The Bulletin: November 2007

The Bulletin is a monthly newsletter for Children's and community providers.

Expanded After Hours Clinics in Seattle and Bellevue

Beginning Oct. 1, Children’s After Hours clinics increased their hours in response to feedback from patients and referring providers. After Hours clinics at the main hospital in Seattle and at Children’s Bellevue will see patients from 7 to 10 p.m. Monday through Friday and from 11 a.m. to 8 p.m. on weekends and holidays.

The After Hours clinics are available at times when a primary care provider’s office is closed and a patient has an illness or injury that is not urgent or life-threatening. For a patient with a more serious and emergent illness or injury, Children’s Emergency Department (ED) on the Laurelhurst campus is available 24 hours a day, seven days a week.

Families can access the After Hours clinics by calling the Children’s Resource Line at (206) 987-2500 or (866) 987-2500.

If you have any questions about the After Hours clinics or Children’s emergency services, please contact Dr. Tony Woodward at tony.woodward@seattlechildrens.org or Dr. Usha Sankrithi at usha.sankrithi@seattlechildrens.org.

Best to Phone in New Appointment Requests

Phoning in requests for new appointments is faster and more efficient than faxing, and Children’s encourages providers to request new appointments by phone rather than faxing a New Appointment Request Form (NARF).

Ninety-five percent of calls are completed in less than five minutes and hold time is minimal.

Providers and staff calling in the requests are able to give all necessary information directly to a clinical intake nurse, eliminating the need to send a fax back to the provider to clarify or get additional information.

To phone in a request, call (206) 987-2080 and select option 1, or dial toll-free(866) 987-2000, extension 72080.

Interventional Radiology Clinic Opens

Interventional Radiology (IR) is adding a new service to help determine the best course of treatment for patients. The services include an inpatient or outpatient evaluation, and a history and physical, lab work and other imaging studies as necessary.

If it is determined that an IR procedure is appropriate, the procedure, the post-op visit, and any diagnostic imaging procedures that may be needed will be scheduled at the time of the initial evaluation.

In addition to increasing the efficiency and quality of care, this service will also give patients and families an opportunity to ask questions and understand the upcoming procedures, helping allay some of their fears.

For outpatients, the IR Clinic is held on Friday afternoons on the 4th floor of the Ambulatory Care Building. The requesting physician orders the consult in the Ambulatory CIS through a Power Form, the same as requesting consultations in other specialties. Families can call (206) 987-4599 to schedule a clinic visit, or the IR scheduler will contact the family after receiving a consult request.

The interventional radiology providers include Dr. Fredric Hoffer, division chief, and Drs. Dennis Shaw and Jack Vo. Two additional interventional radiologists are expected at Children’s within the next year. If you have questions about whether an IR consultation is needed, contact the interventional radiologist on call.

Flu Shots Offered to Patients and Household Contacts

Children’s has expanded its flu vaccine program to ensure that all patients and their household contacts are educated about the vaccine and have the opportunity to be vaccinated.

Household contacts — family members, siblings and others who live with a patient — can receive a free flu shot at Children’s; patients receive the shot and are billed as part of their service at Children’s.

All Children’s inpatients and outpatients over 6 months old will be screened for contraindications and encouraged to get a flu shot while at the hospital.

The Centers for Disease Control and Prevention (CDC) recommend the flu vaccine for:

All hospitalized children between 6 months and 5 years old
Children 5 to 18 years of age who are at increased risk for complications from flu because of underlying medical conditions, those with a weakened immune system and those who are receiving long-term aspirin therapy

The CDC also recommends the flu vaccine for household contacts of high-risk patients, especially the family members of children under 6 months of age, because infants can’t receive the vaccine themselves. Children’s is offering the vaccine to the household contacts of all patients (not limited to those of high-risk patients).

Flu vaccines will be noted in patients’ medical records, and household contacts will receive documentation for their records and to share with their primary care providers. For questions, contact Dr. Danielle Zerr at (206) 987-2653.

Faculty and community providers who attend at Children’s are encouraged to get a free flu shot through Occupational Health Services. For more information, contact Suzy Bramwell at (206) 987-6647.

Children's Flu Shot Clinic for Providers and Staff from Nov. 5 to Nov. 10

Faculty and community providers who attend at Children’s are encouraged to get a free flu shot through Occupational Health Services (OHS). The yearly OHS flu shot clinic for staff and providers will be held near the Train elevators on the 1st floor from Nov. 5 to Nov. 10 from 7 a.m. to 7 p.m. If you miss the week-long clinic, you can still visit OHS and get a flu shot during regular drop-in clinic hours. For more information, contact Suzy Bramwell at (206) 987-6647.

