In this Issue.... 6/25/07

Clinical Corner
Save the Date.... September 26th
Pediatric In-Services Sessions
Practice Makes Better Care
Tools Pediatrics Practitioners Can Use
Pediatrics Inpatient Unit Update
Emergency Patient Fever Packets are a Hit
Meet our new Pediatric Surgeon
Sign up for PediPulse

Clinical Corner

What's your diagnosis?

A previously healthy 16-month-old boy is brought to the ED by his mom for a rash around his mouth, which has been worsening over the past four days. The boy was seen the previous day at an urgent care center and started on Keflex for presumed impetigo. He has exhibited no fever, vomiting, diarrhea or URI symptoms.
 

In addition, the mother states the child has been more fussy than usual and must have hit his head because of a bruise she found there.
 

Click here for diagnosis

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Save the Date....
September 26th

The first Providence St. Vincent Pediatric Conference will be held Sept. 26. Participants will enjoy presentations from an outstanding faculty of local experts, and as a special bonus, John Bradley, M.D., director of the Division of Infectious Diseases at Children's Hospital in San Diego is coming!

Those who remember John from his days in Portland (recipient of OHSU's Bilderback Teaching Award in 1982 and of the Oregon Pediatric Society Annual Award for Service to Children in 1988) will be delighted to renew acquaintances and all will gain new insight into current issues in pediatric infectious diseases. Paul Lewis, M.D., from the Oregon Health Division, will share the stage to offer his expertise in thorny infectious disease issues with an Oregon perspective. The day will conclude with a discussion of the challenges of translating recommendations into actual practice: Robert Mendelson, M.D., has graciously agreed to address the practical aspects of trying to accomplish universal vaccination in a society that lacks universal health care coverage.

In addition to the overall focus on infectious diseases, small-group sessions will cover other areas of interest to pediatric practitioners, including new developments in juvenile diabetes, practical aspects of management of autism and other behavioral disorders, and strategies for helping obese patients. For caregivers who want hands-on experience, an additional session will offer an opportunity to practice intraosseous needle insertion and use of laryngeal mask airways in the context of coping with pediatric emergencies in the outpatient setting.

Brochures with the complete conference agenda as well as registration materials will be mailed during the summer. If you are interested in this event, but have been inadvertently excluded in the mailing, please page Dr. Cristofani at 503-201-3029 or visit the Providence physician extranet where we will post further details in the coming weeks, http://phsnet.phsor.org/physicians/default.htm.

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Pediatric In-Services Sessions

Information about future in-service sessions will appear in this newsletter.

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Practice Makes Better Care

While no institution can promise perfection, pediatric staff at Providence St. Vincent are determined to enhance the care that children receive here. One means of promoting optimal care is to practice management of emergencies before they occur.

To this end, Cindy Cristofani, M.D., and Mary Rummell, R.N., PNP, have instituted monthly mock codes. These drills are tied in with the topic of the monthly in-service sessions, and they are staged at variable times and locations.

Staff who respond to the mock code are given the opportunity to resuscitate an intubatable pediatric mannequin. Not only do these events permit individual staff members to review essential steps of resuscitation and become more familiar with the code cart, but they permit an evaluation of the full resuscitation team and the system under which the team functions.

Improvements in communication and resuscitation integration have resulted, and it is anticipated that continuing practice will result in continuing improvement.

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Tools Pediatrics Practitioners Can Use

A standard set of pediatric admission orders has been developed and placed in "Quick Links" on the Providence physician extranet. Routine admission order sets covering common admitting diagnoses, such as dehydration, bronchiolitis, asthma and seizures, have also been developed. These specialized order sets are in the final stage of approval, and when completed, will be available to all physicians on the extranet. Availability of standard orders will save physicians significant time and enhance quality of care.

