In this Issue....

March 20, 2008
Inpatient Pediatric Unit Update
Recap of Fall 2007 Pediatric Conference
Child Abuse Lecture
Pediatric Anesthesia Lecture
Wall Charts and Resuscitation Guides
Welcome Two New Pediatric Subspecialty Providers
Update from the ED
Teddy Bear Hospital: A Big Success in 2007
Children's Services at Providence St. Vincent Medical Center
Clinical Corner

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Inpatient Pediatric Unit update

Since opening in September 2006, our inpatient pediatric unit at Providence St. Vincent Medical Center has cared for more than 1,000 infants, children and adolescents. The unit was opened so that we might care for the growing numbers of infants, children and adolescents who required inpatient, overnight care following treatment in the Providence St. Vincent emergency department, maternity ward or Gerry Frank Center for Children (surgical services).

A summary of our intradepartmental admissions follows:

•  More than half of our first 1,000 patients were admitted from the emergency department at Providence St Vincent.
   
•  Neonates represented 15 percent of our population. (Most were less than one week old; 97 percent were born at Providence St Vincent. Some were transferred from the postpartum unit; others were transferred from the neonatal intensive care unit. Some were admitted from their primary care practitioner's office after their initial outpatient visit.)
   
•  Fifteen percent were children who needed postoperative inpatient care following surgery at our Gerry Frank Center for Children.

Pediatric hospitalists provided inpatient care for more than half of our population. Pediatric surgeons managed 30 percent. Pediatric subspecialists (surgical or medical) directed care for 15 percent. And, primary care pediatricians admitted and cared for 10 percent of our population.

The inpatient program was designed to provide short-term care. Our average length of stay is two days. Most patients are hospitalized for less than 24 hours. Some patients have required a higher level of care than we could provide – 12 children (< 1.3 percent) were transferred to centers for pediatric intensive care.

Our patient satisfaction reports remain outstanding. Some of our returning teenage patients have requested admission to our inpatient unit even though they had celebrated their 18th birthdays between admissions. Other children who were transferred for higher-level care have requested on subsequent hospitalizations to come back to the unit. Some parents have requested the inpatient unit so that they could stay in the same room as their newborns.

The number of children admitted to the inpatient unit is increasing monthly. We have filled our 12 beds on many occasions and are able to maintain our quality of our care in instances that require additional beds beyond our normal capacity.

We will continue to provide safe, high-quality care to the children who come to Providence St. Vincent.

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Recap of Fall 2007 Pediatric Conference

The fall Providence Pediatric Conference proved to be an exciting program. With a focus on pediatric infectious diseases, the conference featured keynote speaker John Bradley, M.D., who is known to many in our medical community from his prior practice in Portland. He is now chief of infectious diseases at San Diego Children's Hospital and a member of the Redbook committee.

Paul Lewis, M.D., from the Oregon Health Division presented a local perspective on pediatric infections, while Robert Mendelson, M.D., and a panel of pediatricians discussed difficulties with vaccination programs and strategies for coping with them. Breakout sessions featured local experts discussing topics such as current issues in diabetic management, ADHD and behavioral disorders in children, pediatric obesity, and management of emergencies in outpatient practice.

Planning is underway for the 2008 fall conference, which will be held Oct. 2 at Providence St. Vincent Medical Center. We are now determining the content for that conference and appreciate the many suggestions for speakers and topics offered by participants of last year's session. Further details regarding the conference will be provided in future editions of Pedipulse and in upcoming mailings. We invite you to share your ideas and to join us for the 2008 conference.

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Child Abuse Lecture

The Providence St. Vincent pediatric in-service session in December was offered by Sue Skinner, M.D., and Karen Phifer, LCSW, both of CARES. Their stimulating presentation outlined challenges confronting physicians in diagnosing child abuse and gave suggestions for how to conduct an interview with a child and with family members when the possibility of abuse is being considered.

This thought-provoking in-service session was an excellent means of encouraging outpatient and inpatient caregivers alike to act on behalf of children who are in danger. In view of the continuing tragedy of non-accidental trauma, as well as the recent passage of Karly's Law mandating adequate evaluation of children who may have suffered inflicted injuries or neglect, it is essential that all practitioners involved with the care of children remain vigilant and proactive in protecting children.  

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Pediatric Anesthesia Lecture

Greg Nadol, M.D., medical director of pediatric anesthesiology at Providence St. Vincent Medical Center, delivered our January pediatric in-service presentation. Dr. Nadol discussed peri- and postoperative pediatric airway issues, including preoperative screening of children with upper respiratory tract infections and typical general anesthesia procedures, as well as postoperative management of situations, such as croup, negative pressure pulmonary edema, and premature infant apnea monitoring.

