Cedars-Sinai has long been at the forefront of multidisciplinary care, based on the understanding that complex medical problems require comprehensive assessments and solutions that draw on multiple perspectives. That’s why Cedars-Sinai Guerin Children’s offers multidisciplinary clinics where our young patients can benefit from this approach.

In a combined urology and nephrology clinic at Guerin Children’s, pediatric urologist Andrew Freedman, MD, and his team offer the many benefits of multidisciplinary care to children with complex urologic disorders. The clinic’s patients present with everything from renal deficiency and kidney stones to congenital abnormalities such as urogenital sinus and bladder exstrophy.

Laura Wozniak, MD, serves as the lead gastroenterologist for a new aerodigestive clinic, which is offered through the Pediatric IBD Program at Guerin Children’s. Wozniak and her colleagues see children of all ages, from newborns to older kids with complex conditions. The clinic’s most frequent cases are children with congenital abnormalities of the airway and esophagus, such as esophageal atresia and tracheoesophageal fistula. The team also treats a wide range of other conditions, including chronic cough, gastroesophageal reflux and eosinophilic esophagitis.

“Arriving at the right diagnosis and the best care plan means understanding these conditions from every angle, which means involving more than one specialty,” said Wozniak, whose team includes an ear, nose and throat (ENT) specialist, a pulmonologist, a pediatric surgeon and a dietitian.

Everything Under One Roof, in One Day

To make things easier and better for young patients and their families, these clinics are single-day programs. The assessment is conducted by a team of experts during one visit and in one location. The program is tailored to each family’s specific situation so the child can be seen by all the necessary specialists on the same day. In addition, the single-day approach allows children to miss just one day of school and parents or guardians to miss only a single shift at work. 

There are also several clinical benefits to having all specialists see the patient at the same point in time. “Symptoms are dynamic,” said Wozniak. “If I see a patient on Monday at 11 a.m. and another specialist sees them on Thursday at 4 p.m., we aren’t seeing the exact same patient,” she explained. “Patients can have greater confidence in a diagnosis and expert advice when these are based on the same visit and data points.”

Besides urology and nephrology experts, Freedman’s clinic employs a dietitian, like Wozniak’s team, and both programs offer a social worker, as needed. This reflects Cedars-Sinai’s view that good healthcare does more than just address medical concerns. School, schedules, parking, transportation and insurance are just some of the issues that can complicate medical care for patients. In those instances, support from a social worker can be invaluable.

Optimal Coordination of Care

Along with the clinical benefits, the main advantage of multidisciplinary clinics is the coordination of care. “I can’t overstate what a difference this makes,” said Freedman, who holds the Walter and Shirley Wang Chair in Pediatric Surgery. “Instead of having appointments with different doctors in different places on different days, navigating multiple care plans and trying to get all these doctors to talk to each other, families can obtain clear information, ask questions and receive a unified treatment plan in a single session at Guerin Children’s.”

This is especially important with young patients. As pediatricians know, families are often anxious when their child is confronting a medical crisis. Wozniak sympathizes: “Imagine the added frustration of trying to gather medical records from different providers and trying to convey to each doctor what the other one said.” She adds that providers’ busy schedules can exacerbate the situation.

Freedman also notes that different electronic health record systems in different medical offices can also make it hard to share information quickly and efficiently.

“The one-day clinic solves all those problems,” he said, adding that some patients who come to the clinic have had duplicate imaging and lab work done because the same diagnostics were ordered by different providers, further exhausting the family and complicating the record.

The good news is Guerin Children’s providers keep in close contact with referring physicians to communicate treatment plans throughout the process. If a patient consents, Guerin Children’s providers will share reports with the patient’s original doctor, which include a unified opinion and a care plan.

Most importantly, Guerin Children’s providers make themselves available to referring physicians. “If you call us, you won’t be forwarded to an assistant,” said Freedman. “You’ll always be able to speak with us. We’ll work together to make sure your patient gets the very best care possible.”

What to Expect

The clinics are offered once per month. After a preliminary intake, families arrive for their appointment. In some cases, tests may be done on-site. Patients then meet with specialists, one at a time, over the next several hours. The experts then review results, compare notes and consult with each other before agreeing on the path forward and discussing the plan with the family before they go home.

In some cases, consultations in these multidisciplinary clinics may be done remotely.

As to outcomes, “multiple studies show that multidisciplinary aerodigestive clinics lead to better outcomes for many conditions,” said Wozniak.

The ultimate measure of success is patient satisfaction, and according to Freedman and Wozniak, families are as thankful as they are relieved when they discover that the clinics at Guerin Children’s were exactly what they were looking for. For all these reasons, Guerin Children’s is planning to open additional multidisciplinary clinics in a number of other specialties, so more children can benefit from the best that Cedars-Sinai has to offer.

 

To learn more or to refer a patient to any of our programs, contact us at 310-423-7337 or referralsupport@cshs.org.