Department of Medicine

Combined Service Strengthens Continuity of Care 

As an advanced practice provider, Laura Zitella, NP is taking teamwork
The Med9 team from left to right: Carl Kulpa, NP; Mary Petrofsky, NP; Chris Szura Shen, NP; LIndsay Stringer, NP: Laura Zitella, NP; Lauren Maeda, MD; Megan Harrington, NP; Rondeep Brar, MD, Zach Koontz, MD. Not pictured: Quan Thai, NP, and Denise Ricigliano, NP
to a new level. With Med9,
a new collaborative care model created to meet the demands of an increasing number of patients with hematologic and oncologic malignancies; she oversees a team of eight nurse practitioners  to help  foster communication and coordination of care with  one of  three supervising attendings assigned to the service.

The combined Hematology/Oncology service builds on 20 years of experience using advanced practice providers (nurse practitioners and physician assistants) to care for patients with cancer. Zitella was an important part of the working group that designed Med9. “One advantage of a collaborative model is having trained nurse practitioners who can provide a majority of patient care,” she said. “The physicians are available to consult and direct complex issues. It’s rewarding, because the patients receive expert medical care and every provider practices at the highest level of their training.”

Graduating fellows, Lauren Maeda, MD, Michael (Zach) Koontz, MD, and Rondeep Brar, MD, came on board as clinical assistant professors to staff Med9.  Each attending spends a total of four months out of the year on the inpatient service and the rest of the time in clinic. After giving it some thought, the idea of a small team of dedicated physicians and nurse practitioners appealed to all three.

“The advanced practice providers have specialized knowledge about chemotherapy and treatment-related side effects,” said Maeda, who plans to work in hematology and lymphoma clinics. “Med9 combines inpatient and outpatient care, which is ideal for developing my career.”

Rondeep Brar also appreciates the familiar and supportive environment of Med9.  He added. “I like providing nurse practitioners with didactics. The APPs are intellectual, curious, and have diverse backgrounds and extensive experience. I’m constantly learning from them and the patients.”

Care Teams of the Future

Another difference, added Linda Boxer, MD, PhD, Department of Medicine Senior Vice Chair, Chief of Hematology, and Interim Chief of Oncology, is that while an attending is on Med9, he/she does not go to clinic. “The faculty, APP’s, nurses, and other members of the health care team are enthusiastic to always have an attending on the ward for teaching and patient care. The service is helpful for clinical trials and research; it’s easier for small teams to assist patients to enroll in clinical trials and is familiar with the details of the different clinical studies.”

With Med9, Stanford joins other academic institutions with similar combined services, which use advanced practice providers to supplement housestaff at a time of shorter work hours for residents and fellows. The Med 9 working group meets on a regular basis and is ready to open discussions with the hospital to increase the number of nurse practitioners if the program expands. “As outpatient services grow so must resources to care for inpatients as well,” said Boxer.

The service opened its doors in early September and has the capacity to treat up to 15 patients. Three nurse practitioners work 12 hour shifts during the week and two nurse practitioners handle the weekends. A nocturnist covers overnight shifts. The continuity of care on Med9 increases patient satisfaction.

“Universally, patients appreciate the level of personalized care, communication, and education they receive from the nurse practitioners trained in oncology-specific care,” said Zitella. “Patients feel positive about the service. I think it’s an exciting advance for Stanford and an excellent model for the future of care teams.”

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