The Bulletin: December 2007

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

New Discharge Communication Process Implemented

Children’s has implemented a new process to notify primary care providers (PCPs) when one of their patients is discharged from the hospital.

The new process responds to concerns voiced by PCPs about not receiving communication when their patients were discharged.

The general medicine service has already implemented this practice, and the subspecialty services will follow, providing an opportunity to evaluate and incorporate improvements into the system.

If the PCP is not immediately available, the operator will leave a message with callback information. If the PCP is not available at all, the operator will ask for the physician on call. PCPs are asked to call back as soon as possible after receiving a page or message from Children’s. One additional attempt will be made to reach the PCP or on-call physician.

In order to make this process successful, PCPs are asked to discuss the new process with their office staff and request that they be interrupted if they are with a patient when a call comes in from a Children’s physician. A “physician calling another physician” option at the front of the practice’s phone tree is also requested to streamline the call.

For more information, see the Frequently Asked Questions. If you have additional questions, contact Dr. Glen Tamura by e-mail or phone at (206) 987-1918.

Phoning in Appointment Requests Takes Fewer Steps

The most efficient way to refer a patient to Children’s is by phone.

A recent study noted that faxing a New Appointment Referral Form (NARF) requires a minimum of two steps for referring providers, and at least three steps for Children’s. Sometimes there are additional steps when questions are faxed back and forth between Children’s and the referring office.

Phoning in appointment requests can be completed in one step for both Children’s and the referring office. The clinical intake nurse taking the call gets all necessary information while on the phone with the referring provider’s office. The wait time is minimal.

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

ED Summary Printing Problems Being Addressed

Children’s has received feedback regarding the length of faxes received by the Emergency Department’s (ED) new FirstNet System, which integrates the ED summary along with enhanced specific clinical and laboratory information.

As requested, this report has more information than the previous notes; however, the way the information is laid out results in additional pages.

Children’s Information Services and the Emergency Department appreciate the feedback and are working diligently to change the format where possible, though this work is limited by computer code. This issue has been escalated to Cerner, the system vendor, who has been asked to design and implement a solution as soon as possible. This may take several months.

Children’s apologizes for any inconvenience this may cause. Questions can be addressed to Dr. Mark Del Beccaro at (206) 987-1444.

Plastic Surgery Available for Ambulatory Consultations

Children’s plastic surgeons are available to perform routine skin lesion excisions and other plastic surgery ambulatory procedures, in addition to more complex surgeries.

“With four plastic surgeons on staff, we have been able to radically increase our clinic access and patient satisfaction while decreasing procedure wait times,” says Dr. Richard Hopper, chief, Division of Pediatric Plastic Surgery and surgical director, Craniofacial Center. To refer a patient, call (206) 987-2080.

Children's to Implement Electronic Medication Reconciliation

Children’s is developing a new electronic medication reconciliation process — in day surgery, the Emergency Department and on inpatient units — that will significantly improve patient safety.

The new process complies with Joint Commission requirements by standardizing the format for the medication list and establishing one location for storing the information.

“The goal of the new process is to ensure that we review each patient’s medications on admission, at the time of each transfer between inpatient levels of care and on discharge,” says Dr. Mark Del Beccaro, chief medical information officer and pediatrician-in-chief.

At these times, the prescriber will compare the information in the Clinical Information System (CIS) with the patient’s active orders and decide whether to continue, change or discontinue each medication.

The new process will be implemented this winter in day surgery, the Emergency Department and the inpatient units. Ambulatory staff will continue their current process.

The electronic process is similar to the current paper process, but the CIS will now have one designated location for the information - the Medication Profile. New medication intake coordinators will interview patients and families to identify the medications a child is currently taking, comparing the information provided by the family with information in the child’s medical record and entering the updated information in the CIS. Families will receive a copy of their child’s medication list.

Hospital-acquired Bloodstream Infection Rate Drops

Children’s has implemented standards and procedures to prevent central-line-associated bloodstream infections (BSI). As a result, the house-wide BSI rate has dropped dramatically from an average of 5.8 infections per 1,000 catheter days, over the past five years, to only 3.7 in fiscal year 2007.

