children's connection | issue 1, 2010
DESCRIPTION
A Journal for PhysiciansTRANSCRIPT
PicU
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nicU
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sTealTh sUrgery
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ProJecT adaM
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nehii
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a JoUrnal for PhysiciansissUe 1, 2010
Proudly serving children since 1948, children’s hospital & Medical center is the only full-service, pediatric health care center in nebraska. located in omaha, it provides expertise in more than 30 pediatric specialty services to children and families across a fi ve-state region and beyond. The 145-bed, nonprofi t hospital houses the only dedicated pediatric emergency department in the region and offers 24-hour, in-house services by pediatric critical care specialists. children’s hospital & Medical center has achieved the Magnet designation for nursing excellence and is an infoworld 100 award winner for innovation in information technology. a pediatric affi liation established between children’s hospital & Medical center and the University of nebraska Medical center college of Medicine supports enhancements in pediatric education, research and clinical care. children’s is also the primary teaching site for the family practice and joint pediatrics residency programs at creighton University and UnMc. for more information on children’s hospital & Medical center go to childrensomaha.org.
PicU
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Total team effort and ecMo technology are two of the reasons for improved outcomes in the Pediatric intensive care Unit.
nicU
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a new neonatology team, with more than 100 years of collective experience, will oversee children’s comprehensive nicU services.
sTealTh sUrgery
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children’s pediatric neurosurgeon uses state-of-the-art electromagnetic tracking device for accurate 3-d imaging.
ProJecT adaM
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children’s is helping to raise awareness of this project to place aeds in schools and other public areas.
nehii
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vital patient information is shared immediately when physicians and health care centers are linked as part of the nebraska health information initiative.
conTenTs
sPecialTy PediaTric cenTer oPens sePTeMber 1
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children’s sPecialTyPhysicians
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new Physicians
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research award
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oUTreach clinics
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also:
children’s connecTion advisory coUncil
shahab f. abdessalaM, M.d.John d. KUgler, M.d.JosePh T. (Jay) snow, M.d.Jayesh c. ThaKKer, M.d.don w. coUlTer, M.d.Peggy hogan, r.n., Physician liaison
PicU: iMProving oUTcoMesTo redUce MorTaliTy raTe
Quality programs and “a total team effort” at the Pediatric Intensive Care Unit at Children’s Hospital & Medical Center are improving outcomes and reducing the mortality rate at a time when the unit is treating record numbers of sick children.
PICU Clinical Service Chief Mohan Mysore, M.D., FAAP, FCCM, credits the unit’s well-
trained, experienced medical professionals, innovative programs and advanced equipment for increasing the PICU’s ability “to care for the sickest of the sick.”
“The fact that 2009 was our busiest year ever, it is even more impressive that our mortality rates remain very close to historic lows,” says Mysore, who in addition to his role at Children’s,
is professor of pediatrics, UNMC College of Medicine.
In 2005, there were 725 admissions to the PICU and the mortality rate was 3.63 percent. In 2009, there were 890 admissions – an average of nearly 75 patients per month – and the mortality rate was 2.73, less than half the Standardized PICU Mortality Ratio of 5.67
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percent, which is based on the severity of the illnesses, Dr. Mysore says.
The 19-bed PICU is the only pediatric intensive care unit in the region with 24/7, in-house, board-certifi ed intensivists. These intensivists work with the nurses, respiratory therapists and medical staff in the PICU, and with other physicians such as primary care doctors, surgeons and subspecialists like cardiologists and gastroenterologists.
“Every member of the PICU team and support staff is exceptionally qualifi ed for pediatric critical care,” Dr. Mysore says. “The patients at Children’s benefi t each day from our expertise and years of experience.”
He points to the fact that 21 PICU nurses (63 percent of the unit’s nurses) have earned their Critical Care Registered Nurse (CCRN) certifi cation from the American Association of Critical Care Nurses, “an excellent and commendable effort on the part of our nurses that illustrates their recognition as providers of the highest level of pediatric critical care.”
