Why our co-located C.S. Mott Children’s and Von Voigtlander Women’s hospitals are a model for optimal collaboration and patient and family-centered care
After being raised in a home that doubled as a children’s daycare center, ballet dancer Danielle Haviland was excited to have a baby of her own. And when Danielle’s husband, Ben, a specialist in the United States Army, learned that he would not have to serve a second tour in Afghanistan and was eligible for honorable discharge, the couple was excited to relocate from Nashville, Tennessee, where they were stationed, to Fenton, Michigan, which is home to Danielle’s mother and other relatives.
However, 20 weeks into the pregnancy and two months before they were scheduled to move, Danielle and Ben learned that their baby had a benign lung malformation called a Congenital Pulmonary Airway Malformation, or CPAM. A CPAM is a lung mass that requires frequent monitoring because of its potential to grow quickly and lead to heart failure. Two weeks before the Havilands’ move to Michigan, Danielle’s Vanderbilt University Medical Center team contacted the University of Michigan Fetal Diagnosis and Treatment Center (FDTC) to transfer her care. In December 2012, Danielle became a U-M patient.
Of the 4,200 deliveries we perform annually at UMHS, 30 percent are classified as high risk. UMHS is a referral destination for many high risk Obstetrics/Gynecology (OB/GYN) patients because we have leading specialists in some of the most complex OB/GYN and pediatric conditions and because we are one of a handful of health systems in the nation to co-locate our children’s and women’s hospitals.
Co-location of C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital means that mother and baby are not separated – they stay together – and that other family members don’t have to navigate multiple buildings to see them. It means that the patient is seen in one location by everyone that provides care to her and her baby, which is a fundamental element of patient and family-centered care. And it sets the stage for optimal collaboration and communication between providers, which minimizes errors and improves patient satisfaction. The positive impact on patient satisfaction is evident in “overall rating of care” data for Mott, which rose from 89.7 in 2010 to 90.2 in 2012 and is currently at 94.0, and Von Voigtlander, which rose from 87.6 in 2010 to 89.3 in 2012 and is currently at 91.0.
Of course, all that Danielle and Ben Haviland wanted to know is that she and their baby would be in capable, caring hands.
Almost weekly, Danielle saw Dr. Marcie Treadwell, director of the U-M Fetal Diagnostic Center, for ultrasound evaluations. At just over 31 weeks gestation, Danielle underwent a fetal MRI to better evaluate the mass and assess the size of the unaffected lung. A team of maternal and pediatric physicians reviewed the imaging and determined that the CPAM was so large that the baby’s chances for survival at birth were low even with conventional treatment such as a breathing tube and mechanical ventilation. Thus, the team decided that the best course of action was to perform fetal surgery to remove the CPAM in utero and then deliver the baby. This type of open fetal surgery at the end of pregnancy is called an ex utero intrapartum treatment (EXIT) procedure. During the EXIT procedure, the baby doesn’t have to breathe on its own since he/she remains attached to the umbilical cord and receives oxygen from the placenta. The ability to operate on babies before birth allows for a smooth transition to life outside the womb. Notably, our Fetal Diagnosis and Treatment Center is the only comprehensive fetal therapy center in Michigan and one of only a handful in the country.
So, on the morning of March 5, at 39 weeks, Danielle was admitted for the EXIT procedure.
“When I was going in to have my baby I was really scared and I started to cry,” Danielle remembers. “But, I felt they would do what was best for my baby and for me. They made me feel so good and safe and like they were going to take care of us.”
The “they” Danielle refers to is the nearly 30 people who were ready to take care of the two patients – a team led by pediatric/fetal surgeon and FDTC Director Dr. George Mychaliska and Maternal-Fetal Medicine’s Dr. Clark Nugent, and organized by FDTC Nurse Coordinator Jeannie Kreutzman. The team included specialists from maternal and pediatric anesthesia, pediatric cardiology for continuous monitoring of the baby’s heart, ECMO in case the lungs could not be aerated well after the mass removal and the NICU for transition care and transport.
Just 2.5 hours after Danielle entered the operating room, Noah Haviland was born via successful EXIT procedure. He transitioned well with only ventilator support and spent just 20 days recovering in the NICU. His incision has healed well and his lung capacity is expected to be normal.
To orchestrate and perform complex procedures like the one that brought Noah safely into the world with the ability to develop healthy lungs exemplifies what is truly exceptional about having co-located children’s and women’s hospitals: any specialist can be on the scene during the surgery or within minutes; mother and baby are safe with access to any care they need; we are providing effective and collaborative team care; and families stay together.In the next several years, we aim to ensure our ability to handle more cases, expand our fetal therapy program and make outcomes data available online to improve transparency and accessibility with the public and researchers.
I am extremely proud of our Mott and Von Voigtlander faculty and staff, and their continued dedication to excellence and patient and family-centered care. This is The Michigan Difference. This is what it means to be Victors Valiant.