Lafayette General Medical Center—Lafayette, Louisiana

by Brooke Doucet, RN, BSN, CBN

Brooke Doucet, RN, BSN, CBN is the Bariatric Program Manager at Lafayette General Medical Center, Lafayette, Louisiana and the Allied Health Chair for the Louisiana State Chapter of ASMBS

FUNDING: No funding was provided.
DISCLOSURES: The author reports no conflicts of interest relevant to the content of this article.

Bariatric Times. 2013;10(11):42–44.

Lafayette General Medical Center
Located in Lafayette, Louisiana, Lafayette General Medical Center (LGMC) is the flagship facility of Lafayette General Health, a health system with 11 hospitals owned, managed or affiliated. LGMC serves a population of over 670,000 residents and employs nearly 2,000 people. The multidisciplinary bariatric team at LGMC and Acadiana Weight Loss Surgery (AWLS) are committed to and passionate about providing patients with outstanding lifelong surgical and weight management care, in the Acadiana region. Our advanced laparoscopic surgeons are experienced in providing the following procedures: Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and vertical sleeve gastrectomy (VSG). A nonsurgical option for weight management is also available, providing the community with multiple options for the treatment of obesity.

Our Staff
Our Multidisciplinary team comprises of two bariatric surgeons (Philip Gachassin, M.D., Medical Director of Weight Loss Surgery Program and Dennis Eschete M.D., Medical Director of Behavioral and Metabolic Program), a family practioner (Ben Doga M.D., Medical Director of the Medically Supervised Weight Loss Program), a nurse practioner (Lauren Naqui, APRN,CBN), a registered nurse/bariatric program manager (Brooke Doucet, RN, BSN, CBN), a registered dietitian (Amber Faul, MS, RD, LDN), a behavioral modification educator (Nichole Barras, BS, CLC), a patient advocate (Tiffany McZeal, BS), a licensed professional counselor (Dana Manly, MS, LPC), an exercise physiologist (Julie Marks, LCEP), and a medically supervised weight loss program coordinator/surgical clinical reviewer (Amanda Comeaux, LPN).

The bariatric team coordinates with one another to ensure that high quality care is delivered to our bariatric patients. Standardized care plans, admission orders, post-operative orders and written discharge instructions ensure that continuity of care is delivered from the time the patient first enters our weight loss program.

Our Facility
LGMC staffs a total of 377 beds and is the largest full-service, acute-care medical center in the nine-parish area of Acadiana. LGMC provides families with comprehensive medical services at every level of care.

LGMC has the busiest emergency department in Acadiana and handles the highest level of trauma in the region. The hospital’s 32-bed adult intensive care unit (ICU) is staffed 24 hours a day, seven days per week by intensivists (physicians specializing in critical care), while the 25-bed Neonatal Intensive Care Unit (NICU) boasts benchmark status in Key Performance Indicators by the Vermont Oxford Network.

The Medical Center evolved from Lafayette Sanitarium, a six-bed facility that opened in 1911, and has been a leader in health care throughout its existence. Over the years, LGMC has expanded its services and facilities to meet the community’s growing needs, including Center of Excellence status in Minimally Invasive Gynecology and Neuroscience, as well as the distinction as an Accredited Cancer Program, Advanced Certified Primary Stroke Center and Accredited Center for Metabolic and Bariatric Surgery.  A leader in technology, LGMC was the first to bring the da Vinci® (a robotic surgical system), CyberKnife® (a stereotactic radiosurgery system) and Medtronic O-Arm (a surgical imaging system) to Acadiana.

LGMC currently dedicates bariatric suites for all surgery patients on the eighth floor. The post-operative floor provides wide-based commodes, which are reinforced with metal brackets with a weight limit of 1,000Lbs as well as shower capability with an option of a shower chair that can support 1,000Lbs. Each unit that is dedicated to accommodate the bariatric post-operative patient has access to the following: bariatric gowns and blood pressure cuffs, appropriately sized abdominal binders, a scale supporting 880Lbs, bariatric wheelchairs, bedside commodes supporting 1,000Lbs, and bedside recliners with a weight limit of 500Lbs. The facility also has free valet parking for those patients who cannot walk a long distance or for those who need assistance with wheelchairs or scooters.

