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Taubman ACU - University of Michigan Health System

The University of Michigan Department of Urology
3875 Taubman Center, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, Michigan 48109-5330
Academic Office: (734) 232-4943 FAX: (734) 936-8037
What's New November 28, 2014
What's New in the Taubman ACU
by John Stoffel
Faculty, Fellows, Residents, and PAs
12 Minutes
For a relatively small department, our faculty and staff provide a
disproportionate amount of administrative service to the organization.
Just thinking about the biggest roles on the clinical side, we have John
Park as Surgeon-In-Chief of the Mott Children's Hospital, and 3 ACU
directors: Gary Faerber for CSCL, Alon Weizer for the cancer center,
and John Stoffel for Taubman Urology. While these administrative
activities may take time away from our primary missions, they are
nonetheless essential. Without such involvement, our needs will be
subjugated by other departments and hospital administrators. More
importantly, by being involved, we can affect change to control our
practice environment and improve the quality of care we deliver.
This week, we hear from Dr. Stoffel about what's new in the Taubman
ACU, home for many of our providers and our largest urology practice
site. But with the upcoming holiday weekend, business will close in all of
our ACU's, even Taubman Center. Hopefully, everyone will have a
restful weekend and maybe get together with friends and family for a
good meal.
Thanksgiving is also a time when we should be thankful for all that we
have – to be able to provide for our families, to do what we enjoy doing,
and to have the opportunity to work with great people in the best
Urology Department in the country. At the same time, we should think
about those who have less than we do and children who have to go to
bed hungry. This week, we will open our second Urology survey for our
faculty and staff. The purpose is to get to know more about ourselves
as a Urology family. Survey link:
Please follow this link and take a quick minute to answer this month’s
survey. As before, I will summarize the findings in a few weeks.
For those with kids, recounting the tale of TWO THANKSGIVING
DAY GENTLEMAN by O’Henry is a fun way to frame conversation
about those less fortunate. It's reprinted on the web here: I wish you all a wonderful holiday weekend!
- John T. Wei, MD, WN Editor
I would like to start by wishing everyone a Happy Thanksgiving holiday.
Hopefully everyone will be able to spend some time with family and
friends and reflect back over 2014. The past year has been busy in
the TC Urology ACU. FY2014, the TC Urology ACU saw 14,544 patient
visits and are on pace to see over 15,000 patients in FY2015. In the
TC Urology ACU, we currently have 14 patient care rooms, 2 fiber optic
cystoscopy suites, a dedicated fluoroscopy suite complete with Hoyer
lift, and 1 - 2 treatment rooms. Physicians, nurse practitioners, and
physician assistants from Neurourology/Pelvic Reconstruction, General
Urology, Endourology, and Andrology hold clinics 5 days a week.
Procedures offered at Taubman Center include cystoscopy, urethral
bulking for stress incontinence, onabotulinum toxin injection clinics for
urge incontinence/neurogenic bladder, fluoroscopic urodynamics,
percutaneous tibia nerve stimulation for urge incontinence, and
prostate biopsies. In addition, urology nurses continue to perform
catheter changes, bladder instillation, pre-operative teaching, and
voiding trials. As always, Kandy Buckland, Malissa Eversole and Jack
Cichon (as well as many other people) have been instrumental in keeping
the clinic running, efficient and productive.
This What’s New will really be What’s New in the Taubman ACU for
2014-2015. Although our core mission remains unchanged - To provide
kind, compassionate, and complete urologic care to each patient, every
visit – we continue to evolve in our delivery of this care by adding new
services and processes to help. I will briefly highlight new
procedures, processes, and ideas for the coming year.
New procedures in TC Urology Clinics for 2015: MRI/US fusion
prostate biopsies
MRI/US fusion prostate biopsies are now available at the University of
Michigan Taubman Center Urology Clinics. This combination imaging
represents a technological advance for potentially diagnosing high risk
prostate cancer and University of Michigan Department of Urology is
currently the only center in Michigan where this procedure is available.
