The Bulletin: July 2008

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

Quarterly Consult: Pediatric Bone Marrow Failure

Dr. Akiko Shimamura, the principal physician in the Bone Marrow Failure Program at Children’s, provides information for primary care providers on pediatric bone marrow failure.

Seattle Children's Launches Global Alliance to Fight Prematurity and Stillbirth

Globally, premature births and stillbirth represent major public health problems. Premature birth is the leading cause of death during the neonatal period and is responsible for more than a million infant deaths each year. In addition, about 24 of every 1,000 babies are stillborn.

To address these serious global health issues, Children’s has established the Global Alliance for the Prevention of Prematurity and Stillbirth (GAPPS). Under the leadership of Dr. Craig Rubens, the alliance is developing international programs to support research, policy development and advocacy, with the ultimate goal of improving maternal and neonatal health.

With support from the Bill & Melinda Gates Foundation, GAPPS is conducting the following initiatives:

A comprehensive literature review of published and unpublished data on the epidemiology, current rates, direct and indirect causes of death, risk factors, and biology of premature and stillbirth globally.
An analysis of gaps in our scientific knowledge and challenges to successful interventions.
An International Conference on Prematurity and Stillbirth, to be held in Seattle in May 2009, which will feature findings from the literature review, unpublished data review and gap analysis.

In addition, GAPPS is developing a premature birth clinical data bank - the first of its kind in the nation—to support a coordinated system for enrolling, collecting, processing, and banking maternal specimens and umbilical cord blood for research. GAPPS also recently created a partnership with the Puget Sound Blood Center to extend its research network to help increase the blood center’s collection of umbilical cord blood.

The GAPPS Web site is now live, featuring information about GAPPS leadership and core investigators, ongoing research initiatives and advocacy efforts, news and events, plus registration and other details about the international conference in May 2009. Information and resources for families touched by prematurity and stillbirth will also be added to the site.

All visitors are invited to provide feedback about the site to Mark Ruffo, marketing manager at Seattle Children’s Hospital Research Institute.

Remembering Dr. Jack M. Docter

Dr. Jack M. Docter, former medical director at Children’s, passed away June 4. He was 92.

Dr. Jack Docter

An immensely popular pediatrician, Docter specialized in the care of children with cystic fibrosis. When he signed on as medical director in 1959, Docter became the first clinician directly employed by Children’s Orthopedic Hospital. He served in that position until 1981.

Along with Dr. Stanley Stamm, he was instrumental in forming the Cardio-Pulmonary Department, which later became the Pulmonary Division.

In addition to his duties at the hospital, Docter was an associate dean representing Children’s at the University of Washington School of Medicine (UWSOM) and believed that the partnership with UWSOM was a key element in being able to offer the best possible care to children of the region. He had said, “Without university participation in its programs, Children’s would be a good community hospital. With university participation, it is a great regional medical center.”

“Jack Docter was one of the most sensitive and thoughtful physicians that I have worked with. It was a pleasure to follow in his footsteps,” says Dr. John Neff, who succeeded Docter as medical director. “He gave wise counsel and never let an uncomplimentary word leave his lips. He continues to be universally respected and loved by all who worked with him.”

Docter is survived by his wife, Marion, and their three children, Jeffrey, Marion and James.

Individuals who wish to make gifts in memory of Dr. Jack Docter are encouraged to direct them to Children’s Hospital Foundation for the benefit of the Jack Docter, M.D., Endowment for Uncompensated Care.

Weinberger Appointed Radiology Director

Dr. Ed Weinberger has been appointed, and approved by the Board of Trustees, as the new director of the Department of Radiology after a nationwide search.

Dr. Ed Weinberger

He will also continue to serve as division chief of both Radiology Informatics and Magnetic Resonance Imaging. Weinberger is a professor of radiology and of neurosurgery at the University of Washington School of Medicine (UWSOM).

“Ed has demonstrated outstanding leadership in his previous roles at Children’s,” says Dr. David Fisher, senior vice president and medical director at Children’s. “I have complete confidence that he will provide instrumental guidance to his department in its quest to provide timely access and highly effective diagnostic and therapeutic services to children and families.”

