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July 07, 2009
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Peggy Elliott-Zolner, R.N.
Pediatric Subspecialist List Updated
Surgery Scope of Service Update
Gerry Frank Satisfaction Scores
Pediatric Patients in Diagnostic Imaging
Providence Youth Services/Gately Academy
Congratulations to New Certified Pediatric Nursing Staff
How to use Hospitalist Services Available at Providence St. Vincent Medical Center
Please take advantage of our "Important Pediatric Links" section. It has been updated to include important neonatal and pediatric documents. You will now find admission policies and contact information for pediatric patient admission; general information about our pediatric unit and pediatric hospitalists; a list of our subspecialists and their contact information; pediatric admission order sets; a calendar of educational offerings in pediatrics and neonatology; and a calendar of PALS and NRP classes. We hope that this section provides a central repository of information for those who are interested in and refer patients to Children at Providence St. Vincent services. Welcome to our New Pediatric Providers Peggy Elliott-Zolner, R.N. –
Pediatric Clinical Development Specialist Peggy Elliott-Zolner, R.N. comes to Providence St. Vincent Medical Center with more than 30 years of pediatric nursing experience. Peggy has practiced in all areas of pediatric health care from PICU to in-home care of medically fragile children.
Her nursing education was completed at USC Medical Center in Los Angeles. There she participated as a critical care nurse specialist for a variety of complex cases. She moved to Oregon with her husband two years post-graduation and has been here since. Looking to expand her knowledge base and move toward primary care, she became a pediatric nurse practitioner in 1980. At Bess Kaiser, she designed a core curriculum for Pediatrics to Pediatric Critical Care. Over the next several years, Peggy’s experiences and mentoring allowed her to be involved in the development of many pediatric nurses and physicians at local children’s hospitals. Among her other roles, she has served on the board of directors of Children’s Nursing Specialties, and worked as a pediatric case manager for medically fragile children, as a cardiac case manager for a local pediatric practice, and as an assistant manager for case management at Providence Health Plan.
Maureen Baxter, M.D.–
The Radiology Group, P.C., is pleased to announce that Maureen Baxter, M.D. has joined the group and will be working in women’s and pediatric imaging. Dr. Baxter received her bachelor’s degree in economics from Colgate University in Hamilton, N.Y., and her doctorate of medicine from the University of Colorado Health Sciences in Denver, Colo. She completed her residency in diagnostic radiology and a pediatric radiology fellowship at Oregon Health & Science University. Dr. Baxter, a native of Oregon, and her husband Brett Baxter, M.D., reside in Portland with their two young daughters.
Lesley Liu, M.D. –
Lesley Liu was born and raised in Wichita, Kan. She graduated with highest distinction and Phi Beta Kappa from the University of Kansas, with a bachelor’s degree in chemistry, receiving the American Chemical Society Outstanding Senior Chemistry Student award. She also completed her medical training at the University of Kansas Medical School and was elected to the Alpha Omega Alpha honor society. Dr. Liu then completed her combined residency in internal medicine and pediatrics at Baylor College of Medicine. Dr. Liu joined our hospitalist group in 2008. Outside of the hospital, Dr. Liu works for project CURE, which provides medical supplies to developing nations. When not working, Dr. Liu enjoys reading, gardening, cooking and spending time with family and friends.
Kari Mazur, M.D. –
Kari Mazur was born and raised in Birmingham, Mich. She graduated from the University of Michigan with a bachelor’s degree in biology as well as a master’s degree in public health. She completed her medical training at the University of Michigan Medical School in 2004. Dr. Mazur completed her combined residency in internal medicine and pediatrics at the Michigan State University Kalamazoo Center for Medical Studies. Dr. Mazur joined our hospitalist group in 2008. Outside of the hospital, Dr. Mazur enjoys jogging, cooking and spending time with her husband and two children. Pediatric Education Events at Providence St. Vincent Medical Center Save the Date! Please remember… Our 3rd annual pediatric fall conference will be held on Wednesday, Sept. 30, 2009. This year’s conference will focus on pediatric updates for the outpatient, emergency and inpatient pediatric provider.
Speakers will include Douglas Baker, M.D. from Children’s Medical Center of Texas who will share his expertise on management of the febrile infant; Mark Nespeca, M.D., from Children’s Specialties of San Diego who will give an update on the evaluation and management of seizures in infancy; Catherine Lum, M.D., from Pediatric Endocrinology of Portland who will share an update on evaluation and management of obesity and type II diabetes in children; and David Spiro, M.D., director of pediatric emergency medicine at Doernbecher Children’s Hospital, discussing visual diagnoses in the emergency room and updates in management of otitis media.
Further conference information and brochures will be mailed out soon. Links will be provided in the next edition of pediPulse as well. We look forward to seeing you on Sept. 30.