New Lab Instruments Improve Hematology Test Quality

Children’s Laboratory recently replaced its hematology testing instruments with Sysmex instruments that provide higher quality, more efficient CBC and differential testing, allowing for a shorter test turnaround time.

These instruments also require a smaller blood sample size, making them ideal for pediatric patients. The Sysmex instruments provide more accurate WBC differential and numeration of NRBC and are also used at the University of Washington and Harborview.

There have been some changes in the CBC and differential reporting:

A new parameter, immature granulocytes (IG), is reported with CBC differential and CBC ANC. IG includes promyelocytes, myelocytes and metamyelocytes. The elevated IG count indicates left-shifted myeloid maturation and triggers a manual differential, except when CBC ANC is ordered. The reference range for IG is <1%. If IG is >2%, a manual differential is performed. This parameter may have future uses for us.
The reference ranges for MPV are increased by 2.5 FL for both low and high limits in each age category. MPV can be used to suggest responding platelets.
The number of manual differentials performed is significantly reduced as the lab reports more automated WBC differentials. Although the reporting of bands has not been changed, in reality the lab reports fewer bands than before because fewer manual differentials are performed. The automated differential does not report a low level of bands, but includes them with polys.

Manual differential count has been the gold standard for CBC differential. However, in the past ten to twenty years, the development of new technology has significantly changed laboratory hematology reporting of CBC and differential.

Automated CBC and differential counts are proven to be much more efficient, more precise and to have less variation. The automated differential will give relatively accurate neutrophils, lymphocytes, monocytes, eosinophils and basophils.

The caveat of automated differential is its inability to accurately differentiate bands, metamyelocytes, myelocytes, promyelocytes and blasts, although variable flaggings of the presence of those cells are produced by the instrument. The flaggings need to be confirmed by slide review.

The Laboratory received feedback from several physicians regarding band count reporting. After discussing with a few Emergency Medicine physicians and surgeons, the lab decided to implement additional criteria for manual differentials (items 3 and 4 of the report processes detailed below).

Reporting processes:

If there is no abnormality or other significant flagging, the lab will report automated differential.
If there are significant numerical or morphologic abnormalities flagged by the instrument, the lab will review the slides to look for abnormalities including blasts, immature granulocytes and bands. The lab will report automated differential if there are no significant deviations from the automated numbers, and also if the estimated band count by slide review is <10%. Approximately 70% of CBC differential samples have slides reviewed, although only some of them have manual differential performed.
If there are significant abnormalities such as blasts, a significant number of bands (>10%), or some interference so that automated numbers are not reliable, the lab will perform a manual differential.
For samples from patients who are younger than 3 months old, a manual differential will be performed.
For samples with absolute neutrophil counts (ANC) > 8,000, a manual differential will be performed.
In any situation, if you need a band count, or suspect blasts, or have other reasons to have a peripheral smear reviewed, you can always call the lab and request a manual differential.

Questions can be directed to Dr. Min Xu in the Department of Laboratories at (206) 987-2576 or min.xu@seattlechildrens.org.

New Inpatient Visitor Screening Procedure

In keeping with the nationwide trend toward increased hospital security, Children’s began screening all visitors to the 2nd- and 3rd-floor inpatient units on Oct. 15.

All visitors must have the required hospital-issued identification and approval from the patient’s parent or guardian before proceeding to the inpatient units. Security officers will be present on the inpatient units from 6 a.m. to 10 p.m.

Children’s will eventually implement visitor screening on all floors and at all entrances. For questions, call Jim Sawyer at (206) 987-6213.

Lewin Appointed Chief of Cardiology

Dr. Mark Lewin was appointed chief of the Division of Cardiology and co-director of the Heart Center.

Dr. Mark Lewin

Dr. Lewin has been an attending cardiologist at Children’s since 2001. He is co-director of Echocardiography and had been serving as the interim chief of Cardiology since late February. He is spearheading the formation of the Prenatal Diagnostic and Treatment Center and has been the co-director of Cardiac Echocardiogaphy at Children’s. Lewin is an associate professor of pediatrics at the University of Washington School of Medicine (UWSOM).

