Summa Health System Bariatric Care Center: Akron, Ohio

TELL US ABOUT THE ROLES AND RESPONSIBILITIES OF THE LEAD STAFF AT YOUR FACILITY.
Summa Health System’s Bariatric Care Center, a designated American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence, approaches both the surgical and medical treatment of obesity in a multidisciplinary team fashion. The Bariatric Care Center has 21 members on staff.

John G. Zografakis, MD, FACS, has been medical director of Summa Health System’s Bariatric Care Center since its inception in 2004. He is fellowship-trained in advanced laparoscopic and bariatric surgery and is board certified by the American Board of Surgery. Dr. Zografakis is also the director of Summa’s Advanced Laparoscopic Surgical Services and an assistant professor of surgery at Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM). He is an active member of the ASMBS and is a designated ASMBS Center of Excellence surgeon. He is responsible for performing the center’s bariatric surgeries.
Adrian G. Dan, MD, Associate Medical Director, joined Summa in September 2006 as the associate medical director of the Bariatric Care Center. He is fellowship-trained in advanced laparoscopic and bariatric surgery and is board certified by the American Board of Surgery. Dr. Dan is also on the teaching staff with the department of surgery at Summa’s Akron City Hospital. Along with Dr. Zografakis, he is responsible for performing the center’s bariatric
surgeries.

William F. Fallon, MD, MBA, FACS, Chairman, Department of Surgery, supports Summa’s Bariatric Care Center in bariatric surgery revisions and open bariatric surgery when a minimally invasive approach is not possible. He has been performing surgeries and surgical revisions for more than 30 years. With Summa for four years, Dr. Fallon is the chairman of the department of surgery and an associate professor of surgery with NEOUCOM.
Kenneth W. Wells, MD, Medical Director, Medical Weight Loss Management, has been medical director of the Bariatric Care Center’s Medical Weight Loss Management Program since 2005. The Medical Management Program is designed for patients who are interested in a “non-surgical” approach to weight loss. It is a comprehensive weight loss program that focuses on weight reduction and a healthier lifestyle through education, exercise, and dietary and behavioral modification. Dr. Wells is board certified in internal medicine.

John C. Pedersen, MD, FACS, Director, Summa Body Sculpting Center, started the Summa Body Sculpting Center in 2007 because of the demand for post-bariatric body sculpting. The Summa Body Sculpting Center is located within the Bariatric Care Center and works with patients who wish to further enhance their appearance after successful weight loss surgery. With the combined efforts of plastic and bariatric surgeons, patients can achieve their ideal physique. Dr. Pedersen is a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and the American Society of Bariatric Plastic Surgeons.

Kay Hawn, MBA, MSN, Program Director, joined Summa as the program director for the new Bariatric Care Center in 2004. She brings 28 years of healthcare experience to the position and in addition to extensive administrative experience, she has a clinical background in acute care, chronic/rehabilitative care, pediatrics, and home care. Kay is responsible for the development and daily operations of the program.

Debbie Pasini, RN, BSN, the center’s nurse case manager, is responsible for coordinating patient education, surgery scheduling, and outcome data acquisition. Debbie also coordinates an intensive preoperative education class that is required for all patients before surgery. During this class, Debbie and the bariatric dietitian cover issues including how to prepare for surgery, what to expect during surgery, and what will happen while under the care of the hospital. After surgery, Debbie visits each patient twice daily, calls the patient after discharge, and answers all patient postoperative phone calls.
Debbie joined Summa in February 2004 as the RN case manager for the Bariatric Care Center. With 30 years of healthcare experience, Debbie has worked in both hospital and home care settings and has experience in acute care nutrition support, bariatric, and home infusion therapy. Debbie is an associate member of the ASMBS.

Robin Bowman, RD, CD, provides patients with a preoperative nutritional assessment and evaluates their current food habits and dieting history. Robin provides ongoing education about the types and amounts of foods patients will need to consume after surgery, as well as habits and lifestyle modifications necessary after surgery. She works closely with Debbie Pasini, the nurse case manager, to educate patients during the preoperative education class. Robin also coordinates the monthly postoperative support group “LIFE—Losing Inches Forever.”
Robin joined the Bariatric Care Center in May 2006. She has 20 years of experience as a dietitian, with a career-long focus on weight loss
management.

Karen Carson, Clinical Exercise Specialist, works with patients both before and after surgery to develop an individualized plan for exercise that will work for the longterm. Karen uses her exercise physiology education and experience to help each patient meet and succeed at their personal goals for weight loss and lifelong health. Karen has been with Summa’s weight loss surgery program since 2004.