Dr. Mysore says PICU outcomes are improving due to a concerted effort to provide the highest quality care.
For example, signifi cant progress is being made to reduce bloodstream infections – a common concern for all Intensive Care Units and a mortality factor. “Billions of dollars are spent nationally on patients who develop a bloodstream infection (BSI) while in an ICU environment,” Dr. Mysore says. “We have made combating these infections a priority.”
In a program spearheaded by Pediatric Intensivist Andrew J. MacFadyen, M.D., caregivers at Children’s closely follow a specifi c protocol developed by the National Association of Children’s Hospitals and
Related Institutions (NACHRI) during the placement of all central venous lines.
“We have trained observers who watch every line insertion conducted in the PICU and intervene if there is a deviation from the protocol,” Dr. Mysore says. “Every member of the team is engaged in this effort to reduce BSIs.”
A similar effort is underway to decrease the incidence of ventilator-associated pneumonia, under the leadership of Pediatric Intensivist Luke Noronha, M.D. in his role as Clinical Director of Respiratory Care Services.
During the recent epidemic, a signifi cant number of H1N1 patients were treated in the PICU. Two of the most severe cases were successfully treated with extracorporeal membrane oxygenation (ECMO), the use of an artifi cial membrane oxygenator to put oxygen into the blood. The PICU at Children’s is the only unit in the region that provides ECMO service for both cardiac surgery patients and pediatric shock and respiratory failure patients. Pediatric Intensivist Jeffrey DeMare, M.D., serves as Clinical Director of ECMO Services.
“ECMO recorded the busiest 12 months ever between July 1, 2008 and June 30, 2009,” Dr. Mysore says. “This increase in volume has been accompanied by excellent outcomes compared
adMissions To PicU and
MorTaliTy raTes
2005 2009
725ADMISSIONS
890ADMISSIONS
MORTALITY RATE:
3.63%MORTALITY RATE:
2.73%
“THE PATIENTS AT CHILDREN’S BENEFIT EACH DAY FROM OUR EXPERTISE AND EXPERIENCE.”
Mohan Mysore, M.d., faaP, fccMclinical service chief, criTical carechildren’s sPecialTy Physicians
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Physician’s PrioriTy hoTline 1.888.592.7955
to national ELSO (Extracorporeal Life Support Organization) statistics. ECMO has proven to be life-saving in many instances.”
The Children’s Critical Care Transport Service is adding to the PICU’s life-saving capabilities. Unique to the region, the service is staffed by 24 intensive care nurses and nine neonatal nurse practitioners under the direction of Pediatric Intensivist Robert Chaplin, M.D.
Last October, Children’s unveiled a new ambulance housed at the hospital and available exclusively to the Critical Care Transport Team. “This fully equipped, child-friendly ambulance, along with the availability of helicopter and fixed-wing aircraft, further enhance our unique capabilities to bring critically ill children here for treatment and provide critical care services by a well-trained and dedicated staff en route,” Dr. Mysore says.
The transport teams serve Nebraska, western Iowa, northern Missouri, northern Kansas, eastern Colorado and South Dakota. The services are accessed via a phone call to the Children’s Priority Line, 1-888-592-7955, from a physician or health care facility identifying a child needing specialized care and transportation.
Clinical research is another important aspect of the PICU mission. Edward J. Truemper, M.D., serves as the Director of Critical Care Research at Children’s, in collaboration with Brian Olsen, M.D. and other physicians.
Dr. Mysore says current research projects are national collaborative studies through the PALISI (Pediatric Acute Lung Injury and Sepsis Investigators) network and include North American trials on the use of pediatric surfactants, or surface-active substance; a study of severe influenza cases; and a National Institutes of Health-sponsored study examining pertussis infections.
“We are the number one enroller in the nation for the surfactant studies,” he says.
