HJAR Sep/Oct 2024

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2024 45 Joana M. Mack, MD Medical Director Vascular Anomalies Center of Excellence Arkansas Children’s Hospital Key components of the Mini-VA Clinic include: • Team composition. • Clinic schedule. • Patient evaluation. • Telemedicine. The team’s surgical and medical leaders work simultaneously to facilitate patient management. The Mini-VA Clinic is held weekly for a half day, accommodating 15–20 patients per session (30–40 total). Experts examine, diagnose, and treat patients with simple and complex lesions and consult as needed with other specialties. In addition to Little Rock, we recreated this model at our Springdale location to expand access in that region and surrounding states. A tele- medicine outreach clinic in Jonesboro helps reach patients in rural areas and reduces the need for long-distance travel. Noteworthy outcomes Since the initiation of the Mini-VAClinic in August 2023, we have seen a substantial increase in patient volumes and a significant reduction in wait times. Over nine months, the Mini-VA Clinic saw over 500 patients, a 200% increase compared to the Big-VA clinic alone, which typically saw 240 pa- tients annually. Additionally, our outreach clinic served 118 patients from rural areas. The referral- to-visit timeframe decreased from 12–16 weeks to 1–2 weeks. Approximately 15% of patient encounters were shared between the surgical and medical directors, allowing for real-time decision-making and comprehen- sive care. On the first day of one of our Mini-VA Clinics, a baby with Trisomy 18 from out of state was treated. The family was told their child had an infantile hemangioma blocking the airway and they would die from the condition. Our clinic coordinator called and told the family an appointment was available within 48 hours. Instead of an infantile hemangioma, the child received an updated diagnosis in our clinic. A scope was performed in-clinic, and the child had surgery two days later in Little Rock. Today, the patient is thriving, no longer has airway issues, and does not require more invasive airway procedures. The success of the Mini-VA Clinic un- derscores the importance of flexibility and adaptability in multidisciplinary care. By co- ordinating large teams and focusing on a core group of specialists, we provided timely and effective care to more patients by re- ducing the logistical burden of coordinat- ing large teams. This model also preserved valuable resources, allowing us to allocate provider time more efficiently and address less-complex cases without the entire mul- tidisciplinary team. The success of the Mini-VA Clinic model suggests that similar strategies could be beneficial in other institutions facing similar challenges inmanaging complex conditions. Our experience highlights the potential for innovative clinic models to transform pa- tient care and improve outcomes in special- ized medical fields. n Joana M. Mack, MD, is a pediatric hematologist-on- cologist atArkansas Children’s Hospital andmedical director of the Vascular Anomalies Center of Excel- lence.She is the Pediatric Hematology-Oncology Fel- lowship programdirector and assistant professor at University of Arkansas for Medical Sciences. GreshamRichter,MD,FACS,FAAP, is a pediatric oto- laryngologist at Arkansas Children’s Hospital. He is the chief of pediatric otolaryngology and surgical director ofVascularAnomalies Center of Excellence. He is a professor and vice chair of otolaryngology — head and neck surgery at the University ofArkansas for Medical Sciences. EXPLORING new models of care can help healthcare institutions improve patient ac- cess, reduce waiting times, and enhance overall patient care. Vascular anomalies represent a spectrum of disorders with simple or complex vascular lesions that often require amultidisciplinary approach for effective management. We rec- ognized the limitations in patient access and care inherent in our traditional Multidisci- plinary Vascular Anomalies Clinic (Big-VA Clinic). To address these universal challenges, we developed a Mini-Multidisciplinary Vas- cularAnomalies (Mini-VAClinic) atArkansas Children’s Hospital in Little Rock and Ar- kansas Children’s Northwest in Springdale inAugust 2023. New approach The conventional treatment of vascular anomalies is fundamentally multimodal, often necessitating the collaboration of various specialties such as surgery, in- terventional radiology, dermatology, and hematology/oncology. Our Big-VA Clinic embodied this comprehensive approach, bringing together over 20 participants — including attendings, trainees, specialty nurses, and research coordinators — to man- age complex cases. However, coordinating such a large teamposed significant logistical challenges, limiting the number of available clinic spots and extending patient wait times. The Mini-VAClinic was structured to op- erate weekly, focusing on simple and com- plex lesions. It involved a smaller core team consisting of a surgical director, a medical director, associated specialty nurses, and a team coordinator. This setup allowed us to manage a larger volume of patients more frequently compared to the monthly Big- VAClinic.