Before joining Children’s medical staff in 2001, Dr. Lewin completed his fellowship in pediatric cardiology at Texas Children’s Hospital, Baylor College of Medicine and served as assistant professor of pediatrics. He earned his medical degree from the University of Southern California and completed his residency at Children’s Hospital in Los Angeles.

“Mark has worked tirelessly to ensure that all children in the region have access to the expertise of the Heart Center,” says Dr. Bruder Stapleton, Children’s chief academic officer and chair of the UWSOM Department of Pediatrics. “He has fostered the development of our telemedicine program, which allows our cardiologists to view real-time echocardiograms from hospitals around Washington state, and promoted efforts to build the capacity of local technicians to obtain the best images.”

“In collaboration with Gordon Cohen, Mark will lead efforts to improve inpatient care for medical patients, increase clinic access, expand prenatal screening and continue to develop our leadership in diagnosing and treating heart conditions in children throughout the region,” Stapleton adds.

Shugerman Honored

Dr. Richard Shugerman, coordinator of Children’s pediatric residency program, was selected by the Accreditation Council for Graduate Medical Education to receive a Parker J. Palmer Courage to Teach Award, which recognizes excellence in leadership of medical education programs.

Program directors from all disciplines, including fellowship programs, may be nominated. Across the nation, only 10 directors are selected to receive this award.

“Richard has been recognized nationally for his commitment to teaching our pediatric residents,” says Dr. Tom Pendergrass, director of medical education. “In the region, we have long been aware of his exceptional work in resident selection, orientation, teaching, supervision and career counseling.”

Kapur and Siebert Edit Pediatric Pathology Reference

The second edition of Potter’s Pathology of the Fetus, Infant and Child, published in early 2007, was edited by Drs. Raj Kapur and Joseph Siebert of Children’s along with two doctors from Montreal. This two-volume reference is acknowledged worldwide as the major text on fetal and neonatal pathology and is in its second printing.

“With the development of prenatal ultrasound, fetal MRI, and other testing modalities, the input of the fetal pathologist in augmenting treatment of the unborn and counseling families has become crucial to providing the best care possible,” says Siebert.

Copies of this edition are available in the University of Washington Medical Library and Children’s Library.

First-Ever Academic Enrichment Grants Awarded

Children’s Academic Enrichment Fund awarded grants to 12 new research projects.

Project members applied for awards in August and were awarded amounts ranging from $15 thousand to $50 thousand. Following is a list of award recipients and their topics:

Gregory Schmale, MD, and Suzan Mazor, MD: Occupational therapy for humerus fx
Jennifer Keagle, MD: Skull variation in mice
Joseph R. Siebert, PhD: Holoprosencephaly book
Sean Flack, MD and Adam B. Goldin, MD: Anaesthesia for umbilical hernia surgery
Robert Hilt, MD: Parents of children on psychiatric medications
Shilpi Chabra, MD, Michael Neufeld, MD and Dennis Mayock, MD: Vitamin A status and bronchopulmonary dysplasia
Daniel Ledbetter, MD: C-reactive protein as biomarker
Shawn Parnell, MD: MRI and Duchenne muscular dystrophy
Jennifer Reid, MD, and Kimberly Stone, MD: ER simulations
Paritosh Khanna, MD: MRI and murine medulloblastoma
Klane White, MD: Steroid therapy for Legg-CalvéPurthes
Dennis Mayock, MD: Transfusion utilization

New Medical Staff and Allied Health Professionals

Children’s welcomes these new medical staff members and allied health professionals:

Kenneth Gow, MD, Surgery, Children’s
Coral Hanevold, MD, Nephrology, Children’s
Kathryn Harris, ARNP, Regional NNP Program, Children’s
Rebecca Koo, ARNP, Emergency Medicine, Children’s
Brian Krabak, MD, MBA, Sports Medicine, Children’s
D. Michael McMullan, MD, Cardiology, Children’s
Jennifer Meyers, MD, Anesthesia, Children’s
Mary Murdoch, MD, After Hours, Children’s
Teresa Williams, MD, MA, Radiology, Children’s
David Brauner, DO, Pediatric Cardiology of Alaska
Darcy Carr, MD, Maternal-Fetal Medicine, UW
Todd Kooy, MD, Radiology, UW
Nahush Mokadum, MD, Cardiothoracic Surgery, UW

Grand Rounds

View the schedule of upcoming Grand Rounds.

Grand Rounds Online

View online versions of recent Grand Rounds.

On-Call Schedule

The on-call schedule for inpatient services can be found in the secure area of the Medical Staff Web site. It is updated on a daily basis.