Bearings - Summer 2009
Children’s National Opens New NICU
On May 17, 2009, Children’s National Medical Center opened a 54-bed Neonatal Intensive Care Unit (NICU) on the sixth floor of the East Inpatient Tower. The new unit is approximately four times larger than the current space, which admits more than 700 patients annually, of which approximately half are from Maryland.
The 54-bed NICU at Children’s National is the only Level IIIC NICU in the region, the highest distinction available by the American Academy of Pediatrics. That ranking is conferred on NICUs that, among other cutting edge services, offer neonatal ECMO (extra corporeal membrane oxygenation or heart/lung bypass).
Other features of the new NICU include:
- Family-centered care approach to the design of each room.
- 46 single patient rooms, and two 4-bed pods providing family support and privacy.
- Eight beds designated specifically by the neonatal neurology team for patients who require more intensive care and focus on neurological monitoring.
- Remote electroencephalogram (EEG) monitoring in all beds.
- Negative pressure isolation capabilities in designated isolation rooms.
- Two family waiting areas, one designed for extended family with a sibling play zone. The other is a quiet room available for reading or meditation.
- Two parent transition sleep rooms with private bath, allowing parents to spend the night with their child pre-discharge to better prepare to go home.
- Refrigerator at each bedside for storage of breast milk. This allows even very premature babies who use nasogastric (NG) tubes to eat while they are still growing.
- Dim lighting, soothing colors and a quiet atmosphere to account for developmental needs.
“This is a dream come true for our staff, patients, and families,” said Billie L. Short, MD, Chief of Neonatology at Children’s National. “This NICU was designed with input from our families, nurses, and medical care team members, and we couldn’t be more proud of this unit.” Dr. Short is part of the national cadre of neonatologists credited with “solving” the issue of lung development complications due to prematurity or injury at birth. Children’s multidisciplinary team includes neonatologists, neonatal neurologists, pediatric surgical and medical subspecialists, radiologists, and specially trained nurses.
Children’s National has the oldest neonatal neurointensive care program in the mid-Atlantic region and is one of a few hospitals in the country with three neonatal neurologists and two neonatal EEG specialists on staff. Seven pediatric neurophysiologists and three pediatric neuroradiologists also are part of the Children’s NICU team.
Children’s National also focuses on neuroprotection, protecting the brain and ensuring that fragile newborns get the best chance at a solid start once they leave the NICU. The team is pioneering innovative therapies, including whole-body cooling to protect neurological function in newborns who have suffered a lack of oxygen during or just after birth. These cutting edge practices and excellent outcomes earned Children’s National’s NICU a top 10 ranking by U.S.News & World Report in 2008.
“This new facility enhances the unrivaled care offered by the NICU team at Children’s National,” said David Wessel, MD, Senior Vice President of the Center for Hospital-Based Specialties at Children’s National. “We’re proud to open the doors of this new facility to provide the best care possible for the patients and families who rely on us.”
Children’s National has successfully treated infants who weighed approximately one pound at birth and were born at less than 23 weeks gestation. Patients needing neonatal intensive care may be transported by Children’s National’s dedicated Transport Team, which includes the hospital’s own helicopter (SkyBear).
Note: STAT MedEvac is a Direct Air Carrier, E3MA774L, that arranges and coordinates the operation of air ambulance services. All flights are operated by STAT MedEvac.
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Life-saving treatment for the tiniest patients in Maryland
Three years ago, Debbie Harris gave birth to triplet boys: Austin, Barak, and Christian. It took a delicate transport from a community hospital, three surgeries, and a long stay in the Neonatal Intensive Care Unit (NICU) before Barak was able to go home with his brothers and parents.
Debbie went into labor at 32 weeks gestation, and her babies were relatively healthy. After a short stay in a hospital in Montgomery County, the family headed home to Frederick County. A few days later, Debbie noticed Barak wasn’t eating, and on the advice of her pediatrician, she brought him back to the hospital.
Barak Harris following surgery in the Neonatal Intensive Care Unit (NICU)
When his condition worsened, it became clear that Barak needed to be transported to Children’s National for specialized care. Children’s National’s dedicated neonatal transport team was called in to bring him to the hospital. Children’s Transport Team consists of highly trained medical professionals, using equipment specially designed for tiny babies.