In-service on Hemolytic Uremic Syndrome in Children
At the March 20 Pediatric In-Service, we were treated to a discussion of hemolytic uremic syndrome presented by one of the nation's experts on the subject, Randy Jenkins, M.D. At the time of Dr. Jenkins' arrival in Portland some years ago, the region had just suffered an outbreak of serious HUS, and he was immediately plunged into a busy service of children with acute renal failure, some of whom needed dialysis. Since those days, the cause of HUS has been identified, and much more is known about its pathophysiology, but it has not been eradicated. Dr. Jenkins has remained an expert in its management, and he was kind enough to share his insights with the in-service audience. He skillfully combined didactic information with true-to-life cases, which illuminated the clinical management of HUS.
Pediatric Services Utilization Summary 2008 The inpatient pediatric unit at Providence St. Vincent Medical Center serves the west Portland community. It specializes in the care of acutely ill patients from birth to 17 years and their families. Patients may be admitted to this unit if they have medical or surgical diagnoses requiring a mild to moderate level of care, with the expectation for a brief and uncomplicated hospitalization.
Since opening in Oct. 2006, the inpatient pediatric unit has cared for more than 2,000 pediatric patients. In 2008 alone, the pediatric unit volume was 960, a 14 percent increase from 2007. Average daily census was 6.5, representing a 33 percent increase from 2007. The average length of stay was 2.5 days. The most common surgical diagnoses were acute appendicitis, other surgical causes for abdominal pain, and fracture care. The most common medical diagnoses were jaundice, respiratory distress and dehydration. Our pediatric hospitalists cared for over half of the patients on the pediatric unit, while surgical patients made up 25 percent, and the rest were divided among community providers and other subspecialty care providers. More than half of the patients came from our emergency department, and one third were directly admitted from home or primary care provider offices. About 85 percent of patients admitted lived on the west side or far west side of the Portland metro area.
Overall pediatric unit volume has continued to increase while we’ve maintained our community-level scope of care. We look forward to continuing in our endeavor to provide high-quality pediatric care in response to increasing community need for these services.
On April 1, 2009, the Oregonian featured a final follow-up story on Providence Neurodevelopmental Center for Children's Healthy 'n Fit program. The reporter followed a family throughout the 10-week program. In this third article, readers learned that the 11 year old twins lost weight and significantly reduced their cholesterol and blood glucose levels due to their participation in the program. In addition, the boys' mother lost 15 pounds. The next class will be held in fall 2009 at Providence Portland Medical Center. For details on the program and how to refer patients, please visit: www.providence.org/childcenter. Click here for the complete article on Oregonlive.com
Pediatric Subspecialist List Updated
We have updated the list of more than 60 pediatric medical and surgical subspecialists who are available for in-house consultation to the Providence NICU and pediatric unit. Also, the contact lists for pediatric departmental directors and medical director contacts for newborn services, inpatient pediatrics and pediatric emergency have been updated. Please take a moment to review this link and print for your reference.
Due to two recent clusters of Staph aureus infections (summer 2007 and fall 2008), we have evaluated and changed our infection control practices. The following is a summary of major changes impacting physicians:
Gloves are required with all patient contact. One must "gel in and gel out", meaning that one must use an alcohol-based gel before donning gloves (this keeps the gloves in the glove box clean) and after removing gloves (this keeps one's hands clean).
Rationale: Hand hygiene is a key factor in protecting our patients from becoming infected. You might find this link to the CDC on Standard Precautions section IV.A. Hand Hygiene informative for both office and hospital practice.
Click here for CDC Standard Precautions
Cover gowns are required for all physicians entering the NICU from other patient care areas. For example, if you round in pediatrics before entering the NICU, you must wear a cover gown when entering the NICU.
Rationale: Cover gowns decrease the likelihood that clothing contaminated with organisms are not the cause of cross-contamination of NICU patients.
Cover gowns are required for all physicians participating in the stabilization of an infant after birth.
Rationale: Infants are coated with maternal body fluids at birth. Vaginal delivery results in the exposure of the newborn to multiple organisms, including MRSA when the mother is MRSA positive. Given the intimate and sometimes uncontrollable nature of contact during newborn stabilization at birth, a cover gown helps reduce the exposure of one's clothing to such organisms.
Here is the Quick Reference Guide to NICU Policy on Infection Control with more details:
Click here for Quick Reference Guide
We are proud of our historically low infection rates. Our Vermont Oxford Network (VON) data for blood stream infections in infants less than 1,500 grams show that we have been consistently in the top 25 percent of all NICUs in this database for many years. (Top quartile is achieved with a less than 10 percent rate of acquired blood stream infection.) Over the past two years, we have seen a trend toward more infections, so we have implemented many additional steps to attempt to decrease/eliminate this important cause of morbidity and mortality. Attached is the 10-year trend report from the VON registry. You can see that the average rate of hospital-acquired blood stream infections is 20 percent. We have traditionally experienced a rate of 3 percent to 5 percent but have been in the 7 percent range the last two years.