Please note: Our in-service sessions are open to community practitioners and Providence staff. In 2008, the sessions are scheduled from 7 to 8 a.m. in the Board Room at Providence St. Vincent on the second Thursday of January, March, May, July, September and November.

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Wall Charts and Resuscitation Guides

In the wake of the American Heart Association's published resuscitation guidelines with the most recent changes, Cindy Cristofani, M.D., has continued her practice of producing resuscitation guides that incorporate the new recommendations. As always, all guides include adult as well as pediatric doses in order to permit appropriate resuscitation of children who may have reached adult size.

In addition to pocket cards for resuscitation and pocket guides for endotracheal intubation, two new guides are now available. One is an 8.5" x 17" chart (scored for folding), which includes medications, equipment and illustrations of techniques appropriate for the outpatient setting. This chart fits onto a clipboard or inside a cupboard door. A copy has been mailed to pediatricians and family practitioners in our community. If you have not received a copy by mid-March please contact Dr. Cristofani at Cynthia.Cristofani@providence.org to request one.

The second new guide is a large wall chart designed for emergency departments. It includes more medications and invasive procedures, such as endotracheal intubation and thoracentesis, which are unlikely to be undertaken in the office setting.

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Welcome Two New Pediatric Subspecialty Providers

We welcome Barry Newman, M.D., to the Providence St. Vincent medical staff. Dr. Newman has more than 25 years of experience in pediatric surgery and most recently served as director of pediatric surgery of the Ronald McDonald® Children's Hospital at Loyola University Medical Center in Maywood, Ill. Additionally, he served as professor of surgery and pediatrics at Loyola University - Chicago, Stritch School of Medicine. Dr. Newman's clinical expertise includes neonatal surgery and congenital anomalies, with special expertise in pediatric laparoscopy and thoracoscopic surgery. He is joining pediatric surgeon Sonia Butterworth, M.D., at Pediatric Specialties. Their practice is located in Mother Joseph Plaza on the Providence St. Vincent Medical Center campus. They can be reached at 503-216-8654 for consults or referrals.

Also with pleasure we welcome our second pediatric endocrinologist. Catherine Lum, M.D., who has joined Dale Willis, M.D., in the Pediatric Endocrinology of Portland practice. Dr. Lum is board-certified in pediatric endocrinology. After graduating from medical school at UCLA, she completed a pediatric residency at New England Medical Center in Boston. Thereafter she returned to the West Coast for a fellowship in pediatric endocrinology at Stanford University. Since completion of her fellowship, she has served on the faculty at Seattle Children's Hospital and UC Davis before relocating to Portland. She joined Dr. Willis in September, and her arrival has been instrumental in allowing the practice to offer both excellent and timely outpatient care in addition to full-time inpatient coverage for children with diabetes and other endocrine disorders.

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Update from the ED

Providence's pediatric committee recently organized a pediatric skills day for our emergency department nurses. Eighty nurses completed four hours of training in bladder catheterizations, IV/IO starts, child life/holding techniques, pain management and equipment review. Thanks to all our nurses for their enthusiasm and commitment to pediatric care at Providence St. Vincent.

Our goals for the year include providing continuing education in pediatrics to our staff and reviewing guidelines for common pediatric presentations. This will help ensure the highest quality and safest care for our young patients.

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Teddy Bear Hospital: A Big Success in 2007

Teddy Bear Hospital continues to be a highlight of the annual Providence Festival of Trees. For the fourth year, all children 12 years of age and younger who attended the festival received a free bear. During this year's two-day event, 3,400 bears were donated. Each child carried his or her bear to the hospital to be treated for various ailments, ranging from falls, bumps and bruises to serious infections.

The bears were casted and bandaged, operated on, monitored and finally stitched before being discharged. Most treatments and procedures were performed by the bears' owners, giving the children hands-on experience with a variety of medical equipment, such as O2 tubings, syringes, stethoscopes and otoscopes, that they may encounter during routine medical exams or procedures.

The children also viewed X-rays of bears that had swallowed foreign bodies or had broken bones. The main goal of Teddy Bear Hospital is hands-on play for children that can help alleviate fear and anxiety over medical procedures or exams they may need in the future.

Teddy Bear Hospital was continuously staffed by a minimum of 25 volunteers from a variety of backgrounds. Most were Providence Health & Services medical and non-medical staff members. Students from the health career programs at local high schools also volunteered. Special thanks are given to all volunteers who donated precious time to teach children about the world of medicine at this special event.