Rates have been dropping even lower in the pediatric and cardiac intensive care units; last quarter the rate was less than 2, and there were no infections in October. This rate is significantly lower than the rate reported in the CDC’s National Healthcare Safety Network (NHSN) Report data summary for 2006, which was 5.3 infections per 1,000 catheter days, based on data from 36 pediatric intensive care units.

Children’s Hospital’s successful hand hygiene campaign and the standardization of line placement and maintenance of peripherally inserted central catheters, as well as several other measures, have contributed to the drop in BSI. Overall compliance with hand hygiene standards — including hand washing and the use of gel — reached over 85% in fiscal year 2007. Children’s has continued to educate families about the importance of hand hygiene, encouraging them to ask providers if they have cleaned their hands.

Children’s also screens visiting families for contagious illnesses as they arrive at the units. Please remind family members that they should not visit patients if they have symptoms of viral respiratory illness or gastroenteritis.

Children's Expansion Provides Private Rooms for Infection Control

The first of four phases in Children’s Hospital’s 20-year expansion will bring the total bed count to 350, all in private rooms.

Single-patient rooms not only provide much-needed privacy for patients and families at a difficult time, they are also vital to preventing the spread of infection.

Private rooms are becoming the standard of care throughout the world and have been shown to minimize the rate of infection for inpatients. In a recent study published by the director of research for The Center for Health Design, 75% of severe acute respiratory sickness (SARS) victims in Toronto contracted the disease in multibed rooms while in the hospital.

The Bulletin will continue to provide specific information regarding the plans and reasons for Children’s growth. Information is also available on the Master Plan site.

TV Special on Children's Heart Center to Air in December

A one-hour HealthLink special called “Heart of the Matter” takes you inside the Children’s Heart Center. Learn about the team’s breakthroughs in treating congenital heart disease. The program will air on Wednesday, Dec. 26 from 8 to 9 p.m. on KING 5; Sunday, Dec. 30 from 8 to 9 p.m. on KONG TV; and Tuesday, Jan. 1 from 3 to 4 p.m. on Northwest Cable News.

Clinicians Honored With Family Choice Awards

Dr. Bryan King of Child Psychiatry, Dr. Kathy Sie of Otolaryngology, and Anita Wright, MS, of Speech Pathology, recently received the Children’s 2007 Family Choice Awards for providing outstanding family-centered care.

Patients and families nominate physicians, employees, teams or departments for the award, choosing staff members who have made a difference to families during their time at Children’s.

The Family Advisory Council reviewed the nominations and chose this year’s award recipients from more than 100 nominations. Dr. Melissa Walsh and Dr. Amy Carter received Family-Centered Care Resident Awards, which are based on peer nominations. Dr. Richard Molteni was recognized for his career-long commitment to family-centered care.

Marshall Recognized by Parents

Thank you to Dr. Susan Marshall in Children’s Pulmonary Division for her outstanding commitment to family-centered care in treating patients with cystic fibrosis (CF).

The parents of a patient recently submitted feedback about their experience with Marshall:
“Dr. Marshall has gone far above our son’s CF needs. She has helped us deal with emotional as well as medical problems for two years. She made us feel like our son is the most important child in the world and like we are the only family she is seeing. We love her - our son feels safe.”

Diekema Presents Plenary Lecture

Dr. Douglas Diekema, MD, MPH, FAAP, and professor of pediatrics at University of Washington School of Medicine, presented a plenary lecture titled “Gifts, Bribes or Necessity: Managing Conflicts of Interest at the Organizational and Individual Level” at the American Academy of Pediatrics National Conference and Exhibition.

Diekema’s talk addressed pharmaceutical marketing aimed at providers and urged physicians to be aware of attempts to buy their credibility.

“Physicians are people in a position of trust,” says Diekema, “and so they must guard against the subtle forms of marketing they are subjected to regularly by pharmaceutical companies.”

For details on this talk, please contact Diekema at douglas.diekema@seattlechildrens.org

Cowan and Springer Care for Children Abroad

Dr. Chuck Cowan, clinical director of care coordination services and pediatrician in the Neurodevelopmental Program at Children’s, and Dr. David Springer, a member of Children’s medical staff from Wallingford Pediatrics, recently volunteered their time and services to provide care to underserved populations abroad.

Cowan spent the month of September in Siem Reap, Cambodia, teaching staff and seeing patients at Angkor Hospital for Children, a small organization run by Cambodians and funded by philanthropy from the United States and Japan. Angkor Hospital for Children is one of two children’s hospitals in Siem Reap. Cowan previously volunteered in Thailand helping Cambodian refugees.

