The Bulletin: September 2007

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

Updated AHA Guidelines: Fewer Patients Need Prophylaxis for Dental Procedures

As of Aug. 1, Children’s has adopted the American Heart Association (AHA) guidelines about prescribing antibiotic prophylaxis for the prevention of endocarditis.

As part of this change, Children’s cardiologists are including each patient’s level of risk and a recommendation about the use of antibiotics in their clinic notes. Please review the notes before prescribing antibiotics to patients who have taken them in the past as a preventative measure.

However, if you are treating a patient who was last seen at Children’s before Aug. 1, please consult with the patient’s cardiologist by calling (206) 987-2015.

In general, the guidelines recommend that antibiotic prophylaxis is no longer necessary for low-risk patients who need dental or other procedures. Antibiotic prophylaxis solely to prevent infective endocarditis is not recommended for genitourinary (GU) or gastrointestinal (GI) tract procedures, irrespective of the cardiac diagnosis.

The new American Heart Association consensus guidelines state that only patients with the following conditions are considered high risk and should still receive antibiotic prophylaxis for dental procedures:

Prosthetic cardiac valve
Previous infective endocarditis
Cardiac transplantation recipients who develop cardiac valvulopathy
The following congenital heart diseases (CHD):
- Unrepaired cyanotic CHD, including palliative shunts and conduits
- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

The AHA has determined that aortic valve disease is a low-risk condition. Children’s cardiologists are concerned that certain pediatric patients with aortic valve disease may in fact be high risk. Decisions about prophylaxis for these patients will be made on a case-by-case basis until more is learned about this condition and their risk of endocarditis.

As always, good dental hygiene and regular dental care are recommended to reduce the risk for the development of infective endocarditis in both low- and high-risk patients. The 2007 AHA Guidelines are available online at http://www.circ.ahajournals.org.

U.S.News & World Report Ranks Children's in Top 10 in the Nation

This year U.S.News & World Report magazine placed Children’s among the nation’s top children’s hospitals for the 15th consecutive year. Children’s was ranked 9th in the country, and it was the only children’s hospital in the Pacific Northwest to make the list. Children’s was also recognized as the best pediatric hospital on the West Coast.

The results were announced as part of U.S.News & World Report’s annual “America’s Best Children’s Hospitals” issue on newsstands Aug. 27.

“It is an honor to be considered one of the nation’s top children’s hospitals,” said Dr. Thomas Hansen, CEO at Children’s. “Receiving this during our 100th anniversary is particularly poignant and helps recognize our commitment to provide our patients with the best care possible.”

While, in the past, pediatric hospitals have been ranked based on reputation alone in the magazine’s annual “America’s Best Hospitals” issue, this year’s children’s hospital ranking is based not only on reputation, but also on statistics about hospital performance and quality of care.

“This also marks the first time Children’s is ranked among the top 10, and I believe it is due to the tremendous dedication and expertise our employees and medical staff bring to the hospital every day,” added Hansen.

Details about the final rankings and more information about the survey methodology may be found on the U.S. News & World Report Web site.

Children's Installs Two New Scanners: CT and PET/CT

The Children’s Radiology Department has two new CT scanners — one dedicated CT scanner and one CT/PET scanner. Both are 64-slice high-resolution scanners that acquire images up to five times faster than the scanner that was previously available at Children’s.

The availability of two CT scanners increases Children’s capacity to perform scans, making it possible to respond to exam requests more quickly and to avoid sending patients to other hospitals for emergent CT exams.

Children’s is the only pediatric hospital in the country with a scanner that performs both positron emission tomography (PET) and computed tomography (CT). The scanner’s PET capability will be used primarily for oncology, cardiology and neurology patients. The PET information will be used together with CT images to enhance the accuracy of the diagnosis.

In oncology patients, the PET scan can help determine whether certain tumors are active or inactive, and if they have spread, either locally or to outlying locations away from the primary tumor.

The CT information can be used to precisely identify the location of the lesion. The combination of the two technologies enables physicians to detect disease earlier and more reliably, determine the location more precisely and monitor the effects of therapy.

Because of the speed of the CT scanner, a child that would normally have to be anesthetized will now more likely be able to hold still long enough to successfully complete the images. Young children will still require anesthesia for the longer PET/CT examinations.

