The Division of Urology, Department of General Surgery and Division of Gastroenterology (GI) at Children’s Hospital of Philadelphia (CHOP) have teamed up to form the NEuromodulation, Bowel, and UroLogic Alliance (NEBULA). NEBULA was selected by CHOP’s PACE/BOAT program, which provides additional funding and support for clinical programs that showcase high-growth potential, to receive programmatic support for three years. The goal is to build a self-sustaining program within that timeframe. The NEBULA program's main aim is to provide transdisciplinary care for complex pediatric bladder and bowel dysfunction (BBD) patients collaboratively.
Why a collaborative approach matters
Prior to NEBULA, the GI motility, general surgery and urology teams provided independent evaluation, diagnosis and treatment of the issues these patients face. This fragmented approach combined with the lack of appropriate provider extenders (i.e., dedicated advanced practice providers and coordinators for pediatric complex BBD patients) led to provider strain and patient and family frustration.
Program goals
The NEBULA program began in August 2023 with focus areas that included:
- Providing longitudinal transdisciplinary care - Rather than providing multidisciplinary care (a model in which each provider maintains specialized expertise within defined professional boundaries), a transdisciplinary approach encourages a seamless blend of expertise and knowledge. In this way, a more interconnected model of healthcare delivery is provided, and specialists learn from each other and develop integrated treatment plans.
- Creating a consistent team - With this model, all members have equal buy-in to the program's success. Since its inception, the NEBULA program has consisted of one pediatric gastroenterologist (with expertise in GI motility), one general surgeon (with expertise in colorectal surgery) and one urologist (with expertise in neurogenic bladder dysfunction).
- Each physician is supported by one or two advanced practice providers dedicated to the program and attending clinic and meetings each month.
- With support from CHOP’s BOAT/PACE program, NEBULA also has a dedicated nurse coordinator/manager who assists with referrals, follow ups, day-to-day patient/family communications and program development.
- Expanding the use of neuromodulation for pediatric patients with neurogenic and non-neurogenic BBD - By the end of the first year of NEBULA, we completed the first successful implantation of a sacral nerve stimulator for BBD. Neuromodulation has the potential to be a game changer for children and adolescents with complex BBD and through the NEBULA program, patients who struggle with urine and stool continence may be exposed to these therapies earlier and in a coordinated fashion.
Conditions we target
Successful management of urine and stool issues in children with neurogenic and anatomical conditions affecting the bladder and bowel is one of the most crucial factors in determining a patient’s overall quality of life. Conditions that are specific targets of the NEBULA program include:
- sacrococcygeal teratoma
- tethered spinal cord
- spinal cord injury
- spina bifida
- anorectal malformation
After a trial period of once-a-month half day clinics, the NEBULA program expanded to one full day of pediatric BBD clinic per month. Before each clinic, all physicians, advanced practice providers and the nurse coordinator meet to review patients for that day, discuss new referrals and plan program development.
The Division of Urology, Department of General Surgery and Division of Gastroenterology (GI) at Children’s Hospital of Philadelphia (CHOP) have teamed up to form the NEuromodulation, Bowel, and UroLogic Alliance (NEBULA). NEBULA was selected by CHOP’s PACE/BOAT program, which provides additional funding and support for clinical programs that showcase high-growth potential, to receive programmatic support for three years. The goal is to build a self-sustaining program within that timeframe. The NEBULA program's main aim is to provide transdisciplinary care for complex pediatric bladder and bowel dysfunction (BBD) patients collaboratively.
Why a collaborative approach matters
Prior to NEBULA, the GI motility, general surgery and urology teams provided independent evaluation, diagnosis and treatment of the issues these patients face. This fragmented approach combined with the lack of appropriate provider extenders (i.e., dedicated advanced practice providers and coordinators for pediatric complex BBD patients) led to provider strain and patient and family frustration.
Program goals
The NEBULA program began in August 2023 with focus areas that included:
- Providing longitudinal transdisciplinary care - Rather than providing multidisciplinary care (a model in which each provider maintains specialized expertise within defined professional boundaries), a transdisciplinary approach encourages a seamless blend of expertise and knowledge. In this way, a more interconnected model of healthcare delivery is provided, and specialists learn from each other and develop integrated treatment plans.
- Creating a consistent team - With this model, all members have equal buy-in to the program's success. Since its inception, the NEBULA program has consisted of one pediatric gastroenterologist (with expertise in GI motility), one general surgeon (with expertise in colorectal surgery) and one urologist (with expertise in neurogenic bladder dysfunction).
- Each physician is supported by one or two advanced practice providers dedicated to the program and attending clinic and meetings each month.
- With support from CHOP’s BOAT/PACE program, NEBULA also has a dedicated nurse coordinator/manager who assists with referrals, follow ups, day-to-day patient/family communications and program development.
- Expanding the use of neuromodulation for pediatric patients with neurogenic and non-neurogenic BBD - By the end of the first year of NEBULA, we completed the first successful implantation of a sacral nerve stimulator for BBD. Neuromodulation has the potential to be a game changer for children and adolescents with complex BBD and through the NEBULA program, patients who struggle with urine and stool continence may be exposed to these therapies earlier and in a coordinated fashion.
Conditions we target
Successful management of urine and stool issues in children with neurogenic and anatomical conditions affecting the bladder and bowel is one of the most crucial factors in determining a patient’s overall quality of life. Conditions that are specific targets of the NEBULA program include:
- sacrococcygeal teratoma
- tethered spinal cord
- spinal cord injury
- spina bifida
- anorectal malformation
After a trial period of once-a-month half day clinics, the NEBULA program expanded to one full day of pediatric BBD clinic per month. Before each clinic, all physicians, advanced practice providers and the nurse coordinator meet to review patients for that day, discuss new referrals and plan program development.