Registered nurses and physical therapists are the mainstays of Huntsman at Home, she adds. Nurse practitioners employed by the cancer center conduct complex visits and patient assessments; they’re also on-hand to visit patients urgently in their homes if they’re deteriorating. Otherwise, it is registered nurses employed by Community Nursing Services who do home visits. All clinicians are under the direction of a medical director at the Huntsman Cancer Center, according to Titchener.
Salt Lake City isn’t plagued by traffic. “If there are 10 cars on the road, that’s morning rush hour,” she says. Still, to make the best use of clinicians’ time, they’re organized by geographic region. That means, for example, that clinicians aren’t being sent north, east, south, and west; instead, a group of nurses focuses on patients in each region.
What sells healthcare executives on this program? According to Titchener, it’s data. For example, in 2017, there were more than 40,000 emergency department admissions, 40% of whom were among patients who were admitted to the hospital; these patients had an average length of stay of 10 days.
The Huntsman at Home program will lead to fewer emergency room visits, fewer unplanned hospital admissions, reduced length of stay for patients, and improved patient outcomes and family experience, says Titchener. She was unable to share statistics, but her team is in the process of having the results published in a study.
Froedtert & Medical College of Wisconsin offers innovative therapy
In January 2019, Milwaukee-based Froedtert & the Medical College of Wisconsin, a regional health network that operates eastern Wisconsin’s only academic medical center, treated the first cancer patient in the United States using the MR-linac, which integrates high-field MRI and modern linear accelerator technologies. This is a history-making event because, with this technology, providers can image tissue from cancers of the pancreas, liver, and kidney more easily—that’s in addition to being able to tailor the therapy precisely for each patient’s tumor type.
Delivering this therapy entailed a 10-year journey that started with the health system’s process of strategizing about its capital equipment purchases, says Christopher Schultz, MD, chairman of radiation oncology at the health system.
Some lessons he learned:
- Recruiting physicists with experience in MR imaging, not a typical skill set for physicists, is a challenge. Once on board, the physicists helped develop a workflow to incorporate MR imaging into the radiation therapy workflow.
- Planning and patience are important. Schultz describes it as “an engineering hurdle” to put two strong electromagnetic fields next to each other in a room—one magnet in the MRI scanner and the other in the linear accelerator. Stockholm-based Elekta, a medical device company that manufactures radiotherapy solutions for cancer care and brain disorders, partnered with Amsterdam-based Philips, he healthcare technology company with global reach, to develop the platform, which received FDA approval in December 2018.
- Cross-specialty collaboration is key. At first, radiologists weren’t comfortable interpreting these images, since they weren’t in organized in the series they were used to, says Schultz. The solution? His team of physicists and physicians knew enough about MR imaging to build trust with radiologists and bring them on board. The collaboration continues in monthly meetings, mostly to coordinate scheduling; the MRI machine is also used for breast biopsies, brachytherapy planning, and sometimes cardiac imaging.
Aine Cryts is a writer based in Boston.