This award celebrates the innovation and collaboration that are foundational to the success of UT Southwestern Medical Center. It recognizes a group of clinical faculty and staff who have partnered to create, develop, and sustain an innovative program that significantly advances our ability to improve patient care.

Multidisciplinary Liver Tumor Program

Obstetrics Quality Assurance and Performance Improvement

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Multidisciplinary Liver Tumor Program

Amit Singal, M.D., M.S.
Professor of Internal Medicine and in the Peter
O’Donnell Jr. School of Public Health
Division of Digestive and Liver Diseases
Medical Director, Liver Tumor Program

Adam Yopp, M.D.
Associate Professor of Surgery
Division of Surgical Oncology
Surgical Director, Liver Tumor Program

Liver cancer rates are rising rapidly in the United States, in part due to increased prevalence of obesity and diabetes, and the state of Texas has the highest incidence nationwide. The growing presence nationally and the high incidence locally demonstrate the critical need filled by UT Southwestern’s Multidisciplinary Liver Tumor Program.

One of the largest in the country, the program is noteworthy for its collaborative and comprehensive approach to the treatment of hepatocellular carcinoma.

Under the leadership of Drs. Amit Singal, Professor of Internal Medicine, and Adam Yopp, Associate Professor of Surgery, it has grown from caring for 100 patients a year to more than 300 patients annually.

From its beginning, the Liver Tumor Program was designed as multidisciplinary. Clinics at both the Harold C. Simmons Comprehensive Cancer Center and Parkland Health are staffed with hepatologists, hepatobiliary and transplant surgeons, interventional radiologists, and oncologists. This approach provides liver cancer patients with streamlined access to all the specialists they will need.

The program also tackles the disease with a multipronged approach, offering prevention, screening, treatment, and research.

Liver cancer is often associated with hepatitis B and hepatitis C, infectious diseases that can be treated, and the UTSW Liver Tumor Program has cared for thousands of patients with hepatitis C, preventing numerous cases of cancer.

UT Southwestern’s screening program has had a national impact. It was one of the first to demonstrate improved accuracy by combining alpha-fetoprotein measurements with liver ultrasound for screening patients with cirrhosis, and this approach is now part of guidelines by the American Association for the Study of Liver Diseases.

The program’s faculty and staff have been champions of advanced surgical treatments for liver cancer, both resection (removal of the cancerous portion of the liver) and transplantation of a new liver.

Additionally, translational research – activities that move the diagnosis and treatment of liver cancer forward – are a cornerstone of UTSW’s Liver Tumor Program. It was one of the first in the U.S. to use robotic resection for liver cancer surgery, increasing patient eligibility for a curative surgical treatment, and remains the largest in the region to do so. Patients who are not eligible for surgical treatment have access to numerous investigator-initiated clinical trials. Members of the program discovered and validated the first risk-stratification biomarker for hepatocellular carcinoma risk among patients with cirrhosis and are currently evaluating novel immunotherapy combinations as an option for liver cancer treatment.

Said one nominator, “This program has received multiple collaborative team science research awards, including awards from the Department of Defense and the National Institutes of Health, and has been instrumental in changing national guidelines for the diagnosis and management of liver cancer.”

Wrote another nominator, “The program includes laboratory-based, translational, and clinical investigators, patient-care providers, and population and health-services researchers, thus covering the spectrum of screening and prevention, clinical trials, the latest standards of care, mentorship, survivorship, and community outreach. Furthermore, it is now one of the best-funded programs in the country.

“The program extends beyond simple care delivery to also integrate clinical research questions as well as translational discoveries to bring the benefits of cancer research to patients.”

Cultural differences can make a difference in treatment, and the Liver Tumor Program is studying treatment barriers, health literacy, and medical mistrust issues, developing ways to reduce these barriers.