After obtaining his medical degree from Harvard Medical School in Boston, Weinberger completed a pediatric residency at UWSOM and Children’s. He also did his fellowship in pediatric radiology at Children’s. He has been a member of the medical staff since 1986.

Dr. Eric Effmann, who served as department director since 1991, will continue as an attending physician in the Radiology Department and as the division head of General Diagnosis. A celebration of Effmann’s contributions to Children’s will be held on July 7 from 11:30 a.m. to 1 p.m. in the Small Dining Rooms in the Sound Cafe at Children’s.

Children's to Continue Green Efforts in Growth

Children’s is committed to creating and maintaining a healthy environment for patients, their families and our staff. Minimizing the impact of our expansion on the environment is part of that goal to be the cleanest and greenest hospital.

The design of new buildings constructed as a part of our master plan will use green principles to reduce energy usage and promote healthy interior and exterior environments. Plantings and new open spaces in the growth proposal will create tranquil places for patients, families and neighbors to enjoy, and provide a natural shield to minimize noise and light from the hospital in nearby neighborhoods. These garden areas also help control the ambient temperature throughout the year.

Many of our current initiatives reduce harmful effects on the environment, and reduce the costs of our operations. These efforts, recently noted in Continental (Continental Airlines’ in-flight magazine), include composting yard waste and leftover food. Children’s also recycles cooking fat, office paper and computer monitors, cans, bottles and plastics.

“As the best pediatric hospital in the region, Children’s can be a leader in helping to create a healthy hospital environment for patients, families and staff, to educate and serve as a role model for our community, and ultimately to protect and save our environment for future generations,” says Sue Heffernan, RN, MN, BC, clinical nurse specialist.

Cardiovascular Monitoring for ADHD

The American Heart Association (AHA) recently published a statement entitled “Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs”, which implied that patients receiving such medications should have an electrocardiogram (ECG) performed as a part of routine screening. This has generated discussion throughout the pediatric, cardiology and electrophysiology community, and, in fact, because of confusion and discrepancies an erratum to the article was subsequently published.

After these corrections were made, the American Academy of Pediatrics (AAP) and the American Academy of Child & Adolescent Psychiatry (AACAP) endorsed the statement (it is important to note that the original paper did not include in its authorship any members representing either organization). The Heart Rhythm Society (HRS) and the Pediatric and Congenital Electrophysiology Society (PACES) have yet to endorse the AHA statement.

The Children’s Heart Center cardiologists have reviewed this statement in detail with local representatives from community pediatric groups and child psychiatry, and have discussed this with those who have prepared responses on behalf of the AAP and PACES.

Recently, a working group from the AAP Section on Cardiology and Cardiac Surgery released a summary response to the AHA statement that includes an algorithm for workup of patients who are receiving stimulant medications. In summary:

Patients with known cardiac disease should receive further evaluation including an ECG.
Patients with no known cardiac disease should have a history and physical to identify risk factors for congenital heart disease or sudden cardiac arrest.
If risk factors are identified, further cardiac evaluation is indicated.
If no risk factors are identified, no further testing is necessary.

We are in agreement with the AAP that it is unnecessary to perform a routine ECG prior to starting stimulant medications unless the patient history, family history or physical examination raise concerns. The most recent statement is located on the AAP Web site. To date, there has been no scientific evidence to suggest that the use of stimulant medications is associated with an increase in the rates of sudden death in any patient population, a fact which is acknowledged by the authors of the original AHA statement.

Physician Preparation for Children's Nursing Magnet Designation Site Visit

Children’s has applied for American Nurses Credentialing Center (ANCC) Magnet Designation. We will have a three-day site visit from July 30 to Aug. 1. A formal physician leadership interview is scheduled and invitations are being sent to specific physicians. Any physician may be asked to participate during tours of units or clinics.

Magnet™ designation by American Nurses Credentialing Center is recognized as the gold standard of nursing peer review and a valid indicator of nursing excellence. ANCC is a branch of the American Nurses Association, which is the same group that certifies nurse practitioners and other specialty nursing practices.

An extensive body of literature demonstrates more favorable clinical outcomes in Magnet™ facilities as compared to non-magnet facilities, as well as fewer errors, higher patient satisfaction, higher nurse satisfaction, improved nursing staff retention rates and stronger interdisciplinary collaboration. As of 2006, U.S.News & World Report began considering Magnet designation in its scoring for the ranking of top hospitals.

