From
Colorectal Channel
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
hosted by Dr. Marc Levitt & Dr. Todd Ponsky & Dr. Em Gootee
Chapter 1 of 10 · Emerging & Future Directions
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Video
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)
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What the experts said
Notebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.
The AI-generated podcast voices are not customizable; users are limited to the same male and female voices.
Notebook LM's beta version allows users to join the AI conversation interactively.
A urologist produced a review article outline in minutes using Notebook LM with 30 articles, a task that previously took two weeks.
AI can identify gaps in knowledge across a set of uploaded research articles.
Hospitals should have teams that continuously bring new AI tools to clinicians every week.
Em Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video).
Human oversight is necessary to ensure AI-generated medical content is correct.
When documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources.
Colorectal and pelvic disorders in children are intricate, often lifelong, and involve interconnected digestive, urinary, reproductive, and musculoskeletal systems.
Conditions benefiting from multidisciplinary care include anorectal malformations (ARM), Hirschsprung disease, severe constipation from colonic dysmotility, and neurogenic bladder/bowel dysfunction (often in spina bifida).
Collaborative colorectal programs lead to better treatment adherence, improved communication among specialists, fewer complications, and better overall health outcomes.
Initial driving forces for establishing these programs are strong focus, passion, deep interest from key individuals, and solid work ethic; detailed knowledge grows over time.
A dedicated physician leader, typically a pediatric surgeon, is essential to champion the program and envision improved colorectal care quality.
Before building a center, the leader must assess local need, feasibility given existing services, and identify underserved patient populations.
Core initial specialties for a colorectal program are general surgery, urology, gynecology, GI motility, and a dedicated nursing team.
A dedicated, passionate nurse specializing in bowel management is the backbone of the program; without one, even brilliant surgeons cannot make the program function effectively.
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 such cases, a pediatric surgeon may manage gynecologic aspects for female patients, or an adult gynecologist with expertise in Müllerian anomalies or disorders of sexual development may be recruited.
A GI colleague with interest in motility and manometry studies is essential, along with clear constipation management guidelines and criteria for referral to the multidisciplinary team.
Access to anal and colonic motility studies and pelvic floor physical therapy should be incorporated into the program.
Radiologists need education on colorectal diseases and proper performance/interpretation of contrast enemas, colostograms, and cloacagrams; surgeons should actively participate in imaging studies initially.
A pathologist with expertise in intestinal disorders like Hirschsprung disease ensures accurate tissue handling and interpretation; good surgeon-pathologist communication is crucial.
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 the same hospital.
Programs should proactively ask other centers to share materials like intake forms and follow-up protocols, then adapt them locally and share their own innovations back with the community.
All team members, not just surgeons, should participate in learning opportunities such as conferences and specialized training.
Surgical videos are helpful for building confidence and understanding techniques but are not a substitute for hands-on surgical experience.
Systematically collecting patient data and joining research networks or consortia is key to advancing the field.
The colorectal nurse must have strong foundational knowledge of condition types (ARM, Hirschsprung, neurogenic bladder/bowel) and skills in pre/postoperative care, bowel irrigations, catheter management, and teaching families anal dilations.
The colorectal nurse must understand treatment plans from all specialists to effectively communicate with families.
Educating inpatient nursing staff through protocols and sessions ensures consistent high-quality care and increases family comfort during hospitalization.
Essential supplies include Hegar dilators, various catheters, 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 to track include total referrals, total visits, new patients, out-of-region patients, surgical cases (inpatient/outpatient), length of stay, revenues, expenses, and safety/quality metrics like complication rates.
Documenting telephone encounters with patients/families 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 recovery paths.
For private hospitals, tracking relative value units (RVUs) is important for the business plan, though complex in multidisciplinary models.
Data serves dual purposes: internal quality improvement and business case development, plus research and publication to attract more referrals.
In private hospitals, the business case emphasizes attracting patients and downstream revenue; in public hospitals, it focuses on cost savings through reduced complications, shorter stays, fewer ER visits, and improved quality of life.
Building trust with referring physicians requires patience; many have managed these conditions themselves for years and need time to see the value of the multidisciplinary approach.
Successfully managing patients referred for bowel management (even those with prior surgeries elsewhere) gradually demonstrates the program's value; many will need further surgery later.
Offering to collaborate with referring surgeons on complex primary repairs is an effective strategy for building relationships and sharing expertise.
A dedicated care coordinator or scheduler is a top priority for resource allocation to streamline patient visits and serve as a central family contact point.
Building 'bench strength' by initially sharing resources (e.g., allocating a portion of a general surgery nurse's time) is a cost-effective way to start, with the goal of demonstrating need for dedicated staffing as the program grows.
Hospital planning and data analysis departments have expertise in developing business cases and should be engaged early.
Key business case questions include: target patient population, current volume, service gaps addressed, potential to attract new patients or bring back those seeking care elsewhere, resource needs over time, barriers, consequences of not building the program, and alignment with hospital mission/vision/strategic plan.
A multi-year plan with clear milestones for additional resources and expected results is necessary, given that establishing a center of excellence takes sustained effort.
All involved providers must be credentialed with government payers (Medicaid) and private insurers in the state and neighboring states; adequate lead times for credentialing and pre-authorization are essential.
Understanding payment models (diagnosis-related groups for inpatient, case-by-case or bundled payments for outpatient) is key, as is considering telemedicine for initial and follow-up visits, with attention to licensing and reimbursement.
A typical week in an established program includes regular new-patient intake meetings (nursing-led, gathering records, developing initial multidisciplinary plans, addressing psychosocial/nutritional/anesthesia concerns, verifying information with families, starting pre-certification/billing).
The multidisciplinary team (colorectal surgery, urology, gynecology, GI motility, nursing, social work) reviews the nurse's proposed plan collaboratively to streamline diagnostics, reduce visits/tests, and foster shared understanding.
For families traveling long distances, programs consolidate as many appointments as possible into a single visit.
Weekly collaborative meetings for returning patients review status before upcoming appointments/procedures, determine if new testing or surgery is needed, address pre/postoperative considerations, and plan clinic visits (which specialists, time allocation).