Aerodigestive and Esophageal Center Improves Access and Treatment Efficiency, Reducing the Care Management Burden on Families

As home to the oldest aerodigestive program in the nation, Cincinnati Children’s manages and treats some of the most complex airway and esophageal cases. Often, the team finds multiple conditions present along with airway conditions related to the ear, nose and throat (ENT).

The internationally recognized Aerodigestive and Esophageal Center (ADEC) team diagnoses and treats some of the most complex esophageal cases with a coordinated, multidisciplinary approach. Pulmonologists working within ADEC wear multiple hats to provide care for children with airway obstructions, airway abnormalities and comorbidities.

“We are here to manage the underlying pulmonology issues and to move the process along to a healthy pulmonary state so the child can undergo a successful airway surgery for those who need it, or to improve a pulmonary condition along the way toward improved health,” says pediatric pulmonologist Cherie Torres-Silva, MD.

Expertise in Flexible Bronchoscopy

As the largest ADEC in the U.S., Cincinnati Children’s employs innovative technologies while providing flexible bronchoscopies in a variety of settings, explains pediatric pulmonologist Sara Zak, MD.

Medical director of bronchoscopy Dan Benscoter, DO, leads a team of pulmonologists who bring a different perspective to a patient’s condition while working alongside surgeons, gastroenterologists, otolaryngologists and other specialists. Their skills push the envelope on the types of care they can provide during a procedure—such as taking a biopsy or performing cryotherapy.

Whether it’s immediate patient care or research, the collaborative environment at ADEC brings untold benefits, Zak says.

Cincinnati Children’s is a high-volume center that can study large numbers of patients with complex and rare conditions. Zak partners with ENT specialists and surgeons to research procedure outcomes in different patient populations.

“The pediatric population is becoming more complex because kids are living longer with conditions that in the past were not survivable,” Zak says. “Our research lets us provide guidance to families, doctors and other providers about what to expect from specific treatments and what to anticipate in the future.”

Extensive, Coordinated Evaluations

Pediatric pulmonologists within ADEC spend time taking patient medical histories and gathering information. The process helps coordinate a patient’s care before, during and after a procedure or surgery.

Patients come to the ADEC with varied conditions, including airway obstructions, chest weakness from multiple surgeries, congenital conditions, gastrointestinal concerns, neuromuscular disorders, pulmonary insufficiency and tracheostomy.

The pulmonology team assesses patient health to find the right time for surgery. For example, infections can impact recovery after surgery. If a patient is likely to get pneumonia, other complications could result.

“We dedicate our energy to ensure all things are aligned from a pulmonology standpoint,” Torres-Silva says. “This coordinated, multidisciplinary approach sets us apart.”

Understanding what each intervention requires enables the pulmonology team to ensure successful outcomes and provide critical postoperative care. This includes a medical management plan to carry a patient through recovery.

Every Wednesday morning, the ADEC team—including specialists in anesthesiology, cardiology, chest surgery, ENT, gastroenterology, pulmonology and radiology—meets to discuss each patient’s care. This keeps all providers on the same page and provides a unified message to families, pulmonologist Gregory Burg, MD says.

One of ADEC’s goals is to ease the burden of managing healthcare access for patients and families.

“The real magic of ADEC is that there are folks working at a number of different levels to maximize efficiency,” Burg says. “It’s not just physicians and nurses. It’s the speech therapist and schedulers and organizational leaders who all provide support.”

The success of this model is recognized nationally. The ADEC team partners with the Aerodigestive Society to train and build similar programs around the country, says Erik Hysinger, MD. Several members of the society’s board trained at Cincinnati Children’s. Michael Rutter, MD, sits on the executive committee. Zak sits on the research and membership committees.

Managing Future Growth

The ADEC is learning how to manage its growth as the number of referrals increases.

Efforts are underway to train internal pulmonologists in providing bronchoscopy and to recruit new doctors.

The team constantly works to improve its processes, Torres-Silva explains. That includes adapting adult procedures for pediatric patients and developing interventional skills that allow procedures like biopsies to be administered during a bronchoscopy.

“Our rapid growth makes it challenging,” Torres-Silva says. “But every division is invested in addressing the needs of the center and making sure their section is not a bottleneck.”

The collaborative model “translates to more cohesive care,” adds Zak. “We could not do what we do individually. By working together, we can advance and improve care.”