Best Practices for Building a Multidisciplinary Fontan Clinic & Combined Heart-Liver Transplant Program
Overview:
Purpose: Multidisciplinary care enables a comprehensive clinical approach providing better coordination of care, improved outcomes, and less expense to patients. The Heart Institute (HI) at Cincinnati Children’s Hospital Medical Center (CCHMC) developed a multidisciplinary Fontan Clinic for Adult Congenital Heart Disease (ACHD) patients in mid-2018. This abstract assesses the success of the Fontan Clinic as well as the process of building a subsequent Combined Heart-Liver Transplant (CHLT) program to provide better outcomes for Fontan patients.
Project Design: Fontan patients are at risk of developing multi-organ dysfunction with increasing time since the Fontan procedure. The Fontan Clinic uses standardized cardiac and non-cardiac surveillance testing to monitor organ function to create individualized care plans. The Fontan Clinic established weekly physician collaboration huddles and a monthly steering committee meeting. A care coordinator was hired to help collect patient data for the pre-visit planning meeting. At these meetings the care team discusses each patient, reviews imaging, and determines a care plan based on the individual needs of the patient with input from multiple specialties. Advanced liver disease is common in the older patients with Fontan circulation. In select patients, including those with hepatocellular neoplasms, long-term survival may only be possible with a CHLT. CCHMC collaborated with the University of Cincinnati Medical Center (UCMC) to provide a care continuum for adult patients in need of CHLT and designed the first iteration of the program in eight months. The physicians from both organizations met to discuss the process and provide input to arrive at a plan for these complex patients.
Results: Since the start of the Fontan clinic, clinic volume has grown by over 165% (71 encounters in Year 1, 188 encounters in Year 3). Additional specialties have been added to allow for more personalized and comprehensive care for patients. Cost reduction was a large benefit for patients as they only pay one hospital bill for a combined visit as opposed to multiple hospital bills for multiple specialty visits. Four Fontan CHLT’s have been performed since the start of the program. Three of these patients were followed by the Fontan Clinic and are alive >1 year post-transplant. One patient, not followed by the Fontan Clinic, died in the early post-transplant period. Our team has worked closely with UCMC to ensure there are no gaps in care for our adult patients. We have a common care team that communicates closely when a patient is undergoing the CHLT to have a plan for post-operative care and follow up.
Conclusion: The Fontan Clinic and CHLT program have experienced initial success with great buy-in from the other specialties included in decision making process for treatment, follow-up care, and research. This approach reduced costs and redundant testing by meeting as a multidisciplinary team prior to seeing the patient in order to provide clear and concise care, with the multi-organ transplant program as the final option.
Project Design: Fontan patients are at risk of developing multi-organ dysfunction with increasing time since the Fontan procedure. The Fontan Clinic uses standardized cardiac and non-cardiac surveillance testing to monitor organ function to create individualized care plans. The Fontan Clinic established weekly physician collaboration huddles and a monthly steering committee meeting. A care coordinator was hired to help collect patient data for the pre-visit planning meeting. At these meetings the care team discusses each patient, reviews imaging, and determines a care plan based on the individual needs of the patient with input from multiple specialties. Advanced liver disease is common in the older patients with Fontan circulation. In select patients, including those with hepatocellular neoplasms, long-term survival may only be possible with a CHLT. CCHMC collaborated with the University of Cincinnati Medical Center (UCMC) to provide a care continuum for adult patients in need of CHLT and designed the first iteration of the program in eight months. The physicians from both organizations met to discuss the process and provide input to arrive at a plan for these complex patients.
Results: Since the start of the Fontan clinic, clinic volume has grown by over 165% (71 encounters in Year 1, 188 encounters in Year 3). Additional specialties have been added to allow for more personalized and comprehensive care for patients. Cost reduction was a large benefit for patients as they only pay one hospital bill for a combined visit as opposed to multiple hospital bills for multiple specialty visits. Four Fontan CHLT’s have been performed since the start of the program. Three of these patients were followed by the Fontan Clinic and are alive >1 year post-transplant. One patient, not followed by the Fontan Clinic, died in the early post-transplant period. Our team has worked closely with UCMC to ensure there are no gaps in care for our adult patients. We have a common care team that communicates closely when a patient is undergoing the CHLT to have a plan for post-operative care and follow up.
Conclusion: The Fontan Clinic and CHLT program have experienced initial success with great buy-in from the other specialties included in decision making process for treatment, follow-up care, and research. This approach reduced costs and redundant testing by meeting as a multidisciplinary team prior to seeing the patient in order to provide clear and concise care, with the multi-organ transplant program as the final option.
