The Bulletin: January 2008

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

New Hypertension Clinic to Open

Children’s Nephrology Division has established a dedicated clinic to serve the increasing numbers of children and adolescents with hypertension.

The clinic will operate two days per month beginning in late January.

The clinic faculty includes Dr. Joseph Flynn, director, and Dr. Ikuyo Yamaguchi. Initial comprehensive diagnostic evaluations of patients with elevated blood pressure,
consultations on patients with established hypertension and ongoing follow-up will be offered.

This clinic will also offer specialized services not available elsewhere in the region, including ambulatory blood pressure monitoring, home blood pressure monitoring, nutritional counseling and medication management.

A clinical research component will focus on developing new antihypertensive
medications.

To refer patients to the hypertension clinic, call (206) 987-2080. Call Dr. Flynn directly through the physician operator at (206) 987-7777 for urgent questions.

Physicians' Opinions About Growth Plans Count

Families in our community highly value Children’s physicians’ opinions when it comes to getting accurate information about the hospital’s growth plans.

The Bulletin will serve as a resource for faculty and referring physicians to help them respond to questions from families and others in the community.

Question: How do I answer people who approach me with concerns about the scope of Children’s growth plans?

Children’s is planning four phases of growth over the next 20 years that will enable the hospital to add beds as they are needed. Based upon regional population growth and current pediatric care trends, Children’s expects to need 250 to 350 additional beds over the next 15 to 20 years, which will bring the total count to 500 to 600 beds.

Our census is often at or near capacity of our current 250 beds. It will become increasingly difficult to care for those needing services with the number of patients in the region and the complexity of their medical needs growing.

Read Dr. Tony Avellino’s perspective on being an ambassador for Children’s.

New Recommendations for Meningococcal Vaccine

The Advisory Committee on Immunization Practices (ACIP) has revised its use of quadrivalent meningococcal conjugate vaccine (MCV4) in children 2 to 10 who are at increased risk for invasive meningococcal disease. View new recommendations.

Recommended Hand Hygiene Practices

Children’s is committed to eliminating hospital-acquired infections. Compliance
is measured through observations of physician hand hygiene on entering and exiting patient rooms. The observed physician hand hygiene rate has increased from 60% in 2005 to 84% in the last quarter of 2007, but it is still lower than the most recent nursing compliance rate of 90%.

Studies show that a patient’s environment becomes contaminated with the pathogens they have, including MRSA and VRE. Bed rails, bedside tables, doors, call buttons and tray tables are frequently found to culture pathogens, according to a 2006 study published in the American Journal of Infection Control. Therefore, it is important for care providers to clean their hands every time they enter and exit a patient’s room, regardless of why they are visiting.

Children’s exceptional hand hygiene practices have contributed to the reduction in bloodstream infections from a rate of 6.2 per 1,000 line days in 2005 to 1.7 infections per 1,000 line days in November 2007.

Children's to Expand in Bellevue

On Dec. 12, the City of Bellevue announced its intent to sell 6.6 acres near downtown Bellevue to Children’s for a 50,000-square-foot outpatient facility that is expected to open in 2010.

The new facility, near the northeast corner of 116th Ave. NE and NE 12th St., will offer 25 clinical services, including cardiology, orthopedics and adolescent medicine. The facility will also include two operating rooms for outpatient surgery, laboratory and radiology services, and urgent care offices.

“There continues to be a need for additional pediatric specialties on the Eastside,” said Lisa Brandenburg, chief administrative officer at Children’s. “We really felt we wanted to bring our services closer to where our patients live.”

Koyle Appointed Urology Chief

Dr. Martin Koyle joined Children’s this month as chief of the Division of Urology, succeeding Dr. Richard Grady, who has served as the division’s interim chief since 2006.

Dr. Martin Koyle

Koyle leaves his position of Chairman, Department of Pediatric Urology at The Children’s Hospital in Denver. He was also vice-chief of the Division of Urology and professor of surgery/urology and pediatrics at University of Colorado School of Medicine. He has recently completed his term as president of the American Association of Pediatric Urology and is a member of numerous task forces and committees
within that organization and the Society for Pediatric Urology.

“I look forward to Dr. Koyle joining our team,” says Dr. Richard Grady, interim chief. “His strengths will complement our program, and he has an impressive track record of commitment to teaching and research that will reflect well on the ethos of Children’s. I know our team will continue to excel under his stewardship.”

