Adult Weight Management Retreat, Sept. 19, 2007Sunday, September 23, 2007
This full-day retreat, held at the new Centre for the Advancement of Minimally Invasive Surgery (CAMIS), was the first opportunty for me to meet many of the staff of the WW Adult Weight Management Clinic (AWMC). There were over 20 people in the room representing a wide range of professions including dietetics, nursing, psychology, physiotherapy, social work, medicine and surgery. There was also a good representation of the administrative staff that is key to running a smooth operation.
A number of topics came up that I believe are highly relevant to the smooth running and expansion of the program:
– Integrating new disciplines: while historically the AWMC (or adult bariatric program, as I prefer to call it) started as a dietetic/surgical service, it has rapidly expanded into a full-fledged multi-disciplinary program that will provide a wide range of tertiary-care bariatric services to the region and beyond. Integrating and taking full advantage of the wide range of expertise now available within the group will be an exciting endeavour.
– Patient Intake: This appears to be a key issue for the effective functioning of the clinic. Currently patients, after 2-3 years on the waiting list, enter the assessment clinic with little to no information on what the program can offer. Given the complexity of individual cases, it may well be that patients are not yet prepared to embark on tertiary-care obesity treatments and/or have other significant problems that do not make them good candidates for intervention. Also, intake staff has to spend considerable time explaining the purpose and treatment opportunties in the program. This results in a rather inefficient overall process that needs to be urgently re-engineered. I presented a possible strategy for triaging patients to community services following an “Orientation Workshop”, where patients are given information about the program. This Orientation Workshop would be followed by a series of interactive educational community workshops to provide participants essential skills required for long-term weight management.
– Post Surgical Rehab: The suggestion was made to develop a structured post-surgical bariatric rehab program, not unlike rehab programs in other disciplines (e.g. post-MI). Participants would not only (re-) learn essential skills but would also have the opportunity to (re-) engage in social and physical activities, deal with psychological issues arising post surgery and discuss other aspects related to life after bariatric surgery.
-Space: Currently the clinic is operating out of incredibly cramped offices – this situation is hopefully about to change with the idenfication of new office space.
-Continuing Education: Given that bariatric care is such a rapidly evolving field, it is essential that we continue to review best practices in light of new literature. For this purpose, regular “academic” meetings to discuss latest findings and their implications on our program are essential. Attendees were engouraged to join the Canadian Obesity Nework at and sign up for the literature alert services OBESITY+ (for clinicians) or Pre-OBESITY+ (for clinicians and clinical researchers). I also recommended subscribing to the blog “Weighty Matters“
-Staff: It was widely recognized that we urgently need a data-analyst to help monitor the current data flow in the program. While we have the opportunity to collect a large amount of data that could help us improve and streamline our services (and of course address research questions), analysing these data cannot be done without a dedicated analyst. Another important gap that was identified pertained to occupational therapy, an essential piece of bariatric care.
Overall, the day was a resounding success in that it provided attendees with a good overview of the AWMC and provided an opportunity to share some of the strategic plans for making this a world-class program.
Appreciate any comments,
Saturday, September 29, 2007
In follow up to the above post, I received several e-mails with helpful content, which I summarize below (I understand that some of you may be hesitant to post directly).
OK, the topics that came up were the following:
– Realistically appraising all resources available for treatment over the long-term (i.e., access to medical services, social services and support from family and other caregivers).
– Clear team guidelines and rigid adherence to criteria (i.e., discharge protocols; non-compliance; patients unwittingly “triangulating” team members).
– Defining areas in which different team members have decision-making autonomy.
– Providing patients with clear guidance as to whom his or her primary clinical contact is (i.e., case manager).
– Matching of individuals to specific treatments.
– Communicating frequently with external providers to coordinate care and avoid splitting.
– Increasing the frequency and length of intervention
– Building stronger social support systems (i.e., employment of group settings; active participation of “family” members).
– Concurrent utilization of cost-effective community resources (i.e., sliding scale agencies; psychiatrists; pastoral counselling)
Great thoughts! Keep them coming.
Several of you have also requested copies of my retreat presentation – I have forwarded a copy to Lisa Devlin. We will soon have an internal platform on which such and other files can be archived and will be acessible to all of you.