UCHealth University of Colorado Hospital has cemented its place among the nation’s leaders in treating and caring for patients who are among medicine’s most vulnerable.
They are people who receive stem-cell transplants for leukemia and other diseases of the blood and marrow. Newly available data from the Center for International Blood and Marrow Transplant Research show that the BMT Program at University of Colorado Hospital has achieved greater than expected one-year survival rates for these patients for four consecutive years.
Nationally, only five other BMT centers have achieved this distinction, noted Jonathan Gutman, MD, associate professor with the Division of
Hematology in the University of Colorado School of Medicine’s Department of Medicine and clinical director of Allogeneic Stem Cell Transplantation at CU.
The latest outcome figures are based on three years of data gathered from 2012 to 2014 for allogeneic transplants (those that use cells collected from donors rather than the patient’s own cells) and are risk-adjusted to account for patient acuity, Gutman said.
He noted that the consistently superior survival rates occurred during a period when the BMT Program increased its case volume by half, from 65 in fiscal year 2012 (which ended June 30, 2012) to 97 in fiscal year 2014. In fiscal year 2016, the program performed 127 transplants. Gutman said the program aims to double that number in the next five years.
Only the beginning
It will require concentrated effort to achieve that goal while maintaining or exceeding the program’s quality standards, he said.
“The care of these patients is complex and multidisciplinary,” Gutman said. “The outcomes data is a testament to our team building.” He pointed to clinical research and integration with ClinImmune, a CU-led bank for cord blood that is a valuable source for donor cells, as additional differentiators for the program. He also cited strong leadership from Clay Smith, MD, program director for the BMT and Blood Cancer programs as essential in guiding the program forward.
Gutman noted that the program now has nine attending physicians, up from four in 2010. But physicians work closely with a large team that includes nearly two dozen advanced practice providers, inpatient and outpatient clinical nurses, case managers, social workers, pharmacists, dietitians and other providers. They care for patients who face the challenge of arduous procedures followed by lengthy hospitalizations and periods in which their immunosuppressed systems are exposed to infection while their bodies rebuild their supplies of healthy cells.
“Our patients present at the most vulnerable times in their lives,” said Jamie Nordhagen, RN, nurse manager of the Oncology/BMT Unit at UCH. “What we do to them will cause pain and potentially harm in the short term. They are sometimes here several weeks and are completely dependent on us.”
In strengthening the BMT program, staff and providers confronted a familiar hospital issue, Nordhagen said: strengthening communication between the various teams and departments that provide patient care.
“We worked hard to get people out of their silos, she said.
An Institute for Healthcare Quality, Safety and Efficiency (IHQSE) project is helping to do that. Inpatient and outpatient leadership worked
together to improve care coordination for BMT patients, Nordhagen said. The linchpin is daily bedside rounding that includes all key team members. They visit each patient and his or her family members and work together to identify barriers and develop plans of care, both for the inpatient stay and after discharge.
The rounding began last September. “We’re still fine-tuning it,” Nordhagen said, “but it has pushed us all to be our best and to become a single program instead of siloed units.” Inpatient and outpatient leaders now meet once a month to strengthen communication and build working relationships, she added.
The addition of 20 direct-care nurses in the past year bolstered the effort, Nordhagen said. They received specialized training in caring for transplant patients.
“Leadership has helped to ensure that we have the resources and the processes in place to do our jobs,” she said.
Nordhagen acknowledged that challenges remain, however, especially monitoring patients after they leave the hospital. Many come from outside the Denver metro area but must stay close to the hospital for 90 days after discharge. During that time, they need follow-up care, including outpatient clinic visits, medication management, and attention to social and logistical barriers that can prevent them from getting it.
“We’re continuing to work on our discharge processes and managing our patients’ transitions of care,” Nordhagen said.
Across the years
The BMT program’s outcomes data is impressive, but warm bodies often tell a more compelling story than cold numbers. One example occurred Jan. 13 when 73-year-old Lynn Kelly of Denver returned to the BMT Unit at UCH. Kelly underwent two stem cell transplants after she was diagnosed with leukemia in March 2015. Providers from throughout the unit thronged around a smiling Kelly, while her sister and caregiver Ginger McLaughlin looked on. Kelly said she’s been “feeling good” since the second transplant.
The stem cell donor for both procedures was Dustin Radke from the St. Louis area. The 20-year-old Radke, accompanied by his parents John and Bridgette, was in town to meet Kelly for the first time. He donated his cells – all 19 million of them – after attending a blood drive at the University of Missouri and registering as a blood and marrow donor. He was 18 at the time.
When it turned out his blood was a match for Kelly – whom he wouldn’t know for some time – Radke agreed to go to Georgetown University for a complete physical and stem cell collection, which required two trips in May 2015. The first transplant Kelly received at UCH didn’t succeed. However, the hospital hadn’t needed Radke’s entire donation and had frozen enough cells for the second, successful transplant.
The two chose to get one another’s names and then corresponded by letters, emails and texts before meeting face to face. The 50-year age gap made no apparent difference to two people bound by something much more profound.
“She’s a rock star,” Radke said of Kelly. Together they rang a bell near the nurse’s station to signal the victory over the disease.
The entire unit could join in their obvious joy. “We’ve built a culture of working together,” said Gutman, who was Kelly’s medical oncologist. “Clinical leaders and all team members have worked hard to bring quality care to the highest possible levels.”