In addition to offering a more child-friendly environment than adult hospitals, Children’s provides unparalleled pediatric expertise in anesthesia, nursing and radiologic diagnosis. Finally, a full-time child life specialist will be available soon to provide support to patients and their families during this process.

Hopper to Lead Plastic Surgery

Dr. Richard Hopper was named chief of the Division of Plastic and Reconstructive Surgery, succeeding Dr. Joseph Gruss, who served in the position for 15 years and will continue as an active member of our surgical team.

Dr. Richard Hopper

Hopper has been a craniofacial, plastic and reconstructive surgeon at Children’s for six years, and he will continue as the surgical director of Children’s Craniofacial Center.

He also serves on the Children’s Medical Executive Committee and the medical staff Quality Improvement Steering Committee. He is an associate professor in the Department of Surgery at the University of Washington School of Medicine.

“We are very grateful to Joe for his leadership,” says Dr. David Fisher, medical director. “He has fostered the growth of our craniofacial center, which is now one of the country’s largest and most comprehensive pediatric plastic surgery services. We look forward to continuing to work with him.”

“Richard is known internationally for his ability to perform complex and unusual craniofacial surgeries,” Fisher adds. “At the same time he is able to relate to our patients and families and help them understand what they will experience when they undergo surgery. He is an outstanding collaborator with all health-care professionals. We are fortunate that he has assumed this new position.”

Over the next five years, the Division of Plastic and Reconstructive Surgery will continue to grow, providing expert clinical care and conducting innovative research in cleft, craniofacial, brachial plexus, hand, microvascular, skin-lesion excision and facial reanimation surgery.

Dental Department Leadership Changes

After 16 years of dedicated service to Children’s, Dr. Bryan Williams will leave Children’s in October.

“As director of Dental Medicine, Bryan has developed and maintained strong partnerships internally and throughout the community and region with a host of health-care professionals,” says Dr. Joel Berg, interim director of Dental Medicine.

“Bryan’s continual focus on patients and the quality of care they receive has established a standard of excellence in the Dental Department that has greatly benefited patients, physicians and dentists, and will continue to benefit patients, residents, and dentists in their practices around the region for years to come,” he adds.

Dr. Rebecca Slayton has been named interim clinic chief of Dental Medicine at Children’s. She will provide clinical oversight at the clinic, which is located in the Hartman Building across from the main hospital campus.

Inside the OR: A Children's Healthlink Special with Jean Enersen

This one-hour special follows Children’s doctors, nurses, staff, patients and families for 24 hours in the Operating Room at Children’s Hospital. Tune in on Monday, Sept. 10, at 8 p.m. on KING 5 TV; Thursday, Sept. 13, at 8 p.m. on Northwest Cable News; or Sunday, Sept. 16, at 7 p.m. on KONG TV.

Handbook for Continual Survey Readiness Available Online

Joint Commission surveys are now conducted on an unannounced basis every three years. We anticipate that our next survey will be in early 2008, although it could be sooner. The updated Handbook for Continual Survey Readiness booklet is a quick reference tool to help you prepare for inspections by The Joint Commission or the State Department of Health. Attending medical staff were sent copies of the booklet in August. The booklet is now available on the Medical Staff Web site.

CIS Reports No Longer Printed for Paper Records

Effective Sept. 1, many of the reports in the Clinical Information System (CIS) will no longer be printed and filed in our paper record.

“The decision to stop printing information that is available in the CIS is another step toward using exclusively an electronic record at Children’s,” says Dr. Mark Del Beccaro, pediatrician-in-chief and chief medical information officer.

These reports include:

Any document transcribed by our Transcription Department (e.g. discharge summaries, clinic notes, operative reports, etc.)
Laboratory/Pathology reports
Radiology reports

This change does not impact the current process for sending copies of dictated notes to community providers and parents indicated in your dictation.

The transcribed reports can be found in the CIS in the following folders:

Discharge summary: in the Inpatient folder
Clinic notes: in the Outpatient folder
Operative reports - in the OR and Procedure folder

If CIS is not available (e.g. due to a planned system downtime or unexpected downtime), a “read only” version of CIS can be used to access clinical information. Instructions for accessing the “read only” system will be provided as part of the regular downtime procedures. If you need assistance accessing the “read-only” version during a downtime, please contact the Information Services Help Desk at (206) 987-1111.

If you opt to print any documents from CIS, please dispose of these copies in the secure recycling bins located throughout the hospital. Please do not maintain them in departmental files, place them in hospital records or send them to Health Information Management for filing.

