Q&A With Dr. Frank Kolucki:
Frank Kolucki, M.D., a board-certified obstetrician-gynecologist, has served health systems in northeastern Pennsylvania for more than two decades. At Scranton’s Moses Taylor Hospital, now an affiliate of Community Health Systems (CHS), Kolucki serves as chairman of the department of obstetrics and helped establish the Women’s and Children’s service line. In 2015, he led a team that enabled the hospital to attain the coveted Joint Commission’s Perinatal Certification.
Driven to reduce the staggeringly high rate of maternal morbidity and mortality in the United States, where pregnancy-related deaths have more than doubled since 1987, Kolucki is passionate about creating and communicating better protocols and practices to promote good health, identify and treat early warning signs of adverse pregnancy outcomes, and ensure patient safety.
What have been the results of your health system’s focus on patient safety?
In 2006, Moses Taylor Hospital instituted what we called a culture of safety where patient safety supersedes all else. In our quest to make patient safety a priority, we looked at taking a team approach to caring for patients. We broke down departmental silos that were preventing good communication and collaboration. We also promoted continuing education, emphasizing that everyone should use their collective intellect to protect patients from harm.
From an obstetrics and gynecologic standpoint, we have positive patient outcomes. In July 2015, we were very proud to be the first hospital in the nation to be certified by the Joint Commission as a perinatal center. We were recertified in December 2017—one of only five in America at that time.
Describe some of your clinical and educational responsibilities.
I am the national physician advisor for the CHS obstetrics and pediatrics council. I also work as a clinical professor at two local institutions of higher learning, and I conduct webinars and conference presentations on issues such as quality, safety and decreasing maternal morbidity and mortality. Education has been an important part of my career, and now I’m working closely with HealthTrust on expanding member education related to women’s health. I have a small sphere of influence in northeast Pennsylvania, but when I work with a national organization like CHS or HealthTrust, it is my great privilege to expand that influence and be able to help physicians and clinicians across the country.
HealthTrust recently decided to concentrate on women’s health categories. Why is that significant?
The category represents a variety of products and implants used in gynecological and urogynecological procedures. HealthTrust was forward-thinking in focusing on this category because thousands of women across the United States (and the world for that matter) suffer from conditions such as stress urinary incontinence (SUI) or pelvic organ prolapse (POP).
POP occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs, resulting in the drop, or prolapse, of the pelvic organs from their normal position. SUI is the leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing or exercise.
A lot of women suffer from these lifestyle-altering conditions in silence, but there are operative and non-operative solutions available. HealthTrust is trying to help physicians make sound, evidence-based decisions about the right way to treat these individuals.
How are these conditions being managed and treated?
Better screening would help identify certain conditions before surgery is necessary. In August 2018, the Women’s Preventive Services Initiative, working with the American College of Obstetricians and Gynecologists, issued new guidelines for the annual screening of women for urinary incontinence beginning in adolescence. The screening assesses urinary incontinence and how it affects their quality of life. Clinicians should refer these women to gynecologists for further evaluation and treatment, when appropriate.
If surgery is needed to repair POP or SUI, a graft is used to recreate the natural anatomic support. Graft materials include autologous, allograft, xenograft and synthetic. Synthetic surgical mesh has been used for many years. It was first used in the general surgical community for hernia repairs, and then later for urogynecological procedures, including the repair of POP and SUI. A positive aspect of synthetic mesh is that it lends itself to a more minimally invasive approach to the surgery.
However, mesh is not perfect. It can have an adverse effect on intimacy and it can lead to some adverse consequences, including mesh erosion, chronic pain and injury to adjacent structures like bowel, bladder and urethra. It can also result in a necessity for reoperation.
The big question is whether or not to select an autologous graft using the patient’s own tissue versus a synthetic graft using surgical mesh. If you opt for mesh, you need to counsel the patient fervently and appropriately about it, then make the best decision you can regarding the type.
The physician community is not saying that synthetic mesh should never be used, but it needs to be used with an abundance of caution. The FDA has been clear in recent advisories on the safety and effectiveness of using surgical mesh implants for urogynecologic procedures. These statements acknowledge that such products are not without potential problems, and one has to closely examine the evidence and research to make a well-informed decision.
What is HealthTrust’s position on these products?
HealthTrust’s role is to inform providers of what’s available, the advantages and disadvantages of each option, and the clinical evidence to support it.
