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Teamwork at the Heart of Award Winning Care Path

March 12, 2013
Lebanon, NH

Esophageal cancer patients endure a long and arduous road to recovery that often includes surgery and other cancer treatments, an extended hospital stay, tube feedings, difficulty with swallowing and months of missed work time.

"Esophageal cancer is not a disease that a single specialty, no matter how accomplished, can treat effectively," says Cherie Erkmen, MD, a thoracic surgeon at Dartmouth-Hitchcock (D-H) who cares for these patients. "It requires a multidisciplinary approach, involving a large number of clinical disciplines and services."

Two years ago when Erkmen agreed to lead a project to develop a better "care path" for esophageal cancer patients, she focused on making it as patient-centered and as inclusive as possible. "A care path defines all of the steps of care that patients experience as they flow through our system, using the best evidence available to support the steps taken," she explains. "The goal is to improve both quality and efficiency of care over time."

During the course of the project, Erkmen met every two weeks with groups representing a total of 12 different disciplines. "We included everyone who interacts with esophageal cancer patients and asked, ‘What's the optimal scenario for you?' and then, ‘What are the barriers to providing that optimal care?'" she says. "In the process, they came to understand what was ideal from my perspective. We carried that same investigative type process to each step of care and worked together to make improvements."

The work was incredibly detailed, but never tedious. "The issues presented by the intake secretaries and administrative staff were the first we took on, and once we gained momentum and people could see how well it was working they got really excited about participating," says Wendy Oliver, a secretary in Thoracic Oncology, who stayed on to provide valuable input at several stages of the project.

One key result of their efforts, says Oliver, was improved coordination between diagnostic staff and the many providers who see patients in clinic—making patients' visits more productive while reducing the need for them to make multiple trips to D-H. Another was a comprehensive patient resource binder developed by project team members to help educate and support patients and families through their journey. Erkmen also organized a patient reunion last September, providing a chance for those in recovery to meet and visit. Clinicians and staff were also invited, and many appreciated being able to see patients who were "back to life" and doing well.

"All serve as examples of how thoughtful and patient-centered Dr. Erkmen's approach has been," says Linda Mason, MSW, a licensed clinical social worker and continuing care coordinator who participated in the project. "She really does see us as a team, and that each person has something to bring and to offer to the patient and to one another. There was a strong feeling of collegiality that has stayed with us as we carry the care path work forward."

Project team member Betsy Maislen, APRN, a nurse practitioner and certified tobacco treatment specialist, agrees. "I have to commend Dr. Erkmen for her outstanding leadership," says Maislen. "Not just for her ability to pull so many people from different areas together, but in making each team member feel like what they do is valuable."

A few months ago, at the Department of Surgery's second annual Care Path Award event, Dr. Erkmen and her colleagues were rewarded for their efforts, earning $25,000. She is using the money to establish a patient support network and to develop additional patient education materials. "I'm thrilled that people took such interest in and also such ownership of their parts of the care path project," Erkmen says. "What we accomplished was far more than what I could have ever thought of on my own."

About Dartmouth-Hitchcock

Dartmouth-Hitchcock is a national leader in patient-centered health care and building a sustainable health system. Founded in 1893, the system includes New Hampshire's only Level 1 trauma center and its only air ambulance service, as well as the Norris Cotton Cancer Center, one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the Children's Hospital at Dartmouth-Hitchcock, the state's only Children's Hospital Association-approved, comprehensive, full-service children's hospital. As an academic medical center, Dartmouth-Hitchcock provides access to nearly 1,000 primary care doctors and specialists in almost every area of medicine, as well as world-class research at the Audrey and Theodor Geisel School of Medicine at Dartmouth.

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