The ANCC Magnet Recognition Program® was established to help organizations create a practice environment to recruit and retain best nurses, and to provide a means of evaluating the organizational environment, quality performance and professional nursing practice. The application process for Magnet designation entails extensive documentation reviewed by external appraisers, evaluation of public comments, and an in-depth appraisal onsite.

Achieving Magnet designation is an important organizational goal and aligns with key aspects of Children’s strategic plan.

Key areas of evaluation include:

Quality of leadership and strategic planning
Organizational structure ensures collaborative, data-driven decision making
Continuous learning and development
Commitment to quality improvement and measured outcomes
Contribution to new knowledge via nurse-led research
Staff satisfaction and retention

During the three-day site visit, expert nursing appraisers will conduct individual and group interviews of representatives from all disciplines and levels of the organization. They will tour all clinical areas and may review documents related to clinical practice, quality, and performance management.

Sessions with medical leadership generally focus on interdisciplinary collaboration in all aspects of design and delivery of health care. The topics below may be anticipated as areas of discussion during the medical leadership session.

Interdisciplinary Collaboration

Strategic onitiatives reflecting interdisciplinary collaboration
Perception of chief nursing officer and other nurse leaders
Operational and departmental partnerships
Quality improvement: continuous performance improvement:

Give specific details of teams on which you’ve served with nurses

Describe examples of interdisciplinary work to define indicators, monitor performance, evaluate outcomes and design improvements.

Clinical Care

Examples that reflect value for nursing contribution to clinical outcomes
Triad model (doctor, nurse and medical assistant see patient together in ambulatory settings)
Shared practice and decision making
Clinical documentation that reflects interdisciplinary care planning

New Phone Line for Requesting Inpatient EKGs

Children’s has implemented a 24-hour phone line to request an electrocardiogram (EKG). The goals are to reduce the wait time between placing an order and getting results and to eliminate variations in the inpatient EKG process.

Providers, nursing staff or unit coordinators need to call (206) 987-7EKG after entering the order in the Clinical Information System (CIS). Testing will proceed as soon as the staff member verifies the order in CIS.

Contacting the EKG staff by phone is required to ensure they receive the order and can perform the EKG promptly. This phone call will help avoid delays because the staff who perform EKGs are often away from their computers and do not receive orders in the CIS in a timely manner.

The exception to this process is in the Intensive Care Unit (ICU), where practitioners will need to contact the ICU respiratory therapist directly to coordinate an EKG for their patients.

If you have questions, contact Megan Wirsching, RN, at (206) 987-3563.

Reducing Contamination with Pathogens in Hospital Rooms

Studies have shown that the environment in inpatient rooms regularly becomes contaminated with pathogens that can live on surfaces for several days or even longer. To prevent the spread of infection, providers and staff should use hand sanitizer gel before and after any contact with a patient or a patient’s environment.

When cultured, the surfaces in hospital rooms of patients with Clostridium difficile, vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) test positive for these pathogens about 40% of the time. Bed rails, bed tables, door knobs and sink surfaces have all been shown to be contaminated with these organisms (Carling, PC et al. Am J Infect Control. 2006;34:513-9).

Another study showed that 20% of cell phones or Spectralink phones used by health-care providers are contaminated with pathogens (Goldblatt, JG et al. Infect Contr Hosp Epidemiol. 2007;28:500-3).

“We need to view the environment of the patient’s room as an extension of the patient,” says Dr. Danielle Zerr, medical director of Infection Control. “It’s very important to clean your hands before and after touching the environment because you can contaminate the environment by touching it, and you can also contaminate your hands through contact with the environment.”

Children’s Infection Control Department monitors the use of gel before and after both patient touches and environmental touches. Housewide physician compliance with cleaning hands before or after environmental touches has been 64% in 2008, as compared to 97% compliance with cleaning hands before or after touching a patient.

Gibson Receives Faculty Mentoring Award

Dr. Ron Gibson, chief of the Cystic Fibrosis Clinic and Pediatric Pulmonary Fellowship director, received this year’s Department of Pediatrics Faculty Mentor Award. Gibson was selected from among many physicians nominated by their peers.

