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For example, the group improved pre-discharge pain management by working through medication-administration pathways to ensure that the transition from epidural to oral medications occurred simultaneously. “Before, a longer delay may have occurred from the time that the epidural was turned oﬀ and oral medications were started,” Dr. Lin says. “Our team worked with pharmacists to rewrite pharmacy orders so that nurses would feel more comfortable giving additional medication to alleviate pain when necessary.” The group also standardized post-discharge medication protocols and focused on spending more time educating patients about pain management. “When we tell patients what medications they will be on and what they should expect, they feel more comfortable because they can get on board and ask questions about it from the very start,” Dr. Lin explains. The ACT UP! program also targets CRS complications and hospital readmissions by engaging patients in an early warning system designed to identify and report potential problems to watch for at home following hospital discharge. These signs include wound drainage, opening or redness, bowel obstruction, abdominal pain or swelling, nausea or problems with eating, high output in their ostomy pouch and problems with cognition or ambulation. To facilitate patient-provider communication, the program is piloting the use of mobile health “We want to make it clear that everyone is important and everyone — the physicians, hospital staff, and the patients — has a voice,” says Anne Lin, MD, of UCLA’s Advanced Colorectal Treatment Uniform Protocol (ACT UP!) team at UCLA. wireless tablets for patients to use during their postoperative hospital stay, and then later at home. “This empowers patients to participate in their own care by notifying us of any issue that seems to be outside of the norm,” Dr. Lin says. “If we’re alerted to problems sooner, we have an opportunity to see the patient in clinic and address the problem or make recommendations over the phone, before the patient ends up in the emergency department or hospital.” The program will also evaluate additional quality measures, including hospital length of stay and patient satisfaction, according to Dr. Lin. “When we tell patients what medications they will be on and what they should expect, they feel more comfortable because they can get on board and ask questions about it from the very start.” For more information about the UCLA Colorectal Cancer Treatment Program, go to: colorectalcancer.ucla.edu Minimally Invasive Procedure Provides New Option for Patients with Rectal Polyps, Tumors Colorectal cancer strikes more than 140,000 people each year, but it may be potentially cured or even prevented if tumors or precancerous polyps are detected early and surgically removed. Transanal minimally invasive surgery (TAMIS) is a newer, less invasive surgical procedure that represents a good diagnostic or therapeutic tool for some patients with rectal polyps or tumors, according to UCLA colorectal surgeon Anne Lin, MD. it allows surgeons to remove not only the specimen, but also the thick layers of tissue and fat surrounding the polyp or tumor. This helps pathologists to better determine whether early stage cancer is present, how invasive the cancer is and whether it has spread to the lymph nodes. The information can then be used to decide whether additional surgery or adjuvant therapies such as radiation or chemotherapy are required. “When the tumor or polyp is larger or not amenable to removal using conventional methods or there is concern about early cancer, we can use this technique to take the polyp out in one piece as opposed to performing a piecemeal resection via colonoscope,” Dr. Lin explains. The advantage to this approach, she says, is that TAMIS is performed using laparoscopic instruments through the rectum and then removing the tumor or polyp. The surgery is associated with less pain and shorter recovery time. 11 UCLA Physicians Update