Barak had been suffering from necrotizing enterocolitis (NEC), a serious condition that is common in premature infants. NEC is a gastrointestinal disease that affects all or part of the bowel. Soon after his transfer, Barak went into the first of what would be three operations to help him heal. His bowel had become obstructed, so the team of pediatric surgeons removed part of it.
“It was so difficult to see him after surgery,” recalls his mom Debbie. “He had lines and tubes coming out of everywhere.” Barak remained in the NICU for more than three months.
Barak slowly started to recover, but then became sick again. Ten days after his first operation, he went back to Children’s National for surgery to remove part of his intestine. According to one of Barak’s pediatric surgeons, Phil Guzzetta, MD, it is not uncommon for premature infants to require multiple operations to recover from NEC.
“Barak was extremely ill and it took a multidisciplinary team of skilled neonatologists, pediatric surgeons, and NICU nurses to help him and his family through,” explains Dr. Guzzetta. “What’s unique about Children’s National is that our team is very comfortable taking care of very sick babies.”
Debbie, who made the two hour drive to see Barak everyday, can attest to the skill – and care – of the team. The NICU nurses encouraged her to visit and considered her an important part of Barak’s care team. She would return home at night to see her other children, but she was comforted by the care Barak received, particularly by one of his favorite nurses, Rey Emmanuel, RN.
“When Barak was most critical, we knew he was in good hands when Rey was with him,” recalls Debbie. “The NICU team loved my boy like its own.”
Slowly, Barak began to grow stronger and recover. He needed one final operation and was able to return home the next month.
Almost three years later, the Harris family is at home, adapting to a busy household with triplets who just celebrated their third birthday. Debbie is grateful for the care her son received at Children’s National.
“If it wasn’t for the doctors and nurses at Children’s, I know Barak wouldn’t be here today with his brothers,” says Debbie. “Every time I see my son, I am thankful for the wonderful team at Children’s.”
Children’s National has the region’s only level IIIC NICU, the highest designation provided by the American Academy of Pediatrics. The multidisciplinary team includes pediatric surgeons and fellowship-trained pediatric anesthesiologists, providing the highest level of care for the smallest patients. Children’s National is the only hospital in the region dedicated exclusively to caring for infants and children.
In addition to providing world-class care, Children’s National also is a leader in research. Pediatric surgeon Cindy Gingalewski, MD, is an international leader in the research of the causes of necrotizing enterocolitis, through her work at Children’s Research Institute.
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Children's National Medical Center Opens New Operating Rooms, Waiting Area
On March 12, 2009, Children’s National Medical Center opened two new operating rooms (ORs), increasing the hospital’s capacity to provide surgical services to children. Along with the ORs, Children’s National also opened an expanded waiting area for families whose children are having surgery. The new facilities will allow the hospital to meet the growing demand for services.
Children’s National performs more than 14,000 operations annually at Children’s Hospital and the Ambulatory Surgery Center (ASC) in Montgomery County. More specifically, in fiscal year 2008, more than 6,200 operations were performed on children from Maryland at Children’s Hospital, and more than 2,500 surgeries were performed at the Montgomery County ASC.
The new ORs are 750 square feet each and bring the total number of operating rooms to 13. Each OR is equipped with state-of-the-art technology, including flat panel screens displaying clear views of radiology imaging and real-time images of the field of operation.
The new waiting area features expanded capacity, a quiet room for reading or meditation, and an educational kiosk with internet access. Members of the family-centered care committee were involved in the design of the waiting area.
“The additional operating rooms are a real win for both our surgical staff and our patients,” said Kurt Newman, MD, surgeon-in-chief at Children’s National. “The large rooms provide the latest technology and sharpest imaging for our surgeons, while parents can wait in a comfortable environment surrounded by our surgical support team.”
One OR is designed specifically for orthopaedic surgery focusing on complex spine repair. It includes an O-Arm that provides real time, 3-D images. Children’s National’s Orthopaedic Surgery team, led by Laurel Blakemore, MD, is one of the largest in the region, with a team of pediatric surgeons specializing in complex spine issues.
The second OR will be used by general surgery and uses the Condor System™, which optimizes the quality of images used in laparoscopic surgery. The ORs are equipped to display images of the surgical field alongside real-time and static medical imaging, such as CT scans, providing precise and clear views. The new ORs include the ability to broadcast the procedure to a nearby education room, further enhancing Children’s National’s ability to train future generations of pediatric specialists.