Dr. Cristofani has created new wall charts for pediatric resuscitation. These large charts will soon be printed and made available shortly to emergency departments and other appropriate sites. Outpatient pediatric resuscitation guides will also be produced and distributed to practitioners in offices where children are treated. These 11" x 17" guides will include medications and techniques useful to outpatient practitioners.

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Pediatrics Inpatient Unit Update

It has been an exciting six months since we opened the pediatric inpatient unit on 4 East Tower. We have been encouraged by the steady growth of our daily census, which is growing faster than originally projected. So far, we have seen more than 500 patients. Our average daily census fluctuates between four and six patients. The unit has been full at various times as well. Feedback from patients and families has been overwhelmingly positive, and we continue to experience new opportunities for growth.

One of the most encouraging aspects of our pediatric unit is the service we have provided to our patients and providers. As we have grown, our team has been fortunate to build relationships with community pediatricians and pediatric subspecialists. A few partnerships of note have been the expansion of our services to diabetic patients and enhanced relationships with our behavioral health colleagues.

We have been fortunate to work with Dale Willis, M.D., a pediatric endocrinologist who opened his practice at Providence St. Vincent last year. Our pediatric nurses and dietitians have been working with Dr. Willis to provide the necessary inpatient education and stabilization of new diabetic patients. We have also provided inpatient support to patients needing to fine-tune their medication regimen.

We have developed a strong relationship with Eugene Borkan, M.D., and the department of child and adolescent psychiatry. This has enabled our pediatric unit to care for patients with a co-diagnosis of psychiatric and medical conditions, such as suicidal attempt with acetaminophen overdose. We have designed an environment of care similar to our integrated medical unit on the adult medicine floor, allowing our pediatric providers to stabilize patients medically while they begin psychiatric care. This situation has allowed smooth transition of patients to pediatric inpatient behavioral health services, when necessary.

Another area of development is with the Providence eating disorders program. We are now caring for adolescent patients who require inpatient medical stabilization. To better facilitate care of these patients, we have formed a work group consisting of medical, psychiatric, nursing and nutrition services. The work group will develop an optimal and consistent environment of care while preparing patients to transition to the outpatient eating disorders program.

Overall, we are privileged to have relationships with almost 50 pediatric subspecialists. While we have enjoyed rapid growth and expanded our subspecialty provider base, our primary scope of service – taking care of patients with mild to moderate degree of illness – continues. Please talk to our pediatric hospitalists, who are available in-house, 24 hours a day, if you anticipate the potential need for subspecialty coverage. We will happily arrange this for you.

Thank you for your ongoing support.

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Emergency Patient Fever Packets are a Hit

It's true. The best things come in small packages. That is why we love our pediatric patients in the Emergency Department at Providence St. Vincent Medical Center. Fever packets are also small, but they offer large benefits to our families.

A nurse from our department came up with the idea of fever packets after reading a journal article about a Texas emergency department that uses this tool. The article was presented to our pediatric committee and lively discussion followed. Providence Health Plan was highly receptive of the project and agreed to sponsor the packets.

Fever packets provide much-needed education about fever and fever treatment. The packets contain a fever information sheet in multiple languages; four ounces of alcohol-free acetaminophen and a dosing card with weight-based dosing for all available types of acetaminophen; a dosing syringe; a digital thermometer; and informational brochures. The packets cost about $6.00 each. Fever packets are given to caregivers who need education and who do not have access to supplies at home. In addition to improving quality of care, the packets are proving to be economical, saving time and funds for everyone.

Families are thrilled with our packets because they aid parents in caring for their children with confidence at home. Clinicians are thrilled also because fever packets enhance our ability to prevent repeat visits in well children with fevers. The packets are a good example of what we do best: teach and advocate for this vulnerable population.

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Meet our new Pediatric Surgeon

Barry Newman, MD, FACS, FAAP, FCCP is our new Board Certified Pediatric Surgeon joining the St.Vincent's team this fall. He is coming from Loyola University Health System in Illinois. Click here to learn more about him.

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