LGMC has bariatric appropriate waiting room furniture that can accommodate up to 750Lbs in our pre-anesthesia clinic, registration center, emergency department, outpatient surgery department, operating room waiting area, GI lab, radiology and surgeon’s practice. Transport equipment such as stretchers and wheelchairs can hold up to 900Lbs. The HoverJack air patient lift system can accommodate 1,200Lbs. All equipment is labeled with codes to maintain bariatric sensitivity. Manuals and bariatric policies and protocols specific to individual units are available to the staff in a bariatric education binder.

An Accredited Center
LGMC and Acadiana Weight Loss Surgery were originally designated as a Center of Excellence by the American Society of Metabolic and Bariatric Surgery (ASMBS) in 2011. Currently, LGMC is fully compliant with the recent ASMBS and American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) standards.

Patients do inquire if we are a Center of Excellence due to the guidelines that were once established by the Centers for Medicare and Medicaid Services (CMS). Surrounding weight loss programs that have not attained the certification often refer patients to the weight loss surgery program at LGMC.

Patient Adherence and Long-term Follow up
All patients are seen postoperatively by AWLS. Patients are seen by their surgeon and dietitian within the first 7 to 10 days postoperatively and every three months following their weight loss surgery procedure for the first year. They continue to be followed every six months for the second year, and yearly after that by their surgeon. The behavioral modification educator provides follow-up with the patient at two months, six months and one year postoperatively. The exercise physiologist provides follow-up with the patient at three months and one year. Follow-up appointments are scheduled upon the patient’s completion of each appointment with the surgeon.

Follow-up appointments are monitored by our ACS trained licensed practical nurse. She enters the data in the accredited bariatric database as well as our online bariatric tracking and analysis software. The surgical clinical reviewer monitors the patients’ adherence to appointments and tracks bariatric and nonbariatric complications, as well as excess weight loss postoperatively.

Overcoming obstacles in patient adherence. There are several challenges in terms of patient adherence that the clinic deals with on a daily basis. One is continuous follow-up with our postoperative patients. We currently have a 75-percent rate at one year postoperatively. Unfortunately, that dramatically decreases to 45 percent at two years postoperative, and we see steady downward trend from that point. Measures such as frequent phone calls and mailed letters to encourage long-term care are taken to capture those patients who are nonadherent. However, patients do not provide us with phone number changes and/or address changes. This continues to be an area that we will work on diligently to recapture our lost clients.

Other obstacles that we deal with routinely are patient adherence to diet regimen, nutritional supplements, behavior change, and exercise. These areas are essential to long-term success and must be monitored and maintained on an on-going basis. The bariatric team stresses the importance of following the established guidelines, pre- and postoperatively, to obtain the maximum results.

Patient Testimonial
Sarah H., a 46-year-old female from Lafayette, started the program at LGMC approximately 18 months ago. Since the beginning of her weight loss journey, she has lost 240Lbs. She said, “I chose LGMC Bariatric Weight Loss Program for several reasons. The staff and doctors of this program are outstanding. The care and compassion I received from the moment I walked in was remarkable and, even after a year and a half, I still feel like part of the family at their office. The best part of the whole experience I’ve had there is the fact that you are treated full mind and body. You are not just a patient number or a statistic; you are a real human being with needs greater than just how much weight you need to lose. It’s about how you gained the weight you did, and how you can achieve the weight loss and keep it off.”

She continued, “What I love about my experience with the LGMC Bariatric program is the fact that you just don’t have surgery and then they give you a book and see you on your way. In fact, there is quite a bit of work you must do before the surgery even happens to be sure that this life-changing procedure is what is right for you. After surgery you have the opportunity to go to support group twice a month. They have events such as a fashion show and socials every year to keep you motivated and on track with your weight loss.”

“I know that I could have never been as successful without all the experienced staff and doctors at LGMC. I owe my overall good health and life to those beautiful people. When family and friends ask about my success, I highly recommend the program at LGMC.”

Embracing New Technologies
A new technology that has been beneficial to our physicians and helps improve the quality of care we deliver to our patients is the the GlideScope Video Laryngoscope made by Verathon (Bothell, Washington). The scope allows for a more accurate visual for those patients who may be a difficult intubation. This results in a lesser chance of a bariatric patient developing hypoxemia prior to tube insertion.
The Echelon Flex Powered Endopath Stapler (Ethicon, Cincinnati, Ohio) is another device that is beneficial to our surgeons. The stapler provides greater stability and surgeon controlled power throughout the surgery, thus resulting in less potential for tissue trauma. The ease of the stapler has allowed for greater efficiency during bariatric cases.