The General and Thoracic Surgery team at Children’s National, led by Anthony Sandler, MD, estimates that more than 40 percent of procedures can now be done laparoscopically, including appendectomies and lung resections. Minimally invasive surgery is easier on patients because it results in a speedier recovery.
Children’s surgical specialists are supported by a large team of fellowship-trained pediatric anesthesiologists. As the only freestanding children’s hospital in the region, Children’s National guarantees anesthesia administered by a fellowship-trained pediatric anesthesiologist around the clock.
The new ORs are the first in a series of additions and renovations to the surgical services, which includes constructing additional ORs and renovating existing ORs.
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Dr. Bear’s University Hosts Maryland Delegates
Elected officials and community and business leaders from across the region visited Children’s National Medical Center on April 28 to participate in Dr. Bear’s University, a mini-internship program designed to provide participants with an in-depth behind-the-scenes experience at Children’s National.
Local leaders spent the day at Children’s National in clinical rotations with physicians and nurses, observed the special care given to our young patients, and learned more about the nature of specialty pediatric care in the region. Delegate Anne Healey (District 22-Prince George’s County), who attended the April 28 event said, "Thank you for the opportunity to get a real close look at what you do for our children. The hospital could not be more impressive. The more you know about Children's National, the more you are impressed by the professionalism of the staff and the high quality of the care. The facility and the support for families are truly outstanding." We thank Delegate Healey for making time in her busy schedule to attend Dr. Bear’s University.
The next session of Dr. Bear’s University will be held in the fall. If you are interested in learning more about Children’s National, how we serve Maryland’s children and families, and what makes us one of the top pediatric hospitals in the country, please contact Tim Jones, Manager of State Government Affairs, at email@example.com.
Delegate Anne Healey (first from right) was among the regional leaders that attended Dr. Bear’s University on April 28.
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Children’s IQ Network Connects Pediatricians in Region
There is little debate that health information technology (HIT) will help improve the quality of health care, prevent medical errors, and reduce health care costs by delivering essential information at the time and place of care delivery. HIT has the potential to dramatically transform the delivery of health care by making it safer, more effective, and more efficient. Two crucial components must exist for an effective HIT infrastructure: widespread use of electronic health records (EHR) and the ability to exchange health information privately and securely. These two components are at the core of Children’s IQ Network.
Children often receive preventive and acute care through encountering multiple providers within a region. These providers may include school nurses, community physicians, emergency departments, and inpatient facilities. The communication that occurs between these venues is generally paper-based and is often suboptimal in legibility and content. Parents are not infrequently burdened with carrying and coordinating essential health information for their children.
The Children's IQ Network was established by Children’s National in 2008 with the goal of interconnecting the essential healthcare data of the children in the Greater Washington Metropolitan region with complete, legible, and accessible information. The Children's IQ Network is dedicated to improving connectivity, care, and outcomes for children - and will be the first of its kind in the Washington, DC, Maryland, and Virginia region. Other goals of the IQ Network include providing every child in the region with an EHR; offering all pediatric providers in the region a subsidized EHR; and establishing a regional health information exchange where pediatricians, specialists, immunization registries, and commercial laboratories in Maryland will be electronically connected to Children’s National.
The data collected during each child’s healthcare visit will be stored in a secure regional data hub governed by the regional stakeholders in the Children’s IQ Network. The data hub will be connected to databases such as the state’s immunization and newborn screening registries to provide Children’s National’s physicians and community physicians with the most accurate medical history of each child that they serve.
Children’s National has committed substantial funding to establish the IQ Network. It is already live on the inpatient side and plans are underway to connect all seven Regional Outpatient Centers. The hospital also is reaching out to pediatric practices throughout the region and offering a subsidy to help offset the startup costs associated with purchasing the EHR software. Instead of the usual $20,000 per provider start up required to establish an EHR, the subsidy offered through the Children’s IQ Network effectively reduces these start up costs to $6,600 per physician for the EHR.
Participation in the Children’s IQ Network is available on a voluntary basis to physicians who care for children in the metropolitan area. Community pediatric providers who join the Children’s IQ Network agree to share essential health care data on their patients within the larger region and participate in quality initiatives in exchange for the subsidy.
Children’s National welcomes the opportunity to work with the State of Maryland on EHR adoption and implementation, both to share lessons learned from our experience and to ensure interoperability with the Children’s IQ Network. By working together, we can ensure interoperability and continuity of care for your constituents and our patients.
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