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 www.urology.med.umich.edu http://matulathoughts.org/ 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: https://umichumhs.qualtrics.com/SE/?SID=SV_0qyUh8OsEmaDcuF 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: http://thenostalgialeague.com/olmag/ohenry-two-thanksgiving-daygentlemen.html. 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 program. New TC Providers: Dr. Jim Dupree, Andrology and Urologic Health Division 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.