Children's and UW to Build Pediatric Dental Facility

Children’s and the University of Washington (UW) School of Dentistry are developing a new pediatric dental facility in Magnuson Park with a lead gift of $5 million from Washington Dental Service and the Washington Dental Service Foundation.

The new facility, expected to be ready in 2010, will double the capacity of the dental programs at both institutions and house an innovative clinical, research and training program to be called the Early Childhood Oral Health (ECOH) program.

“This new venture will bring nationally recognized oral health care and medical professionals together under one roof to ensure our region’s children receive the highest quality oral health care at an early age when disease can be prevented,” said Dr. Joel Berg, DDS, director of the Dental Department at Children’s, the ECOH program and chair of the Department of Pediatric Dentistry at the UW School of Dentistry.

Security Screening Expands in the Hospital

Since Oct. 15, security entrance officers (SEOs) have been screening visitors to the second and third floors of the Giraffe and Train inpatient units as part of a pilot effort to enhance security for patients, families and staff.

Anyone entering these areas is required to show a badge, and all visitors must have approval from an adult family member before they are allowed into a patient’s room. The second phase of the security screening pilot began Dec. 10, when SEOs were added to the Giraffe 4 and Train 1 inpatient units.

All are encouraged to help in the screening process by wearing badges in a visible location; those with visible Children’s identification will not be stopped by SEOs.
“We’re not just asking staff to wear badges because of Joint Commission or hospital policy, although that’s very important,” says Jeff Sconyers, Children’s senior vice president and general counsel. “Every one of us should be doing this out of respect for our families and for the safety and privacy of our patients.”

New Genetics Laboratory Web Site Live

Children’s Hospital’s new Genetics Web site helps identify the appropriate genetics testing strategies for patients with potential genetics disorders.

Users can view the test catalog alphabetically, by disorder and test category, or by laboratory section to identify the required tests quickly and in their preferred format. The site provides information about each test including a description, clinical relevance, similar tests and sample requirements. It also provides information about getting a genetics consultation at Children’s.

The Genetics Laboratories are dedicated to bringing the most current research testing into the clinical arena. The labs include biochemical genetics, molecular genetics, cytogenetics and a research and development laboratory. The laboratories’ advanced technology allows the diagnosis and management of patients across the spectrum of genetic diseases.

Please visit the new site.

Increased Incidence of Pertussis: Reminder of Precautions

Children’s has seen 14 patients with pertussis in the last month, with six of those cases presenting in the last week.

This is an unusually high number of cases, and the region is seeing the same increase, according to Public Health - Seattle & King County. Most Children’s patients are presenting with pertussis in the Emergency Department.

Children’s Infection Control Department believes that one patient may have been infected with pertussis while at Children’s. Occupational Health Services has also been tracking several staff pertussis exposures. The cases are primarily related to contact with infants presenting with atypical pertussis symptoms.

All hospital staff need to take the following precautions when caring for any patient with respiratory symptoms:

Wear a mask and gloves
Wear a gown when you anticipate that your clothing may become contaminated

Pertussis symptoms include:

A cough illness that begins with mild upper respiratory tract symptoms
Paroxysms of cough characterized by inspiratory whoop and commonly followed by vomiting
Absent or minimal fever
In infants less than 6 months, the prominent early symptoms are a short catarrhal stage, gagging, gasping, or apnea, and there is an absence of whoop

These symptoms can apply to many of the patients arriving for care at this time of year, so staff should use appropriate respiratory isolation precautions (see policy on CHILD) when caring for any patient with respiratory symptoms.

If you think you may have been exposed to pertussis, call Occupational Health Services at ext. (206) 987-2633. Remember that you should always stay home from work if you’re sick.

New Dictation System Implemented

Beginning Jan. 15, 2008, the dictation system at Children’s will be replaced with eScription — a computer-aided transcription system.

New yellow and black dictation cards along with slightly modified process instructions are being mailed to every provider with dictation privileges. The dictation number will remain the same at (206) 987-2196.

The eScription system is being implemented to improve turnaround times and reduce the cost of transcription. If you have questions or concerns, please call the transcription office at (206) 987-2076 or Paula Dascher at (206) 987-5180. For more information, refer to flyer.

Electronic Medication Reconciliation to Improve Safety

Children’s is improving its medication reconciliation process this winter by introducing tools in the Clinical Information System (CIS).

Alerts in the CIS will prompt providers to review each patient’s medications on admission, at the time of each transfer between inpatient levels of care and at discharge.