As with any new technology or device, new products need to be vetted extremely carefully before a provider decides to purchase or use them. Unless there is significant, reproducible clinical evidence that an item is safe and effective, it should be used cautiously.
What are some ways that HealthTrust assists physicians in their decision-making?
HealthTrust conducts timely reviews of all the current clinical evidence available and distills that information into an executive summary that can be used by HealthTrust physician advisors and clinical advisory boards to make sound decisions as to what is best for patients. If someone has a busy clinical practice, it can be an arduous task to go through all of the most recent studies. HealthTrust does a lot of that work for them and publishes it in a user-friendly format to aid them in their patient care. Clinical evidence reviews (CERs) are helpful because they may help physicians think about these products in new ways. For HealthTrust members in supply chain roles, the CERs can be helpful in discussing product choice with physicians at their health system or facility.
All of the information HealthTrust is distributing regarding women’s health categories is incredibly important. But it’s also important to remember that women’s health is much more than gynecologic surgery issues. That’s why the physician services team is focusing on women’s healthcare as a whole—including products that decrease the risks associated with pregnancy and childbirth.
For example, we are renewing our focus on preventing a national tragedy—the high rate of maternal morbidity and mortality. The United States is currently ranked 60th of all developed nations in the rate of maternal death. It’s a distressing problem, and it should not occur at this rate.
Frank Kolucki, M.D., a board-certified obstetrician-gynecologist, is the chairman of the department of obstetrics at the Community Health Systems-affiliated (CHS) Moses Taylor Hospital in Scranton, Pennsylvania. He is a graduate of Boston College and the Georgetown University School of Medicine, where he also completed his OB/GYN residency. Kolucki began his practice at Physicians’ Health Alliance, at the time an affiliate of the Moses Taylor Health Care System.
Kolucki serves as the national physician advisor of the CHS’s Obstetrics/Pediatrics Council and as a HealthTrust physician advisor. He is an assistant clinical professor at Geisinger Commonwealth Medical College and a clinical professor in the physician’s assistant program at Marywood University. Kolucki is a fellow in the American College of Obstetrics and Gynecology. He serves on the boards of directors of Moses Taylor Hospital, Physicians’ Health Alliance and Pennsylvanians for Human Life. In 2017, he won the Community Service Award from Maternal and Family Health Services, a nonprofit organization that works to meet the health and nutrition needs of Northeastern Pennsylvania.
Unfortunately, many of these women are dying needlessly—approximately 40 to 50 percent of all those deaths are preventable. We have well-written guidelines to help prevent pregnancy-related deaths. For instance, robust protocols are available through the American College of Obstetricians and Gynecologists, yet some hospitals and providers don’t use them regularly, often leading to tragic results.
What are some of the reasons for the high rate of maternal morbidity in the United States?
There are multiple environmental factors, but the first thing I try to reiterate is that we should never blame the patient—it’s not her fault. Even if she’s of an older maternal age, has high blood pressure or diabetes, or is obese, that’s inconsequential as to how we will treat that patient. Yes, those conditions may make treating that patient a little more difficult and complex, but the onus is on the provider and care team to out-think these obstacles and comorbidities. We should prepare for the complications that may occur and treat that patient appropriately, in an effective, highly reliable, evidence-based fashion. If you do that, most times you’re going to have a positive outcome.
That’s not to say that bad things aren’t going to happen—people are going to get sick. But working together on the issues as a team is where you can make a difference. We want to improve women’s health through education. Knowledge is power over disease.
I’ve been passionate about this issue throughout my career. And, I’m happy that it’s getting attention in the lay press. With HealthTrust’s outreach to so many different providers and institutions, such involvement can have far-reaching, positive consequences. I’m honored to be part of that effort.
Now that you have been a HealthTrust physician advisor for about two years, what are your next goals?
HealthTrust has engaged me to help educate members on ways to decrease these high maternal mortality rates. When it comes to addressing the tragic problem, we have to help stem the tide, turn the ship around and get the issue focused in a right direction for patients. To that end, I will be working with the physician services team at HealthTrust to develop a webinar series that emphasizes high reliability, quality and safety. Programs will also address the four most important targets for reducing maternal morbidity and mortality: decreasing postpartum hemorrhaging, venous thromboembolism and hypertensive emergencies in pregnant women.
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