If you have any questions, please contact Sue Stubbs at (206) 987-3869 or Mark Del Beccaro at (206) 987-1444.

Information Services to Focus on Three Priority Projects

In the next nine months, Information Services (IS) will focus on three key projects that will help ensure the security of our systems and improve the quality of patient care.

These projects include the replacement of obsolete Surgery and Emergency Department systems; the implementation of a new registration, scheduling and billing system to replace Invision, Pathways and NextGen; and ongoing security and infrastructure upgrades.

The Hospital Steering Committee has determined that these projects will take priority over all other service requests, with the exception of requests that are critical to patient safety. All other requests — including those that have already been submitted — will be handled after these three projects have been completed. For more information, see the PARC site on CHILD. You can access the Patient Access and Revenue Cycle (PARC) site on CHILD through http://www.seattlechildrens.org/home/employees.asp.

A nationwide search for a new chief information officer is underway as Children’s moves forward with these improvements.

Children's 100th Birthday Picnic

Celebrate Children’s 100th birthday at a picnic at Woodland Park Zoo on Sunday, Sept. 16 from 11 a.m. to 4 p.m. Enjoy a free picnic lunch, music, animal encounters, face-painting and other activities. You can receive up to four free tickets; additional tickets are $5 each. Reserve your tickets by using the ticket order form or through the Volunteer Office at (206) 987-2155.

Telephone Contact: Working Both Ways

The Children’s Physician Operator, at (206) 987-7777, has proven very effective in allowing community physicians to reach Children’s physicians. Response rates for both 15-minute and “end of the day” calls are consistently more than 90%, and often greater than 95%. Our providers are highly committed to responding to your phone calls.

For an urgent consultation, please feel free to use the “call back within 15 minutes” option. If your call does not require an immediate response, please use the “end of the day” option. The average response time for “end of the day” calls is less than two hours.

When you call, please provide an alternate phone number in case our physicians are unable to reach you on your main office line.

Children’s physicians are working to improve their communication with referring providers about their hospitalized patients. At times, our physicians encounter the same kind of issues at your practices that you encounter at Children’s — unwieldy phone trees, busy signals, being put on hold, voice mail, etc., — which can prevent them from reaching you in a timely manner

We are in the process of calling our community practices to obtain alternate contact information, including back office lines, pager and cell phone numbers, fax numbers and email addresses to be sure we can reach you easily. Please ask your staff to share this information with us when we call and to treat the communication from our providers as a priority.

Thank you for your help in making this two-way communication easier and more satisfying.

Physicians May Report Quality and Safety Concerns to Joint Commission

Children’s medical staff members and employees may report concerns about the safety and quality of care at Children’s to The Joint Commission without fear of retaliatory disciplinary action, in accordance with a revised Joint Commission policy. In the past, the policy about reporting concerns referred to hospital staff in general terms, without specifying that physicians and medical staff were included. You may share concerns about the safety or quality of care with The Joint Commission Office of Quality Monitoring by calling (800) 994-6610, or by sending an e-mail to complaint@jointcommission.org.

CIS Folder Change for Social Work Notes

Currently, social work documentation files are stored under both the Inpatient and Outpatient tabs in the Clinical Information System (CIS) and it is difficult for providers and other readers to find them. The CIS team has created a new folder called “Social Work” in CIS under the consult tab; all social work notes will now be found there.

The only exception is that the Hematology/Oncology outpatient social work notes and assessments will still be entered in CIS under the Hematology/Oncology Outpatient tab. Please contact Roosevelt Travis in Social Work at (206) 987-3965, or Paula Dascher in Transcription Services at (206) 987-5180 if you have any questions.

Almquist Retirement Reception

Dr. Jon Almquist, a pediatrician at Virginia Mason Federal Way, is retiring after 43 years in pediatrics. Almquist has been a member of Children’s medical staff since 1968, and he also completed his pediatric residency at Children’s.

Children’s medical staff members are invited to a reception in his honor on Sunday, Sept. 9, from 1 to 4 p.m. at the Federal Way Community Center, 876 S. 333rd Street.

For more information, call Virginia Mason Federal Way Pediatrics at (253) 874-1618. If you are unable to attend and would like to share some thoughts with Jon, please send them to Dr. Mark Del Beccaro before Thursday, Sept. 6.