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Children's Services at Providence St. Vincent Medical Center:

Educational Meetings and Events, 2008

Pediatric Teaching Conferences
These informal teaching sessions focus on hospital management of common pediatric issues. The sessions are held in the Board Room from 7 to 8 AM, on the second Thursday of every other month.

Next meetings:

•  May 8 – "Evaluation of Anemia and Bleeding Disorders in Children," presented by Gregory Thomas, M.D.

•  July 10 – "Appendicitis and Other Pediatric Surgical Issues," presented by Barry Newman, MD

•  September 11

•  November 13

Pediatric Department Meeting and Grand Rounds
This departmental meeting is held quarterly from 7 to 7:30 AM in Souther Classrooms at Providence St. Vincent Medical Center, followed by pediatric grand rounds from 7:30 to 8:30 AM.

Next meetings:

•  April 23 – "2008 Asthma Update," presented by Dr. Bill  Nichols

•  October 22

2nd Annual Providence Pediatric Conference

An all-day conference to be held Oct. 2, 2008, in Souther Auditorium at Providence St. Vincent Medical Center.

NICU-OB Evidence-Based Medicine Grand Rounds
Monthly evidence-based discussions surrounding neonatal and obstetrical care. Conferences are held in conference room 12 from 7 to 8 AM on the 4th Thursday of each month with the exception of March, November, and December.

Next meetings:

•  April 24
   

•  May 22
   

•  June 26
   

•  July 24
   

•  August 28
   

•  September 24
   

•  October 23

NICU Educational Case Reviews
Interesting and challenging NICU clinical cases are discussed at this monthly meeting, held in conference room 6 from 1 to 2 PM on the 4th Wednesday of each month.

Next meetings:

•  March 26
   

•  April 23
   

•  May 28
   

•  June 25
   

•  July 23
   

•  August 27
   

•  September 24
   

•  October 22

PALS Recertification and New Provider Class
Classes are held at Providence St. Vincent Medical Center on the days listed from 7:30 AM until 5:30 PM. Dr. Cynthia Cristofani is the course instructor.

Providence staff can register at:
http://phsnet.phsor.org/Nursing/PSV%20Orientation/Classes/ClassSchedules.asp?n=EDUCreg01,114,0,0

Non-Providence Staff can register at www.pediatricfocus.org

Please call Marge Clubb at 216-7421 for further questions regarding registration information.
 

PALS New Provider Classes (2 days)

•  September 16 and 17
   

•  October 24 and 25
   

•  November 18 and 19

PALS Recertification Classes (1 day):

•  April 1
   

•  May 28
   

•  June 24
   

•  September 18
   

•  November 3
   

NRP Recertification and New Provider Class
Classes are held in conference room 12 at Providence St. Vincent Medical Center on the days listed. Please call Sherry Johnson, NNP, at 216-8515 for registration information.

NRP New Provider Classes and Renewal Classes are held on the same day. Renewal classes are held from 7:30 to 10:30 AM. New provider classes are held 11 AM to 4 PM.

Next classes:

•  April 21
   

•  May 19
   

•  June 16
   

•  July 21
   

•  August 18
   

•  September 15
   

•  October 20
   

•  November 17
   

•  December 15

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Clinical Corner

Submitted by Nicole Perdue, MD

What's your diagnosis?
The patient was a 14-year-old male visiting from American Samoa with his adopted mother when he began having fevers as high as 104 F and headache. He also complained of cough but did not have vomiting, diarrhea, rash or joint complaints. There were no sick contacts. He otherwise felt well and was eating. On the morning of admission, the patient spiked another fever and was diaphoretic when his family called the emergency department.

In the ED, vital signs were as follows: temperature 104.3, HR 142, RR 16, BP 140/66, oxygen saturation 96 percent on RA, weight 118 KG, height 5 feet 1 inch. He complained of frontal HA, cough and slight nausea, but otherwise looked well and had a normal neurologic exam. He was well hydrated, HEENT normal, lungs clear, tachycardic without murmur, no rashes, joint pain or swelling.

Labs: UA negative, CBC: WBC 6.4 HgB 14.3 Plts 247 differential 74 percent neutrophils, 16 percent lymphocytes, 9 percent monocytes. Comprehensive metabolic profile significant for a mildly elevated ALT of 31. Unenhanced head CT was unremarkable. CSF showed 3 WBC, 1 RBC, glucose 58, protein 33.
 

A diagnostic test was performed, which revealed the diagnosis. Click here for details.

Click here for case discussion.

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