Springer spent 16 days in Daramsalah, India, helping Tibetan refugees build relationships with other kids around the world through a program called Bridges to Understanding. Ninety percent of the children Springer worked with are orphans or have only one parent. He and other volunteers worked with small groups of children on various projects to help promote cultural understanding and “hopefully heal some wounds that are not only physical, but emotional,” he says.

Congratulations to Premera Quality Award Winners

Premera Blue Cross Healthcare Quality Awards honor clinics of all sizes across Washington that provide exceptional preventive, chronic and acute care, and those providing excellent overall care.

The following pediatric practices and providers were recognized this year at statewide celebrations in October and November:

Overall Quality

Ballard Pediatric Clinic
Columbia Pediatrics, PS
Mercer Island Pediatric Associates
North Seattle Pediatrics
Pediatric Associates
Pediatrics Northwest
Redmond Pediatrics

Preventive Care

Cascade Pediatrics
Pediatric Associates

Acute Care

David Springer, MD

Grossman Honored at AAP

The Committee on Native American Child Health presented the Native American Child Health Advocacy Award to Dr. David Grossman of Group Health Cooperative at this year’s American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco this October. The award recognizes Grossman’s significant contributions to Native American children’s health.

New Medical Staff and Allied Health Professionals

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

Cynthia Flynn, PhD, Child Psychiatry, Children’s
Rebecca Johnson, MD, Hematology-Oncology, Children’s
Kimiko Kika, DDS, Dental Medicine, Children’s
Nalini Malarkkan, MD, Anesthesia, Children’s
Srinath Sanda, MD, Endocrinology, Children’s
Greg Davis, MD, Otolaryngology, UW
Rebecca Dunsmoor-Su, MD, Maternal-Fetal Medicine, UW
Peter Hesslein, MD, Swedish Pediatric Specialty Care
Kristin Johannsen, DDS, Northwest Pediatric Dentistry
Michael George, MD, Pediatric Associates-Bellevue
Evelyn Lockhart, MD, Puget Sound Blood Center
Annika Sutton-Wolf, MD, Children’s Clinic of S. Snohomish County
Travis Allen, CRNA, Anesthesia, Children’s
Kathleen Fugere, ARNP, Child Psychiatry IPU, Children’s
Christa Kleiner, ARNP, Inpatient Medicine, Children’s

Children's Library and Information Commons Offers Web of Knowledge Training

Children’s Library and Information Commons will host an introduction to Web of Knowledge on Wednesday, Dec. 5 from 2 to 4 p.m. and Thursday, Dec. 6 from 9:30 to 11:30 a.m. in Wright Auditorium.

Web of Knowledge is a research platform for finding, analyzing and managing information across scientific disciplines. The first hour of the session will be devoted to the database Web of Science. The second hour will cover Journal Citation Reports and the program EndNote Web. Participants may attend any portion on either day.

Two additional two-hour sessions will be held on the same dates at Seattle Children’s Hospital Research Institute. Call the library at (206) 987-2098 for times and locations.

WPSR Presents Quarterly Community Production "Children's Health: Making Products Safe for Kids"

Washington Physicians for Social Responsibility (WPSR) will host a free presentation and discussion on child vulnerability to toxic chemicals on Dec. 3 at 7:30 p.m. at the Phinney Neighborhood Center in room 2. This event features child health and toxic exposures experts Richard Grady, MD, Steven Gilbert, PhD, DABT, and Sheela Sathyanarayana, MD and provides suggestions on how the public can get involved in reforming how chemicals are placed into the marketplace.

PALS Courses for 2008

In 2008, Children’s will be offering two abbreviated PALS courses for experienced providers from 8 a.m. to 6:30 p.m. on Saturdays Jan. 26 and June 7.

These courses have been compressed into one day and tailored for physicians and experienced pediatric health-care providers.

Throughout the year there are also eight PALS renewal courses and four standard two-day PALS provider courses. Health-care providers can find more information and register online on the Medical Staff Web site.

For questions about registration, contact Rachel Thompson by e-mail or phone at (206) 987-5319. For questions about curriculum, contact Eileen Reichert by e-mail or phone at (206) 987-5320.

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.