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Gastroenterology & Hepatology
Newsletter

February 9th, 2016 Issue #1

GI Nutrition Services at DHC

The Stanford Digestive Health Center has developed the GI Nutrition Program to foster its mission of delivering comprehensive world-class care for all digestive disorders.

Our GI Nutrition Program includes a multi-disciplinary team of a physician, nurse, and dietitian who specialize in the treatment of simple and complex nutrition-related disorders. There are three areas of nutrition focus that we provide in the outpatient setting:

Nutrition Support Clinic (TPN/EN)
Research has shown that skilled and coordinated management of total parenteral nutrition (TPN) or tube feeds / enteral nutrition (EN) benefits clinical outcomes and reduces adverse events. The Nutrition Support Clinic is a one-stop shop for multi-disciplinary oversight and management of TPN and EN, central line or enteral access, electrolyte and micronutrient lab monitoring, and treatment of nutrition-related complications for optimal delivery of TPN/EN care. Patients referred for gastrostomy tube (PEG) placement will receive pre-operative assessment, education, and EN setup, as well as longitudinal post-operative follow-up and care. These benefits thus allow the referring specialist to be free to focus on the medical aspects of the patient’s care.

Refer to Gastroenterology with comment “GI Nutrition” and specify indication.

Intestinal Failure Clinic
With one of the largest cohorts of intestinal failure patients on the West Coast, the Intestinal Failure Clinic specializes in treating patients with complex nutritional disorders and malnutrition due to short bowel syndrome, inflammatory bowel disease, chronic malabsorption, and/or diarrhea-related causes. Treatment strategies include a combination of targeted nutritional, medical, and psychosocial approaches to optimize outcomes.

Refer to Gastroenterology with comment “GI Nutrition” and specify indication.

GI Dietitian Services
Our GI Dietitian also provides patient consultations to identify problematic foods in the diet, reduce eating-related symptoms, improve food intake, and reverse undesired weight loss. Our GI Dietitian performs a nutrition assessment, formulation of a nutrition plan of care, education, and counseling for patients to maximize the efficacy of nutrition recommendations.

Refer to Clinical Nutrition with comment “Medical Nutrition Therapy” and specify indication.

The GI Nutrition team can see patients as primary specialists or as support clinicians for the referring gastroenterologist, surgeon, or primary care provider. Nutrition services do not interfere with Gastroenterology billing.

IBD Corner

Our IBD group is gaining momentum, and I want to share a few of the exciting initiatives that are in the works. There is consensus and that the sum of us is greater than our parts, and that we are ready to evolve from a sub-specialty clinic into a center. We have established a bi-monthly group meeting as a forum for collaboration on program development, clinical challenges, and research opportunities.
From a clinical perspective, we have identified a number of goals:

Emphasize the personalized care that we strive to provide each patient.

This is a distinguishing aspect of care at Stanford, which we would like to focus on by offering both the time to understand and communicate about complex treatment decisions, and a culture of hospitality in care, characterized by a spirit of generosity and respect.

Improve access both for new IBD patients and for established urgent patients.

We are improving the process of evaluating and scheduling new patients and piloting a template with an urgent visit slot.

Build on the momentum of expanding education for our fellows, as well as visiting trainees.

The group meeting establishes a venue for discussion of complex cases, advances in therapies, and project development.

Increase collaboration with our colorectal surgical and pediatric colleagues.

Our plan is to open the IBD group meeting up to both our pediatric IBD and colorectal colleagues for appropriate shared topics, and have an IBD focused DDCC quarterly.

Expand our role in the IBD community with outreach and education.

Continue to support educational programs, such as the upcoming CCFA Palo Alto Patient Education Conference, increase outreach to local and regional gastroenterologists, and facilitate patient support groups.

More to come on research projects…

Clinical Service Upate

Inpatient service was launched with great success. It is working very well. Thanks to all!
Strategic planning has moved on from physical design of Redwood City Pavillion D second floor (clinic) and third floor (endoscopy), which are scheduled to open in 2018, to “Operation Readiness.” This involves designing and instituting a broad range of practice improvements and pilot initiatives NOW in clinic and endoscopy (e.g. scheduling in endoscopy).
We will be asking many of you to help with Operation Readiness planning and piloting in your respective areas. More to come!
Please look at the Visibility Walls in and outside the Endoscopy Conference Room for a map of all current initiative.
Linda has been piloting a “patient navigator/scribe” model with Odie, one of our star MAs. It is a great success so far, and we hope to generalize it to all when staffing is adequate to support it.
We have drafted Clinic Guidelines for all patients – setting out our “moral contract” with patients, and setting expectations and responsibilities. Guidelines to follow in a separate e-mail.
ADR initiative has been launched. We anticipate first data report in February 2016. Stay tuned.
We are actively pursuing a staffing model that will provide fair and equal support to all faculty, including RN support for all. APP (NP or PA) collaboration/support is being handled separately, depending on strategic needs and available resources.
We need to agree on a policy regarding second opinions/transfers of care within our faculty group. We plan to discuss this at faculty meeting.
Remember: clinical activities now affect compensation / bonus in multiple ways – e.g. please close all your encounters on time, and pay attention to your PG Likelihood to Recommend Provider scores (this will have a direct impact on funds flow to the division as well as on our bonus as individual faculty)

Valley Care Credentialing

As you all have heard, Valley Care in Pleasanton and Livermore is now part of the Stanford Health Care System. We are asking all Clinical Faculty in GI to complete the credentialing process for VC. The Hepatology Team has already started the process and Jeff Mathews, Administrative Associate in our division, has built a strong relationship with the credentialing people at VC, and he's become our resident expert on the process. Jeff will be available to assist you and/or your own Administrative staff in completing the necessary forms. His email is jsmath@stanford.edu.

Endoscopy

Please welcome Amanda Butler, our new endo nurse who has just transferred from the Mayo Clinic Arizona. She is an experienced endoscopy and manometry nurse.
We have now begun performing paracentesis in the endoscopy unit.
Our nurses have been in-serviced in the care of LVAD patients and general anesthesiologists also had their grand rounds on LVAD patient management this week. Hopefully this should smoothen the endoscopic care of this patient group.

LTR Score

Every month we will publish the latest Likelihood to Recommend scoresheet for GI completely de-identified. You will receive your own number shortly and you will need to use that number every month to track your score. GI is doing well, very close to being in the green for the division, just a small percentage to go.