All providers in day surgery and on inpatient units will now need to write prescriptions using the EasyScript program to ensure each patient’s medication information is up-to-date in the CIS. To learn how to use EasyScript, you can take a Web-based training course if you are at Children’s by clicking on the Application portal icon on your desktop, choosing “CIS Web-based training,” logging in, and then selecting the training called “Ambulatory CIS EasyScript.” To access the training outside of Children’s, visit Children’s Remote Portal. As the new process is rolled out, providers will be able to see a PowerPoint training presentation on the actual medication reconciliation process.

This process will be implemented in the Emergency Department starting on Jan. 8, and the inpatient units and day surgery will follow in February and March. If you have any questions, contact Dr. Mark Del Beccaro at (206) 987-1444. For more information, read the electronic medication reconciliation FAQs.

Phoning in Appointment Requests Takes Less Time

Calling in referrals is significantly faster and more efficient in getting referrals to Children’s.

According to recently gathered data, it takes referring practices two to five minutes to write and fax a New Appointment Request Form (NARF). Once the NARF reaches Children’s, it can take several hours to process if there are questions about the referral that require additional faxes.

Ninety-five percent of phoned in referrals take less than five minutes to process. The average time on hold for the clinical intake nurse during the last three months was 33 seconds.

To call in referrals, dial (206) 987-2080 or (866) 987-2000, extension 72080.

Remembering Dr. Theodore S. Roberts

Following are comments from Dr. Richard Ellenbogen, professor and chairman, Department of Neurological Surgery, University of Washington School of Medicine and holder of the Theodore S. Roberts Endowed Chair in Pediatric Neurological Surgery regarding the recent passing of Dr. Theodore S. Roberts:

Professor Ted Roberts died peacefully Thursday, Dec. 20, with his family at his side.

For those of us whom he mentored and befriended, he will be deeply missed beyond any words I can possibly express at this time.

For those who did not know him, Ted, a member of the “greatest generation,” World War II Navy veteran, and a University of Wisconsin alumni, became one of the true greats in neurosurgery through hard work, skill and scientific imagination.

He was a pioneer in the field of stereotactic surgery and developed one of the most widely used stereotactic devices in the world, the Brown-Roberts-Wells system. He had the vision to see that computer and image guidance to remove deep seated lesions was the future for neurosurgery. He executed that vision brilliantly; that contribution has been long lasting in the field of pediatric neurosurgery.

He was the first to devise a clever and successful way to divide craniopagus twins. He was one of the first to be Chairman of Neurosurgery at the University of Utah and served as a professor of neurological surgery here at the University of Washington prior to retiring.

He possessed a rare combination of technical virtuosity, courage, integrity, compassion, kindness, honor and, most of all humility, despite all these talents.

Our thoughts and prayers go out to his family.

Eddy Named Hickman Chair

Dr. Allison Eddy, chief of Children’s Nephrology Division and professor of pediatrics at the University of Washington School of Medicine (UWSOM), has been named the first holder of the Robert O. Hickman Endowed Chair in Pediatric Nephrology.

Eddy has been on the Children’s medical staff since 1997 and also serves as director of the Center for Tissue and Cell Sciences at Seattle Children’s Hospital Research Institute. She has gained international attention for her research on the genetic control of scarring in the kidney.

“Children’s Pediatric Nephrology Division has grown to international prominence in clinical care, education and research under Allison’s leadership,” says Dr. Bruder Stapleton, Children’s chief academic officer and chair of the UWSOM Department of Pediatrics. “It is wonderful to honor a clinician and researcher of her status in connection with Bob Hickman and the significant contributions he has made.”

Hingorani Recognized by Parent

Dr. Sangeeta Hingorani of Children’s Nephrology Division was recently thanked for her outstanding commitment to family-centered care by the parent of a patient who said, “Dr. Hingorani has been excellent to work with over the past two years. She always has the utmost respect for my son and my family. I am completely confident in her care for my son.”

New Medical Staff and Allied Health Professionals

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

Christine Clancy, PhD, Rehabilitation, Children’s
Sumit Pruthi, MD, Radiology, Children’s
Anika Sanda, MD, After Hours, Children’s
Amy Carter, MD, Pediatric Associates-
Bellevue
Isabella Knox, MD, Neonatology, UW
Amy Luedemann, DDS, Dental Medicine, UW
Kenneth Martay, MD, Anesthesia, UW
Albert Merati, MD, Otolaryngology, UW
Peter Neligan, MD, Plastic Surgery, UW
David Francis, ARNP, Regional NNP Program, Children’s

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.