The job of Beverly Hendrickson, Bariatric Financial Specialist, is to make sure patients understand their insurance benefits, complete the insurance preauthorization requirements, and help them move quickly and easily through the process. She reviews each person’s benefits and explains all applicable co-payments, co-insurances, deductibles, and other fees that may apply.
Beverly joined the Bariatric Care Center in May 2004. Previously, she spent 14 years at Summa working as a unit secretary in Women’s Health.

Other integral team members include the following:
• Cindie Gatskie, Administrative Secretary
• Billie Jarvis, Medical Assistant and Scheduling Coordinator
• Jeff Lucas, Medical Office Associate
• Lauren Rutan, Receptionist
• Julie Siglow, Claims Analyst
• Laura Richardson, Clinical Exercise Specialist
• Heather Webb, Body Sculpting Associate
• Carly Close, Body Sculpting Associate
• Janie Michaels, Body Sculpting Associate
• Susan Hill, Administrative Staff for Drs. Zografakis and Dan
• Rachel Hinton, Administrative Staff for Drs. Zografakis and Dan.

The surgical team is comprised of a core group of dedicated and experienced personnel. Lisa Parise, RN; Lisa Howell, RNFA; Lori Kline, RN; Patty Wolfe, RN; Stacie Zufall, RN; Crystal Saffles, ST; Armando Calderon, RN; David George, RN; and Phillip Swansinger, RN, help Drs. Zografakis and Dan perform the center’s surgeries. Their clinical expertise and passion for minimally invasive surgery are an integral part of the excellent surgical outcomes that the center has enjoyed throughout the past four years.

Please describe your bariatric facility.
Located in Akron, Ohio, the Bariatric Care Center is located on Summa Health System’s Akron City Hospital campus, which is a 577-bed, Level I trauma facility. Summa is one of the largest organized delivery systems in Ohio, encompassing a network of hospitals, community-based health centers, a health plan, a physician-hospital organization, an entrepreneurial entity, research and medical education, and a philanthropic foundation. Summa is nationally renowned for excellence in patient care and for exceptional approaches to healthcare delivery.
The System represents more than 1,800 licensed, inpatient beds on the Akron City, St. Thomas, Cuyahoga Falls General, Robinson Memorial, Wadsworth Rittman, and Barberton Hospital campuses. In addition, outpatient care is extended throughout the county in four community health centers and through partnerships with the Cuyahoga Falls Natatorium and the Shaw Jewish Community Center.

How many patients are treated annually at your facility?
Since the Bariatric Care Center opened in 2004, the program has grown steadily. We have conducted more than 350 surgeries since December 2004, including laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic and open revisional
surgery.
Laparoscopic Roux-en-Y gastric bypass patient demographics are as follows:
• Average BMI – 49 kg/m2
• Average LOS – 2.18 days
• Average age – 54 years (range: 20-67)
• 19% male
• 81% female

Laparoscopic adjustable gastric banding patient demographics are as follows:
• Average BMI – 46 kg/m2
• Average LOS – 1.01 days
• Average age – 50 years (range: 23-72)
• 15% male
• 85% female.

How do you handle patient compliance and long-term follow-up?
Patients are seen frequently for the first postoperative year and are then encouraged to follow up annually for life. It is important to offer education regarding diet and exercise as well as evaluate patient vitamin and protein levels and correct any abnormalities. The annual visits make sure patients are following the appropriate diet and exercise requirements and adhering to healthy food and nutrition habits. If a patient is not making his or her annual appointments, we make follow-up phone calls to encourage them to visit.