Dr. Jeff Montgomery is spearheading this program for our
department. The following description about the biopsy system is from
Dr. Montgomery:
“We have nearly 18 months of experience performing MRI/US
fusion biopsies in the Taubman Center. This has been part of a
DOD trial designed to evaluate the use of whole-body PET scan in
addition to MRI/US fusion biopsy to diagnose localized prostate
cancer. Multiparametric prostate MRI allows for more reliable
identification of intermediate and high-risk prostate
cancer. These lesions can then be targeted during a prostate
biopsy using software that allows a previously obtained prostate
MRI to co-register with live prostate US – as the US probe
moves, the MRI images with previously marked targets move to
correspond with the live US image. This week, we are expanding
our commitment to this cutting edge technology with the launch
of our Uronav system… Initially, the Uronav fusion biopsy will be
used in men with previously negative prostate biopsy with
continued concern for prostate cancer or men with known
prostate cancer who are considering pursuing active
surveillance. We expect that this will eventually expand to the
majority of men who are presenting for prostate biopsy.”
Please contact Jeff Montgomery if you have a patient who you feel may
benefit from this prostate biopsy technique or to learn more about the
New TC Providers: Dr. Jim Dupree, Andrology and Urologic Health
Dr. Dupree joined our department in 2014 and specializes in Andrology
and particularly infertility. Please see his excellent What’s New from
11/14/2014 for more about his path to the University of Michigan. I
would like to briefly highlight him again here to remind people that he
has clinics every other Tuesday am in the TC clinics (as well as in
Briarwood and Livonia). Since the state of Michigan is suffering from a
lag in population - please refer patients to him!
New Clinical Services: Transitional Care and Urgent Care
As you can see from the below graph, unscheduled readmissions
continue to be a persistent problem both for the Urology Department
and the hospital.
Because of this need, The Urology Transitional Care Clinic opened
September 2014 in the Taubman Center. The target population for
this clinic is post surgical urology patients at high risk for readmission
after discharge. This includes all non bladder cancer urinary diversion
patients, patients receiving unscheduled CT during admission, patients
with unexpected complications such as acute kidney injury, and those
referred to skilled nursing facilities. Since most bladder cancer
cystectomy patients are now following an established pathway in the
Cancer Center, the TC Transition Clinic hopes to serve the needs of
non-oncology high risk patients. Dr.Ted Skolarus, and PA’s Elizabeth
Marsh and Mary Nowlin helped develop this clinical program and are
working to define the needs of this population.
Currently, transition care patients will be scheduled at discharge and
informed of their follow up appointment date. It should be within 3-10
days after discharge. If patients decline an appointment, the patients
will be called by nursing and a transition clinic checklist will be
completed over the phone. Even if patients decline the post operative
transition clinic visit due to transportation issues, please offer the
patient a follow up call through nursing. Mary and Liz have details on
how to facilitate this.
Over the next few months, we hope to better understand the
utilization of this clinic, who benefits from a transition care visit, and
barriers for transition care access. Hopefully, this information will
help the department develop guidelines for how to best implement
transitional care for our at risk patients.
Patient access for urgent urologic care is also a high priority in the TC
Urology Clinics. Our goal is to open 1-2 slots every day in the TC
Urology clinic to see established urology patients with urgent urologic
conditions. The slots will be in late morning/early afternoon and will be
for established urologic patients who need and an urgent assessment
but do not need to go to the ER. Examples of urgent needs patients
would be patients with rapidly progressing symptoms of UTI and a risk
for sepsis, urinary retention and unable to perform CIC, and gross
hematuria causing urinary obstruction. The goal would be to assess and
treat these types of patients rapidly and avoid sending them to the ER.
The clinic is not for routine problems like chronic pain management,
prescription refills, routine wound care, routine catheter changes,
or patients wishing to have a clinic appointment moved up.
We are currently reviewing the Departmental Consult database for
more information on who can best benefit from an urgent care
appointment. Stanley Mukundi, Cindy Stroup, and Diane Collin are in
the process of developing time slots for these patients. Please thank
them for participating in this important initiative.
New Process: Site Dashboard
Our goal in the TC Urology Clinic is to provide optimal access for
urology patients. Understanding how access at TC relates to the other
urology practice sites (Livonia, Cancer Center, Mott, Brighton,
Briarwood, Chelsea, Ypsilanti, Domino Farms, and Northville) is
critically important to offering patients the quickest appointment with
the correct provider. We are starting to develop the following metrics
by both site and provider into a “Site Dashboard” which we can
compare monthly between sites. This will allow us to better
understand how to distribute clinics and urologic access as the
department continues to expand.
Dashboard will include:
Lead time to scheduling new appointment, RV
% utilization of available clinic slot (scheduled and overbooked)
% cancellation and reschedule
(We are also looking at time to closing encounters now on a monthly
basis, so please continue to close them!)
Thank you for reading this over the Thanksgiving break and a big thank
you to everyone in the department for the excellent, compassionate
care that you do every day for our patients.
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