We often hear that health care in the U.S. costs more and delivers poorer outcomes than other industrialized countries. Here is a case where St. Luke’s in Idaho is delivering higher value health care to patients with a very challenging and deadly disease than others throughout the world.
This is a great example of the work we are doing to achieve the better care part of our Triple Aim: better health, better care, and lower cost. Congratulations to Dr. William Traverso, our leader in this undertaking, and to all the many folks, from nursing to imaging to nutrition services to intensivists to interventional radiologists, for the outstanding teamwork that improves outcomes of care.
Sandra Wurdemann, our internal communications coordinator, interviewed Dr. Traverso and wrote the following report:
Integrated care has meant exceptional results for Dr. William Traverso and St. Luke’s pancreatitis patients.
Since 2010, Dr. Traverso has led a multispecialty, integrated team at St. Luke’s in advancing treatment for pancreatic necrosis. From 2010 to 2013, 15 patients with severe pancreatic necrosis were treated with drains instead of surgery and recovered with fewer major complications.
It takes time to assimilate new methods, Dr. Traverso observes. “You have to be positive. You have to push ahead.”
Pancreatitis can be caused by many things, including gallstones, alcohol use, or the use of certain medicines. Pain occurs when the digestive enzymes normally released into the small intestine remain or leak into the pancreas and attack it.
This can cause tissue in the pancreas to die or become infected, called pancreatic necrosis and pancreatic abscess, respectively. About 100,000 people nationwide are hospitalized with acute pancreatitis each year, resulting in about 2,000 deaths, according to the Cleveland Clinic.
Dr. Traverso, a surgeon with St. Luke’s Clinic – Pancreatic and Liver Diseases, has authored or co-authored more than 250 articles on the treatment of pancreatic diseases, many of which now can be cured for the first time in history. He is certified by the American Board of General Surgery, is a fellow of the American College of Surgeons, and specializes in pancreatic neoplasms and inflammatory diseases, including pancreatic cancer and acute and chronic pancreatitis.
One of Dr. Traverso’s passions has been to reduce the need for surgery and related deaths connected to acute pancreatic necrosis.
“What happens if you operate on someone? You lower their resistance and healing ability,” he said.
In the early 1990s, Dr. Traverso and Dr. Patrick Freeny, an interventional radiologist, began developing percutaneous drainage, the use of catheters to drain fluid and other material from the pancreas, for the treatment of severe pancreatic necrosis.
Dr. Traverso worked with a multidisciplinary team in Seattle, using interventional radiology treatments first, and surgery only if the percutaneous drainage failed. The group had the earliest study published of 32 patients.
“We sort of pioneered this,” he said. “Catheter-based treatment allows material to come out slowly.”
In 2010, Dutch investigators followed the Seattle team’s work using percutaneous drainage on 43 patients prior to considering surgery. They found that many patients responded to percutaneous drainage only, decreasing major complications and the death rate for those patients.
The Dutch study reported a death rate of 19 percent for patients who had percutaneous drainage. There were no deaths among St. Luke’s Boise patients, though their conditions were slightly more severe.
Boise patients also spent fewer days in the hospital, with a median of 43 days versus 50 for the Dutch patients. Boise patients were in the Intensive Care Unit a median of five days, compared with nine days for the Dutch patients. No Boise patients required operations; 60 percent of the Dutch patients did.
These results were presented May 18 in Orlando to the Pancreas Club, a gathering of surgeons and subspecialists from around the world. See the abstract: Pancreas Club Abstract Necrotizing Pancreatitis
“This is further evidence to support the concept that catheter-based drainage is better,” Dr. Traverso said.
Credit for these ‘superlative’ results, he said, goes to the St. Luke’s team members, including interventional radiologists, gastroenterologists, hospitalists, nutritionists, nurses, and surgeons.
“If you can think of any disease that requires this much integration, I defy you to name one,” Dr. Traverso said. “Without the coordination and without these people involved, we fail.”
The integrated approach requires leadership, communication, and standardization, he observed. “One of the most difficult parts of the communication was to standardize our approach.”
Members of the team meet once a week for a Pancreas Care Conference to discuss treatment plans, follow-up, and outcomes, and daily on specific cases. The meetings bring specialties together and allow them to educate each other on what they can do and how they can work together, according to St. Luke’s interventional radiologist Dr. Sean Carr.
“When responsibility is shared, the knowledge of what to do is shared,” Dr. Traverso said.
Gastroenterologist Dr. John Witte said changes in treatment include placing drains sooner and using methods Dr. Traverso has learned through the years.
“I’ve learned so much,” Dr. Witte said. “I’ve become more confident in treating these complicated patients.”
The efforts are making St. Luke’s a magnet for the treatment of pancreatic necrosis, Dr. Carr said.
“Instead of sending patients out of state, we’re becoming a referral center,” he said.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.