Click here for 10 year trend chart
Our goal this year is to return to a rate of less than 5 percent for blood stream infections in our patients less than 1,500 grams. Since we see nearly 150 of these infants a year (almost one-third of the patients born in the state at this size), we are hoping to see fewer than seven blood stream infections in this population this year. We are off to a good start and have now gone 135 days without an acquired blood stream infection in any of our NICU patients. You will note that we have a display of days without infection at the entrance to the NICU to help with everyone's awareness of this effort.
You may be aware that Oregon law now requires public reporting of hospital-acquired infections. We are working with the Oregon Health Division (OHD) to move forward with our part in this. It currently looks like the OHD will accept the VON data from the seven NICUs in the state as our means of making this report, so you should anticipate seeing this data publicly in the future.
Thank you for your help in our efforts to make the NICU a safe place for our patients. Please let me know if you have any questions.
John V. McDonald, M.D.
The newly redesigned adolescent partial hospital eating disorders program serves adolescents between the ages of 13 and 18 and their parents. Utilizing a structure of empirically supported treatment methodology, we provide medical stabilization and monitoring, nutritional evaluation and counseling, individual and group therapy, and family therapy. Parent involvement is strongly encouraged as a means to improve treatment outcomes with multi-family therapeutic group breakfasts and dinners, weekly meal planning group, psycho-educational and support group, in addition to individual family therapy. Our multidisciplinary staff strives to meet patients and their families where they are and help them move to the next stage in their recovery process.
The treatment program runs from Monday through Friday from 8 a.m. to 3:45 p.m. three days a week, and from 9 a.m. to 6:15 p.m. two days a week. We favor a skills-based approach to help adolescents learn about nutrition and healthy eating, health effects of eating disorders, how to manage emotions and survive crises, and navigate interpersonal difficulties successfully. Other groups focus on mindfulness, body image and self-esteem. Incorporated into the treatment week are individual psychotherapy, family therapy, and psychiatric and medical monitoring.
We work to engage the adolescent by rolling with any resistance and by approaching them with a number of experiential exercises. Our patients are given the opportunity to be themselves within the context of intense and meaningful therapy. They bring in their favorite music, decorate the group room and leave their handprints behind when they go. Each patient and family is provided the knowledge and coping tools to create a foundation for sustainable recovery.
For further information about the program, or to refer a patient, please call Barb Oyler, PMHNP, or Linda Schmidt, M.D., at 503-216-2025.
The Gerry Frank Center for Pediatric Surgery and Neurodevelopmental Care opened in 2004. It consists of a short-stay unit with eight patient care rooms, supporting pre-op and pre-procedural care of pediatric patients requiring surgery, diagnostic imaging, endoscopic and phase-2 post-operative care.
The scope of service for pediatric surgery patients was recently
reviewed and updated by Minh Pham, M.D., medical director of pediatric
anesthesiology, and Marie Curley, R.N., nurse manager of inpatient
pediatrics and pediatric surgery. The main updates include expanding
scope of service to include pediatric patients who are younger than 6
months old. Guidelines for monitoring, including overnight monitoring
requirements for full term and preterm infants, have also been updated.
…click here for the surgery scope of service…
Congratulations on a great March in the Gerry Frank Center! Press Ganey results for overall care, nursing and physician care, facilities, friendliness of staff, recovery room/response to patient and family needs, and likelihood of recommending care were all in the 99th percentile for all of ambulatory surgery. Kudos to Marie Curley, R.N., nurse manager of inpatient pediatrics and pediatric surgery, and her staff for their great work and service to the pediatric community.
Pediatric outpatients scheduled for diagnostic imaging may require anxiolytic medication or a deeper form of sedation in order to obtain adequate imaging. Anxiolytic medications, such as oral and intranasal versed and oral Valium, work very well for exams, such as voiding cystograms, and nuclear medicine exams that require catheterizations. These medications can be ordered by the radiologist and given by the diagnostic imaging nurses. Patients receiving anxiolytic medications have to be admitted through Gerry Frank Children’s Center.
For exams that require children to hold still (such as MRI and CT scans), anxiolytics do not work well and actually hinder the exam as the child distracts too easily after anxiolytic medication administration. For CT exams, children rarely need any form of sedation since the scans are typically very quick. Children under 1 year of age can often be scanned during nap time. Older children often do very well with the assistance of a nurse or child life specialist. Toddlers present a challenge, and many require deep sedation to obtain imaging. Pediatric patients requiring sedation beyond anxiolytic are referred to anesthesia for sedation.