New Physicians Directory

You should have already received your 2007-2008 Physicians Directory in the mail. We understand that it can be helpful to have multiple copies for practice staff and providers. If you want additional copies, please use the Health Care Provider Materials Request Form on the front page of the Medical Staff Web site or call Physician Relations at (206) 987-5221.

Johnston Named Editor of Injury Prevention

Dr. Brian Johnston, chief of pediatrics at Harborview Medical Center and an inpatient attending physician at Children’s, was named editor of the international peer-reviewed journal Injury Prevention. A publication of BMJ (British Medical Journal), Injury Prevention features articles on the prevention of injuries in all age groups, including unintentional and intentional injuries. Johnston is also an associate professor of pediatrics at the University of Washington and an investigator at the Harborview Injury Prevention and Research Center.

Children's Staff Flu Vaccine Campaign Recognized

Children’s was recently honored by the American Nurses Association (ANA) as a Best Practice Organization for its staff influenza immunization program.

Children’s Occupational Health Services (OHS) Department partners with nurses throughout the hospital to make it easy for staff to get the flu shot in care areas and on-site clinics.

Last year nearly 70% of Children’s employees in direct-patient-care areas were vaccinated, well above the national average of 40% for health-care settings. Children’s ultimate goal is for 100% of employees in direct-patient-care areas to be vaccinated.

“The hospital’s flu vaccine program has been increasingly successful over the years,” says Rena Irwin, interim vice president, Human Resources. “The commitment of our OHS staff to supporting the hospital’s vision of being the best for our patients and families translates into an outstanding influenza vaccination program.”

New Medical Staff and Allied Health Professionals

Children’s welcomes these new medical staff members:

Maneesh Batra, MD, Neonatology, Children’s
Samuel Browd, MD, Neurosurgery, Children’s
Eric Chow, MD, Hematology/Oncology, Children’s
Kelly Evans, MD, Pediatric Chief Resident, Children’s
Joseph Flynn, MD, Nephrology, Children’s
Jeffrey Friedrich, MD, Hand Surgery, Children’s and Harborview Medical Center
Molly Gunsaulis, DDS, Dental, Odessa Brown Children’s Clinic
Eric Gustafson, MD, Pediatric Chief Resident, Children’s
Ray Hsiao, MD, Child Psychiatry, Children’s
Elizabeth Jacobson Misbe, MD, IICU, Children’s
Jeremy Kassebaum, MD, After Hours Clinic, Children’s
Jerry Kim, MD, Anesthesia, Children’s
Rohit Khosla, MD, Plastic Surgery, Children’s
J. Lawrence Merritt, MD, Metabolic/Biochemical Genetics, Children’s
Erica Michiels, MD, Pediatric Chief Resident, Children’s
David Moe, MD, Radiology, Children’s
Eva Moore, MD, Hospitalists, Children’s
Angela Peck, MD, Infectious Disease, Children’s
Carol Rockhill, MD, PhD, Child Psychiatry, Children’s
Emily Rudnick, MD, Otolaryngology, Children’s
Akiko Shimamura, MD, PhD, Hematology/Oncology, Children’s
Kimberly Stone, MD, Emergency Medicine, Children’s
Vijaya Vemulakonda, MD, Urology, Children’s
Victoria Wilkins, MD, MPH, After Hours Clinic, Children’s
Jacob Zauberman, MD, Neurosurgery, Children’s
Amy Seymour, ARNP, Neurodevelopmental, Children’s
Annaka Thibodeaux, ARNP, MSN, Hematology/Oncology, Children’s
Chris Bergeron, MD, Otolaryngology, UW
Mark Boseley, MD, MS, Madigan Army Medical Center
Denise Garcia, MD, Ophthalmology, UW
Krista Heidar, MD, Eye Associates NW-Seattle
Paul Kraemer, MD, Orthopedics, UW
Pamela LaBorde, MD, Pediatrics NW-Tacoma
Vivek Manchanda, MD, Radiology, UW
Anthony Russo, MD, Orthopedics, UW
Gwendelynn Seaver, MD, Pediatric Associates-Bellevue
Joseph Shvidler, MD, Larrabee Center for Facial Plastic Surgery
Austin Spitzer, MD, Transplant, UW
Ildiko Thomas, MD, Pediatric Associates
Melissa Walsh, MD, Richmond Pediatric Clinic

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.