Please give a general synopsis of how your patients are treated while under the care of your center.
Our top priority is always our patients. The Bariatric Care Center’s comprehensive program was designed with the patient in mind—from the chairs in the waiting room to special equipment in exam rooms and our compassionate staff. We provide thorough preoperative and postoperative lifelong care as well as the support patients need along the way. We make sure each person who walks through our door is comfortable, well informed, and treated with respect.
In order to ensure a successful outcome, all patients considering bariatric surgery at Summa undergo extensive education and evaluation by our multidisciplinary team. The first step in our process is attendance at one of our free monthly weight loss informational seminars, led by Dr. Zografakis or Dr. Dan, Summa’s bariatric surgeons. They explain the surgical options, discuss the program requirements, and answer questions.
Once a patient schedules the initial consultation, he or she receives a welcome packet that includes a map, driving directions, and contact information for the bariatric team.
The patient’s first visit starts with an assessment of the vital information and a “before” photo. At each follow-up visit after surgery through the first 12 months, additional photos are taken to mark progress. Postoperative photos are an important visual image for patients as they undergo their postoperative transformations.
The patient then meets with the surgeon, Dr. Zografakis or Dr. Dan, who completes a thorough review of the patient’s medical history and performs a physical exam. Based upon the results of the assessment, an individual treatment plan is created, and preoperative tests and consults are ordered.
Each patient also meets with the center’s financial specialist, who reviews his or her insurance benefits and outlines the steps needed to obtain approval for surgery. All applicable co-payments, co-insurances, deductibles, and other fees that may apply are explained.
Once the patient enrolls in Summa’s bariatric program, he or she is scheduled to undergo the tests and consults ordered by the surgeon. This includes a comprehensive bariatric nutrition assessment, completed by the center’s registered dietitian; an in-depth psychological assessment, coordinated through Summa’s department of psychiatry, and pre- and postoperative exercise evaluations, which focus on an individual program the patient can use for the rest of his or her life. For those patients who need additional psychological resources, individual and group counseling are available through Summa’s department of psychiatry.
Once preauthorization is obtained for the surgery, the program’s nurse case manager works closely with the patient and the surgeon to schedule a surgery date and ensure all patients complete the comprehensive preoperative education class. Upon completion of the class, the patient is prepared to undergo surgery and is ready for the weight loss journey. After surgery, the case manager visits the patient at least twice daily while an inpatient and calls him or her the week he or she goes home to answer any further questions. The case manager is an integral part of the patient’s success and remains the primary contact after surgery.
To ensure the best chance for lifelong success, Summa’s Bariatric Care Center strongly encourages regular attendance at its monthly support group meetings. These group meetings are important for our patients as they provide support, education, and camaraderie, especially during challenging times. Although they target the postoperative patient, preoperative patients are also welcome to attend the groups to begin the networking that is so helpful after surgery.
Monthly support group meetings are strongly encouraged for all patients both pre- and postoperatively. This group, fondly referred to as “LIFE—Losing Inches Forever” by our patients, provides a mix of education, speakers, and support. Held on the Akron City Hospital campus, patients are encouraged to attend for the rest of their lives.

WHAT ARE SOME OF THE NEW EQUIPMENT, DEVICES, AND PRODUCTS INTRODUCED AT YOUR FACILITY LATELY?
Summa is committed to providing state-of-the-art minimally invasive technology to support the surgeons in their endeavor in minimal access weight loss surgery. Drs. Zografakis and Dan utilize any of four minimally invasive operating room suites – the Stryker iSuite®, a fully integrated operating room catered to minimally invasive surgery. The 1188 HD 3-Chip® Camera from Stryker offers superior picture quality and enhanced clarity during surgical procedures. This is evident on the boom mounted Stryker 21” Vision Elect® HD Flat Panel Displays. All of the equipment is managed through the SwitchPoint Infinity® Control System, a voice operated video, audio, and information router of the iSuite® Operating Room. Surgical images, patient vitals, digital radiology, diagnostics, and telemedicine can all be managed via the SwitchPoint Infinity®.
Both surgeons use the On-Q® postoperative pain relief system. This is a subcutaneously inserted local anesthetic delivery system that has greatly reduced the patient’s postoperative pain.
In addition to minimally invasive weight loss surgery, Drs. Zografakis and Dan have most recently introduced Enterra® Therapy, laparoscopic gastric electrical stimulation used for refractory gastroparesis (Medtronic, Inc.).
Surgeons at Summa also offer robotic (daVinci®) surgical therapy for various cardiac, urologic, and gynecologic procedures.

How has managed care affected your facility and the care that it provides patients?
Access to care is always an important issue. We have positive relationships with the managed care organizations in the market and work with the managed care staff to move patients to surgery who meet the established medical criteria. All providers we work with cover bariatric surgery; however, in most cases each employer makes the final decision whether to offer the benefit. Our recent designation as an ASMBS Center of Excellence now allows us to care for Medicare patients and has increased our accessibility to some of the major commercial payors.

Does your facility utilize any alternative therapies?
For those patients who are not surgical candidates or do not wish to undergo surgery, we offer a 12-week “non-surgical” medical management program. This in-depth, physician-led program offers patients an alternative to surgical therapy. Dr. Wells, working closely with the bariatric dietitian, focuses on treating and educating patients about dietary and behavioral modifications.

How are employees oriented and trained for working with the bariatric patient?
All individuals employed by Summa Health System are required to attend a new employee orientation, which includes an overview of the system, education regarding patient sensitivity, and ergonomic recommendations for transporting/moving patients. Personnel working closely with the Bariatric Care Center receive further education regarding the special needs of patients of size, including the surgical care plan and recognition of postoperative complications, such as leaks and pulmonary embolism. The importance of protecting the patient’s dignity and providing respect are also discussed, along with support strategies to assist each patient in maximizing success following surgery.
We work every day to provide staff not only with the training and education necessary to care for patients, but also to make sure they have the appropriate tools and team support needed for success. A tremendous emphasis is put on teamwork and the belief that patients will have the best success within a comprehensive care team. Education starts with the employee’s first day with the team and continues with both Summa Health System requirements and bariatric program-specific continuing education and training.

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