Visiting Associate Professor of Surgery, Division of Plastic Surgery. His interests include post-weight loss plastic surgery combined with lifestyle and nutritional counseling to maintain weight loss. He has authored numerous publications and was a two-time recipient of the Joseph M. Serletti, MD, Resident Award for Excellence in Academic Plastic Surgery. Dr. Vicki March is Co-Director and Co-Founder of UPMC BodyChangers, and is a Clinical Assistant Professor in the Department of Internal Medicine. In addition, she is the Medical Director of The Lifestyle Program in the Minimally Invasive Bariatric and General Surgery Division. Dr. March received her medical degree from the University of Pennsylvania. She then completed her residency at Drexel University in Philadelphia, Pennsylvania. She is March is board-certified in both Internal Medicine and Obesity Medicine and has authored several publications

Drs. Jeffrey Gusenoff and Vicki March has 1 post(s) at EngagingPatients.org


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