Dr. Ron Gibson

“Ron loves to learn, discover, and apply what he knows to the care of children with chronic and acute lung disease,” says Dr. Greg Redding, Pulmonary Division chief. “He fosters these activities in all of those around him and does so with great humor and humility.”

“Ron is the perfect choice for this Faculty Mentor Award,” says Dr. Bruder Stapleton, chief academic officer. “His clinical skills, medical knowledge and humanistic values are truly inspirational.”

New Awards Presented to Community Physicians

Two new awards, both called the Ronald J. Lemire WWAMI Leadership Awards, were created by the University of Washington School of Medicine (UWSOM) Department of Pediatrics to recognize leadership of community pediatricians who train medical students and pediatric residents.

The first recipient of the award for pediatric resident programs is Dr. Cathy Shubkin, resident site coordinator for the Port Angeles pediatric WWAMI site at Peninsula Children’s Clinic. The award for medical student programs was presented to Dr. Randy Poncher, a pediatrician in Spokane.

The awards are named for Dr. Ron Lemire, who passed away in February this year. Lemire was one of the founders of the WWAMI program and led the pediatric WWAMI efforts for many years. WWAMI represents the UWSOM region for medical student and resident training, and includes Washington, Wyoming, Alaska, Montana and Idaho.

End-of-the-Year Teaching Awards Presented

The following awards were presented at the annual graduation dinner for the Pediatric Residency Program in June.

Resident Teaching Award: Reid Farris, MD, 3rd year pediatric resident

Bergman Prize, recognizing the pediatric resident who most effectively acts to advance the well-being of children treated at Harborview Medical Center while providing exemplary care to pediatric patients and their families: Samuel Kohn, MD, 2nd year pediatric resident

Family-centered Care Award: Lila O’Mahony, MD, and Andrew Beckstrom, MD, 3rd year pediatric residents

Fellow Teaching Award for excellence in teaching: Elaine Albert, MD, Critical Care fellow

Faculty Teaching Award: Brianna Enriquez, MD, attending physician in Emergency Medicine and Terrence Chun, MD, attending physician in Cardiology

Stanley Stamm Award, recognizing faculty who are role models in their commitment to patients and families, commitment to children in the community and to excellence in clinical activity: Ted Carter, MD, attending physician, Pulmonary

New Medical Staff and Allied Health Professionals

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

Alison Golombek, MD, Child Psychiatry, Children’s
Robert Smith, MD, Anesthesia, Children’s
Janet Jacob, ARNP, Hematology, Providence - Pediatric Subspecialty
Karen Knuth, ARNP, Neonatology, Children’s

CME Program on Prenatal Diagnosis

Seattle Children’s Prenatal Diagnosis and Treatment Program and the University of Washington, Division of Maternal Fetal Medicine presents the CME program Prenatal Diagnosis: Outcomes and Transition to Pediatric Care on Nov. 1 and 2.

Held at Seattle Children’s, this course will provide information on advances in prenatal diagnosis, maternal fetal medicine and pediatric care, allowing practitioners to update their knowledge about high-risk perinatal care and long-term outcomes for several pediatric conditions.

The program is designed for obstetric and pediatric providers, pediatricians, family physicians, nurse midwives, sonographers, genetic counselors, nurses, nurse practitioners and physician assistants. The program brochure is available on the medical staff Web site.

Annual Bioethics Conference on Genetic Testing in Children

Children’s will sponsor the fourth annual conference on pediatric bioethics presented by Children’s Treuman Katz Center for Pediatric Bioethics on July 25 and 26 at the Bell Harbor International Conference Center. Lectures, panel discussions and breakout sessions will address a variety of questions related to genetic testing in children and their families. For more information or to register, visit the bioethics Web site.

Management Training for Physicians and Clinical Professionals

The University of Washington (UW) Certificate Program in Medical Management (CPMM) is designed to help physicians and other clinical professionals acquire practical business and management skills to enhance their everyday effectiveness and prepare them for leadership positions. Applications are due Aug. 22.

The CPMM consists of four courses offered one evening a week. The first class, Medical Practice Quality Measurement and Management, begins Sept. 24. All courses are transferable into UW’s Executive MHA Program. For course details, and to apply, visit the certificate program Web site. Contact Bree Rydlun by e-mail or at (206) 616-2947 with questions.

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.