Scheduling and Inventory
Our bariatric patient advocate, Tiffany McZeal, currently coordinates the procedure scheduling. We use Millenium software (Cerner, Kansas City, Missouri) for surgery scheduling. Our program manager, Brooke Doucet, RN, oversees the scheduling, inventory, and staffing processes.

Jodi Cobb, RN, is responsible for purchasing equipment and supplies in the operating room. Jodi also acts as the bariatric liaison in surgery.
All inventories are managed through McKesson’s ERP system. The system allows us to adequately manage and track medical and surgical supplies. As supplies are used, debits and credits occur, which track the movement of supplies throughout the hospital and health system. Once an item has been depleted to a preset level, an order is automatically generated for the replenishment of the supply. The entire process is done electronically, which allows for greater efficiency and time management.

Purchasing of all equipment follows through the Materials Management Department. Requisitions are generated by the end user and once approved are sent out for purchase. A purchase order is issued for the supply or equipment.

Patient Assessment
Determining appropriateness for surgery is a multidisciplinary process at our facility. Review of past medical history, psychological stability and nutritional history is conducted prior to surgery in attempt to determine any areas of concern. Contraindications for surgery are defined by National Institutes of Health (NIH) and ASMBS guidelines.

If the patient is deemed an appropriate candidate based on these guidelines, yet is deemed a patient of concern by a member of the bariatric team, the patient is then placed on a roster for discussion. Collaboration of these patients by the bariatric team is conducted at a clinical meeting held monthly with our Medical Director of Metabolic and Behavioral Services, Dennis Eschete, M.D. Appropriate actions and recommendations for the patient are documented and determined at this time.

Managed Care
Meeting a patient’s needs means exceeding the requirements of managed care and insurance companies. With that standard, LGMC offers a comprehensive program to educate patients about their procedure and recovery. The teaching begins 6 to 8 weeks prior to surgery, and extensive follow up ensures the patient’s treatment will achieve the best results.
As a result, the program is an accredited center by multiple entities. Managed care emphasizes the importance of accreditation designations. Some insurance carriers require these credentials to deliver reimbursement.
Because managed care is pressing for population health, nonsurgical weight loss treatments are becoming more widely accepted by payers. Advancing this trend, LGMC provides a medically supervised weight loss program under the medical directorship of Ben Doga M.D. in addition to housing a registered dietitian offering a full array of necessary vitamin and mineral supplements to patients.

Cost and Efficiency
LGMC has taken multiple measures to contain and cut cost and improve efficiency. One of the ways we do this is through our pre-operative screening process. Potential patients are required to meet with the bariatric team, which includes our bariatric certified nurse manager, registered dietitian, behavioral modification educator and exercise physiologist multiple times prior to surgery. The team evaluates the patient’s knowledge, mental and physical readiness and nutritional needs for the specific weight loss surgery they are about to endure.

This screening process reduces the amount of re-operations and re-admissions postoperatively by detecting potential nonadherent patients, thus resulting in decreased complications and contained cost.

Patient and Staff Safety
Proper ergonomic training consisting of safe patient handling, demonstration of Hovermatt, HoverJack, and portable lift training are taught annually to all employees who may potentially provide care to  bariatric patients. Safety is taught via an online course and annual skills lab training specific to each unit.

Staff Training
Annual bariatric sensitivity training is mandated for all employees at LGMC. Additionally, those who care for bariatric patients are educated regarding proper body mechanics and complications upon hire and on an annual basis. Nurses that are dedicated for bariatric patient care are required to attend a pre-operative education class. The class consists of dietary changes pre-operatively and postoperatively, hospital stay protocol and possible complications, behavior modification education pre and postoperatively, as well as exercise education. Upon completion of the pre-operative class and required orientation period, the new nurse must meet with the bariatric coordinator in order to sign off on appropriate understanding of the policies, procedures and care of the bariatric patient.

A Unique Facility
LGMC has invested multiple resources into the bariatric program and is building an emergency department and operating room suites to better serve our growing community

Our extensive multidisciplinary team and follow-up care helps our program stand alone from other bariatric programs. In keeping with our medical center’s mission statement, “To Restore, Maintain and Improve Health,” our bariatric program is designed to treat the patient as a whole, not just his or her obesity. We focus on lifestyle changes and establishing new healthy habits to promote a lifetime of success. Multiple resources are invested by both Lafayette General Medical Center and Acadiana Weight Loss Surgery to ensure the bariatric patient has all the necessary tools to achieve and maintain their individual goals.

To learn more about us, visit LafayetteGeneral.com/Bariatrics.

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