In their words: “We are truly honored and humbled by this recognition, as this program reflects over a decade of work at all levels, including clinical, educational, and research endeavors. The Liver Tumor Program has taken a multidisciplinary approach to tackling gaps in care across the cancer care continuum, from prevention and screening to treatment and survivorship. Using a team-based approach, leveraging areas of expertise across campus, we have successfully implemented interventions that have reduced liver cancer incidence, improved early cancer detection, and reduced liver cancer mortality. Focused efforts at each of these steps have not only allowed us to offer aggressive and innovative treatments to our patients in the North Texas area but also help shape the field on a national scale.”

 

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Obstetrics Quality Assurance and Performance Improvement

Shivani Patel, M.D.
Associate Professor of Obstetrics and Gynecology

Postpartum hemorrhage, which is excessive bleeding by a woman who has given birth, is a serious condition that can sometimes necessitate a hysterectomy and can lead to organ damage and even death.

The Obstetrics Quality Assurance and Performance Improvement (QAPI) program, led by Dr. Shivani Patel, made changes to obstetrics practices that dramatically reduced the incidence of postpartum hemorrhage, cutting it from 14% to just 5% of births.

In 2019, the Obstetrics QAPI program began its efforts to lower the postpartum hemorrhage rate by taking a comprehensive look at the labor and delivery process. Then the team began implementing changes – some procedural, some cultural. They made it standard practice to have two postpartum medications in the delivery room during each birth; if a decision is made that these drugs are needed, they are already on hand. QAPI faculty and staff worked with the blood bank to create an obstetrics-specific massive transfusion protocol, which allowed blood to get to the unit faster. With the new protocol, the average time it took for blood to reach the patient was reduced by a precious five minutes.

Additionally, a new system was set up to measure the amount of blood loss for postpartum patients, ensuring measurements would occur at 15-minute intervals. Importantly, a certain level of measured blood loss now automatically initiates a set of orders for dealing with hemorrhaging. And, perhaps most creatively, a new system was put in place that allowed any member of the care team – physician, nurse, advanced practice provider, or patient-care technician – to escalate the level of care.

With all these changes in effect, the need for blood transfusion of more than four units decreased from 10% to 3%, and the number of women being admitted to the ICU dropped from two per month in 2019 to just five total since the beginning of 2021.

The QAPI program headed by Dr. Patel substantially improved outcomes on other quantifiable measures as well, including the time to treatment for patients with severe hypertension and the number of surgical site infections. Team members innovated to create bundles that spanned the ambulatory and inpatient settings and involved the patient in their care and outcomes. Those bundles included standardized Maternal Early Warning Sign notes and “one-stop shop” order sets that streamlined delivery of care.

Said Dr. Patel’s nominator, “Our Obstetric QAPI program is the standard by which service line QAPI programs are built. Dr. Patel has been asked to help other service lines develop a QAPI program, and she has created a how-to slide deck to assist other service lines in achieving similar success.”

Although the Obstetric QAPI program begins with quantifiable metrics, there have been changes in the department that cannot be numerically measured. “Our culture is now proudly one of safety and respect. Every member is intentional in trying to create a team-based, respectful, humble, and safe place with a sense of belonging for each member of the team,” said Dr. Patel’s nominator. “The Obstetric QAPI program has created a culture that aims to communicate three messages: You are part of this group; this group is special; we have high standards.”

In her words: “We are humbled and honored to have the Obstetrics Quality Assurance and Performance Improvement Program recognized by our leadership and colleagues at UT Southwestern. The program started in 2019, and its foundation is built on the four core values of our institution: excellence, compassion, innovation, and teamwork. Our team is a multidisciplinary, cross-functional, and collaborative group whose purpose is to innovate and strategically solve problems. We look at problems not only scientifically, but also from the human perspective of our patients. Central to our process is continuous learning, curiosity, and teaching others. With every problem, we start small, change course when needed, and continually iterate and test to find the best solutions for our patients and our people. And through this process, we have created a culture of respect, trust, safety, humility, and a space where everyone openly shares ideas. All of this translates into a program whose goals are to provide quality care and service with both our patients and our people at the forefront. We seek daily to be a team with a solution-focused culture leading with humility.”