From
Dr. Marc Levitt
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)
With Dr. Marc Levitt · hosted by Dr. Marc Levitt & Dr. Todd Ponsky & Dr. Em Gootee
Part of
Anorectal Malformation 101 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Colorectal and pelvic disorders in children are intricate, often lifelong, and involve interconnected digestive, urinary, reproductive, and sometimes musculoskeletal systems
Conditions requiring multidisciplinary care include anorectal malformations (ARM), Hirschsprung disease, severe constipation from colonic motility issues, and neurogenic bladder/bowel dysfunction in spina bifida
These conditions significantly affect children's quality of life, create family stress, and can contribute to mental health issues
Collaborative programs lead to better treatment plans, improved communication between specialists, fewer complications, and better overall health outcomes
Initial driving forces for establishing colorectal programs are strong focus, genuine passion, deep interest from key people, and solid work ethic
A dedicated physician leader, most often a pediatric surgeon, is necessary with genuine interest, commitment to long-term care, and vision for improving colorectal care quality
Program leaders must assess local healthcare landscape: genuine need, feasibility given existing services, and underserved patient populations
Initial essential specialties for multidisciplinary colorectal programs are general surgery, urology, gynecology, GI motility specialist, and dedicated nursing team
A dedicated, passionate nurse specializing in bowel management is the backbone of the program; without one, the program won't function effectively regardless of surgeon expertise
For non-English speaking countries, having a nurse fluent in English who can attend international meetings is advantageous for staying current on best practices
Complex colorectal cases often require combined surgical expertise from pediatric surgery, urology, and gynecology in the operating room
Finding a pediatric gynecologist can be challenging; in those cases, a pediatric surgeon may manage gynecologic aspects for female patients
If involving an adult gynecologist, they must have specific expertise in Müllerian anomalies or disorders of sexual development
GI colleagues need interest in motility and performing manometry studies, which measure muscle contractions in the digestive tract to diagnose bowel function issues
Programs need clear guidelines for managing constipation, referral criteria to the multidisciplinary team, and definitions of when standard medical treatments have failed
Access to anal and colonic motility studies and pelvic floor physical therapy to strengthen bowel control muscles are key program components
Radiologists need education on colorectal diseases and proper performance/interpretation of contrast enemas, colostograms, and cloicograms
Active surgeon participation in imaging studies, especially initially, ensures everyone interprets findings consistently
A pathologist with expertise in intestinal disorders like Hirschsprung disease ensures correct tissue handling and interpretation
Regular multidisciplinary meetings, ideally once or twice weekly, are essential for reviewing patient needs and developing coordinated care plans
A dedicated multidisciplinary outpatient clinic is ideal, but if not feasible, coordinating same-day appointments across different locations is an acceptable alternative
Continuous learning strategies include visiting established colorectal centers, staying current with research, watching surgical videos, and visiting other multidisciplinary programs within your own hospital
Programs should proactively ask other centers to share materials like patient intake forms and follow-up protocols, then adapt them to local needs
Surgical videos are helpful for building confidence and understanding techniques but are not a substitute for hands-on surgical experience
Systematically collecting data on your own patients and joining research networks or consortia advances the field
The colorectal nurse needs strong foundational knowledge of anorectal malformations, Hirschsprung disease, neurogenic bladder/bowel, and skills in pre/postoperative care including bowel irrigations, enemas, catheter management, and teaching families anal dilations
The nurse must understand treatment plans from all specialists to effectively communicate with families
Educating inpatient nursing staff through protocols and educational sessions ensures consistent high-level care and increases family comfort during hospitalization
Essential clinic supplies include Hagar dilators, various catheter types and sizes, gravity bags for enemas, and specialized surgical retractors like the Lone Star retractor
Building a robust data library is essential for demonstrating clinic efficiency, establishing regional reputation, and showcasing effectiveness of new treatment techniques
Key data metrics include total referrals, total visits, new patients, out-of-region patients, surgical cases (inpatient/outpatient), length of stay, revenues, expenses, and complication rates
Documenting nursing telephone encounters is important to justify adequate nursing staffing, as these patients require significant ongoing support and care plan adjustments
Children with colorectal and pelvic conditions often need long-term chronic care and don't follow typical surgical patient recovery paths
In private hospitals, business case emphasis is on attracting patients and downstream revenue; in public hospitals, focus is on cost savings through reduced complications, shorter stays, fewer ER visits, and improved quality of life
Building trust with referring physicians requires patience and politeness, especially with those who have managed these conditions themselves for years
By successfully managing patients referred for focused care like bowel management, programs gradually demonstrate the value of the multidisciplinary approach
Many patients initially referred for management issues will likely need further surgical intervention later
A dedicated care coordinator or scheduler is a top priority resource allocation to prevent nurses from spending disproportionate time on scheduling
Building bench strength by initially sharing resources from existing departments (e.g., allocating partial nurse time from general surgery) is a cost-effective way to start
Most hospitals have planning and data analysis staff with expertise in developing business cases; engaging these internal resources early is smart
Establishing a true center of excellence takes time and sustained effort, requiring a multi-year plan with clear milestones for additional resources and expected results
All involved providers must be properly credentialed with government payers (Medicaid) and private insurance companies in both home state and neighboring states
In established programs, weekly new patient intake meetings involve nursing-led preparation: gathering records, developing initial multidisciplinary care plans, verifying information with families, and addressing pre-certification/billing issues
The entire multidisciplinary team (colorectal surgery, urology, gynecology, GI motility, nursing, social work) reviews the nurse's proposed plan collaboratively to streamline diagnostics and reduce separate visits
For families traveling significant distances, programs consolidate as many appointments as possible into a single visit