Anesthesiologists now sedate children regardless of age. However, for children under 6 months of age, especially those who were born premature or have ongoing health concerns, an overnight stay may be required for airway monitoring. If overnight monitoring is required, the anesthesiologist will work with the pediatric hospitalist to arrange for care.
For any exam requiring anesthesia sedation, certain documents are needed from the referring physician’s office. This includes a signed order by the referring physician for the exam to be done with anesthesia. (For instance, “MRI of brain, unenhanced under anesthesia” or “MRI of brain, unenhanced with sedation provided by anesthesia”.) In addition, anesthesia requires a full history and physical dated within 30 days of the exam.
If you have questions regarding scheduling an exam with anesthesia, please call the diagnostic imaging nursing office at 503-216-4887. We are available from 7:30 a.m. to 6 p.m. Monday through Friday. In addition, the following is a list of departmental phone numbers for diagnostic imaging.
DI scheduling
503-216-2167
Gately Academy is a middle school in Northeast Portland serving the academic, social and emotional needs of students exhibiting learning differences. The school is part of Providence Behavioral Health Division. For the past 10 years, Gately Academy has served students who have ADD/HD and other LD issues. The program focuses on a multi-sensory approach to learning and relies upon several authentic assessment tools in order to check for understanding. It offers a student-to-teacher ratio of 9 to 1. In the fall of 2009, Gately Academy will open their doors to fourth-grade students.
The academic schedule is enriched with courses that support the core of language arts, social science, mathematics and science. Such peripheral courses include the challenge program, providing opportunities for students to collaboratively problem solve by creating their own resolution to a given situation; art two days per week instructed by a highly talented art therapist; a well rounded fitness program; and support courses in the areas of reading, writing, mathematics and social thinking. All students have an opportunity to serve the community through service projects.
For further information or a tour of the school, please contact 503-215-2672 or log onto www.gatelyacademy.org
David T. Ball
The following nurses are now certified pediatric nurses. We recognize the importance of advancement in the nursing profession, higher standards and better outcomes in patient health.
Grace Butorac, RN-CPN
They join these nurses who are already certified in pediatrics:
Kim Lawler, RN-AORN
As a reminder, we have pediatric hospitalists at Providence St. Vincent Medical Center. They are in-house 24-hours per day, seven days per week to assist you. They are available to provide primary coverage or consultation on pediatric patients throughout the entirety of their hospitalization, or if you prefer, they can provide coverage of these children until a time when you are able to take over their management. These times may include clinic hours, nights, weekends or vacation time. When you are ready to take over management, they will provide verbal sign-out (preferably face-to-face), and then would only become re-involved in the patient’s care if you call them with specific requests.
During the daytime, our pediatric service is staffed by one of our eight board-certified pediatricians who also have board certification in internal medicine. The physicians take care of all hospitalist patients on the pediatric floor, as well as adult patients if the pediatric unit census is low. Our physicians round with our multidisciplinary team of nurses, pediatric pharmacists, respiratory therapists and child life specialists at 8 a.m. every day. They also perform informal rounds between 3 and 4 p.m. and whenever patient or family needs dictate the need for another visit. At night, our physicians are in-house to cover only pediatric patients. They round at 8:30 p.m. on the pediatric unit.
Our pediatric physicians also lead our pediatric rapid response team, providing urgent medical coverage for any patient on the pediatric unit or elsewhere in the hospital. They run the pediatric code team alongside our pediatric emergency department staff.
Since our physicians are in-house 24/7, they are always available for communication with primary care providers over the phone or in person. Hospitalists or emergency physicians will call primary care providers for all admissions and our hospitalists call for any change in clinical status and for all discharges to coordinate follow-up plans. A typed discharge summary is also sent on all patients.
To contact our pediatric hospitalists:
1. Call us: a. A pediatric hospitalist is always available at 503-216-1101. This is our pediatric team Spectra-link phone. If we do not answer, we are likely on the phone or in a family meeting. Please page or call again in a few minutes.
2. Page us: a. Call the Providence St. Medical Center operator, 503-216-1234 and ask to have the pediatric hospitalist paged, or b. Call the Inpatient Pediatric Unit, 503-216-4400 and ask to have the pediatric hospitalist paged, or c. Call out pager directly, 503-216-6338 ext. 6216, and enter your call-back number, or d. If you are accessing a computer within Providence, page us directly through our Web site: http://phsnet.phsor.org/psvhospitalists and click on "Pediatric Triage." You can then enter a message and a call-back number.
For any questions or feedback, please don’t hesitate to contact Matthew.Gadbaw@providence.org
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