June 27, 2007
DF/BWCC satellite clinic at Faulkner Hospital completes successful first year
Leroy Parker, a Dana-Farber breast cancer specialist, offers care to Ruth Ridley at the Faulkner clinic.
For breast cancer patient Marjorie Cotton Supple, timing was everything. After surgery at Faulkner Hospital, her chemotherapy infusions took place exactly when the fledgling Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) at Faulkner Hospital opened its doors last summer.
Unintentionally, she became a Dana-Farber patient. "I was proud to receive Dana-Farber level care in the community," says Cotton Supple, who lives on Cape Cod. "I knew I was in good hands with my doctor [Daniel Morganstern, MD] and nurse [Meheret Gebremeskel, RN] and felt reassured that my case would also be reviewed regularly by other Dana-Farber experts."
The satellite clinic opened in June 2006, ushering in a unique blend of community and academic medicine. Cancer patients, such as Cotton Supple, became Dana-Farber patients, while DF/BWCC patients with certain types of cancer, such as breast, could choose to receive their care at Faulkner if they found it more convenient.
The 13,000 square-foot outpatient facility is twice the size of the previous oncology unit at Faulkner Hospital, a 150-bed hospital in Jamaica Plain just 3.4 miles from the Longwood Medical Area. Patients and families were included in the planning process to make sure the space was friendly and supportive, and Cotton Supple now contributes a Faulkner perspective to the DF/BWCC Adult Patient and Family Advisory Council.
As the clinic completes its first year, leaders look back with pride. "We went quickly from an idea to a reality, given that we had to integrate a very complex infrastructure, including our computerized chemotherapy order entry and medical record," reflects Morganstern, a Dana-Farber breast oncologist who has worked full-time at Faulkner Hospital since 2004. Now, eight other DF/BWCC oncologists practice there part-time, in addition to the unit's medical director, Geoffrey Sherwood, MD.
The new arrangement has many pluses for all, says Morganstern: more clinical trials are available, the smaller size creates an easy rapport and collaboration between doctors and nurses, and patients now have a broader array of support services, such as social work and nutrition. Patients and staff can also appreciate the clinic's soothing artwork and light-filled unit with its views of the Arnold Arboretum, across the street.
Some infusion rooms at Faulkner offer soothing views of the Arnold Arboretum.
Hard work, changing roles
A lot of effort by planners and clinicians went into the spacious, sparkling clinic. Nurse program leader Monica Fulton, RN, BSN, MBA, explains that the opening involved more than 25 "service-level agreements" spelling out everything from turnaround time for diagnostic tests to how often the bathrooms would be cleaned.
The transition wasn't easy, recalls Sherwood, a hematologist-oncologist at Faulkner for 25 years before the opportunity for partnership with DF/BWCC came along. "I was a bit skeptical at first," he admits. But now he says it is clear the new unit provides superb care for Faulkner patients and those referred from the DFCI campus. "I appreciate the expanded space, peaceful surroundings, and presence of other oncology experts. In a moment I can get an opinion from a leading specialist," he points out.
It is the first time DFCI-based specialists began practicing at an off-site location, splitting their time between two campuses. Making this transition were Peter Enzinger, MD, and Thomas Abrams, MD (gastrointestinal cancer); Leroy Parker, MD, and Rochelle Scheib, MD (breast cancer); Michael Rabin and J. Paul Marcoux, MD (thoracic cancer); and David C. Fisher, MD, and Eric Jacobsen, MD (hematology/oncology). Although practicing in two locations presents certain challenges, these physicians have found it to be a positive experience, and have enjoyed the opportunity to offer top-level care in the community.
"At first I was apprehensive about moving one of my clinics to the Faulkner campus, but the dedicated staff, relaxed atmosphere, and beautiful setting have really won me over," says Enzinger. "It is a great pleasure to work in the Faulkner satellite."
The nurses had adjustments to make as well. Along with a social worker, nutritionist, resource specialist, and other staff members, they are now part of a larger team, including Dana-Farber based physicians and nurse practitioners. Roles have evolved for all staff, to the benefit of patients.
Lessons learned
As Dana-Farber plans to open satellite clinics in Milford, Mass., and other locations, the clinic provides a model to learn from, says Elizabeth Liebow, vice president of clinical business development. "Opening a licensed, satellite clinic within a hospital was an enormous undertaking, requiring a surprising amount of time and effort," she comments. "But it was well worth it."
The clinic is beginning to accomplish its major goals: to ease overcrowding at Dana-Farber and bring specialized cancer care to the community. With about 700-800 patients receiving physical exams and 400 getting infusions each month, the volume at the Faulkner site is about what was predicted. "We are right on target with our first-year projections, and anticipate being at full capacity by the fall of 2008," Liebow says.
Overall, the two cultures appear to have merged smoothly, as the clinic offers the best of both worlds: world-class cancer care in a cozy atmosphere. "When I go back now it's like the TV show, 'Cheers,'" says Cotton Supple. "Everybody knows my name."
— Christine Cleary
christine_cleary@dfci.harvard.edu