Assisted Ventilation Clinic offers patients outside the box care
“When you’re in the hospital, you lie in a bed and everyone comes to you. Why can’t we do the same thing with our outpatient visits?”
Dr. Robert Sitrin was toying with this question for months when he finally decided he should bring the idea to Galen Toews, his division chief at the time.
“I went to Galen and explained the need for a clinic that could service some of our most complex patients and make their visits easier for them,” says Sitrin. “This would have never happened if the chief hadn’t supported me.”
The clinic Sitrin is referring to is the Assisted Ventilation Clinic run by the Pulmonary & Critical Care Medicine team, a division of Internal Medicine at U-M.
The clinic is specifically designed for patients with severe chronic pulmonary (respiratory and lung disorders) that leave a patient needing a machine called a ventilator for assistance in breathing.
The clinic may be the first of its kind in the country for adults. Similar clinics had been operating for several years in pediatric settings, but not specifically for adults.
“It became clear to me there was a large enough population of patients to support an adult clinic,” Sitrin says.
The clinic opened in 2009 as a joint effort with the Department of Physical Medicine and Rehabilitation after three and a half years of planning.
“We had a reservoir of patients waiting for help that could immediately get us up and running,” Sitrin says.
So what makes the clinic special?
“Going to the hospital or physician’s office is often extremely challenging for the majority of our patients,” Sitrin says. “Our patients may be quadriplegic, have several caregivers that have to help them travel or have other daily challenges. Just getting them to one appointment is a big deal and we wanted to take away the burden of having them have to do that multiple times when a single visit would suffice.”
The clinic allows critically ill patients to be seen by multiple types of providers all at one visit. A patient can be seen by their pulmonary provider, dietician, physical medicine and rehabilitation provider, respiratory therapist, cardiologist, neurologist, and the list goes on.
The clinic sets up extended appointments where all of the specialty providers can be available to the patients and mimics an inpatient team with all of the providers on rounds going from patient to patient.
In turn, patients and their caregivers only have to visit the clinic, instead of trying to schedule appointments with each type of provider.
“It’s one stop shopping for our patients,” Sitrin says. “They really seem to like it.”
Patients come first
Emily Houser knows first-hand how the clinic can help. Her sister, Becky, has a severe brain injury that has made her a patient of the clinic for several years.
“A primary doctor couldn’t manage what Becky was going through,” says Houser, Becky’s legal guardian and caregiver. “If we didn’t have a good system in place or an antibiotic that could be called in that day to help her, we would have to go to the hospital.”
Becky’s doctor referred her to the pulmonary division at U-M and when her pulmonary function continued declining, her pulmonologist recommended she become a patient of the Assisted Ventilation Clinic.
“I was really nervous at first to take Becky to the clinic, but I realized they are so good at managing complex patients. Even if it’s a long appointment, you can get everything you need taken care of at once and all of the physicians work great together,” Houser adds.
But Emily says that’s not the best part about the clinic.
“I can’t say how huge it is that we can manage Becky at home now, even when she’s sick, because of how quickly they respond. She used to be hospitalized four or five times a year before the clinic, but now she’s only been hospitalized twice in the past 10 years.”
Patients and their caregivers can call the clinic at any time to speak with a nurse or nurse practitioner regarding medical help they can perform at home.
“An actual person answers the phone when I call and when I say ‘This is Emily Houser’ they know exactly who I am,” Houser says. “That’s so helpful in taking care of her.”
“As pleased as I am with the structure of the clinic, it’s the human factor that elevates the level of service,” Sitrin says. “Our nurses, Julie Hanley and Kim Rochefort, and our respiratory therapist, Armando Kurili, are the backbone of the clinic operation. They make us all look great every day.”
In the next coming months, the clinic will be adding a telemedicine component to further help patients at home.
“The service would be used to enhance visits and care for our patients,” says Julie Hanley, a nurse practitioner at the clinic and the one spearheading the new telemedicine program. “It will help us stay in contact with our patients. We’ll use it to troubleshoot their concerns in hopes they don’t have to make a trip into the clinic. For example, some of our patients are not able to verbally communicate so a webcam would help us see them and enhance information we’re getting on how they’re doing.”
The Assisted Ventilation Clinic has bright plans for the future and plans to continue giving patients the high-quality health care they deserve.
“Anything we can do to make this easier for the patients and families is always what we aim for,” Hanley says.
Emily says the clinic has truly done just that for her sister.
“Now Becky is at home and happier than she’s been in years,” Houser says.
The clinic will continue moving forward with new plans, such as the telemedicine program, but will be losing one important component next month—the retirement of the clinic founder Dr. Sitrin.
Dr. Sitrin’s contributions have been noticed by many in the division and department, including division chief Dr. Theodore Standiford.
“Bob Sitrin is a person with immense talent and passion,” Standiford says. “In the first phase of his career, Bob was a highly acclaimed laboratory-based scientist. In the second phase, Dr. Sitrin followed his long-standing interest in chronic respiratory failure to create the largest and most comprehensive adult assisted ventilation program in the country.”
“His program is now the gold-standard for others to model.”