Other PICU intensivists at Children’s and their special areas of interest in addition to their clinical duties are Kelly Kadlec, M.D., Education and Simulation; Bridget Norton, M.D., ECMO; George E. Reynolds, M.D., acting vice president, Chief Information Officer and Chief Medical Informatics Officer; and Jayesh C. Thakker, M.D., Clinical Director of the Nebraska Medical Center PICU and PICU Outreach.
In addition to his duties at Children’s, Dr. Mysore serves as Director of the Division of Pediatric Critical Care in the Department of Pediatrics at the UNMC College of Medicine, one facet of the college’s academic affiliation with Children’s.
The PediaTric inTensive care UniT
aT children’s:
➜ Is the only medical facility in Nebraska staffed 24/7 with fellowship-trained, board-certified Pediatric Intensivists,
➜ Provides intensive nursing care and monitoring of important parameters such as heart rate, breathing, oxygen levels and blood pressure,
➜ Offers patients more intensive therapies that are not available on the general hospital floor such as ventilators (respirators) and medications that can be administered only under close medical supervision, and
➜ Makes available other advanced medical therapies including extracorporeal membrane oxygenation, or ECMO, which is essentially heart/lung bypass for children whose heart or lungs have temporarily stopped functioning.
rebecca MerediThicU sTaff r.n.TransPorT
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Children’s Hospital & Medical Center is growing into its new Specialty Pediatric Center on the corner of 84th Street and West Dodge Road and specialists will begin seeing patients there starting Sept. 1, 2010.
The 135,000 square-foot facility features five floors of clinic space and a multilevel garage under the building. Garage elevators bring patients directly to clinic floors. Patients and families will enjoy kid-friendly décor with a water feature and supervised play at a Kids’ Camp for siblings of patients.
Aesthetics aside, the major impact of the Specialty Pediatric Center will be the convenience of having specialists located together. And the larger, more flexible space can accommodate more patients. In 2009, Children’s specialists had 37,000 patient encounters. That number is expected to grow to 56,000 after the Specialty Pediatric Center has been operational for a few years. Because the Specialty Pediatric Center features multi-specialty
modules, a clinic that is experiencing higher demand on certain days can overflow into clinic space that is not as busy.
The demand to see specialists increases nine percent on average every year, and Children’s has been actively recruiting more pediatric specialists who are attracted by the new facility. For patients, this means wait times for appointments will be significantly reduced.
“This new center enables us to continue providing leading edge specialty health care services for children from the community, greater Nebraska and the region,” said Gary A. Perkins, FACHE, president and chief executive officer of Children’s Hospital & Medical Center. “It represents our continued commitment to caring for children now and into the future.”
sPecialTy PediaTric cenTer oPens sePTeMber 1
sPecialTy PediaTric cenTer UPdaTe
children seeing sPecialisTs in any of The following clinics will go To The sPecialTy PediaTric cenTer sTarTing sePT. 1, excePT where noTed.
➜ Allergy
➜ Aerodigestive
➜ Cardiology (early 2011)
➜ Cardiothoracic Surgery
➜ CDC
➜ Craniofacial
➜ Dental (Sept. 13)
➜ Developmental Pediatrics
➜ Endocrinology/Diabetes
➜ ENT
➜ Food Hypersensitivity
➜ Gastroenterology (Oct. 4)
➜ Helmet
➜ Hematology/Oncology
➜ HEROES Weight Management
➜ Infectious Disease
➜ Metabolic Disorders
➜ Nephrology/Kidney Disease
➜ Neurology (Oct. 4)
➜ NICU Follow-up
➜ Orthopaedics
➜ Pulmonology
➜ Rehab (Audiology, PT, OT, Neurodiagnostics, Speech – Aug. 30)
➜ Rheumatology
➜ Sleep Medicine
➜ Surgery
➜ Urology
The Newborn Intensive Care Unit at Children’s Hospital & Medical Center is leading the way in the care of critically ill neonates and newborns. A new neonatology team, with more than 100 years of collective experience, will oversee Children’s comprehensive NICU services now and into the future.
Children’s has named Lynne Willett, M.D., as the new Clinical Service Chief of its NICU. Dr. Willett brings a wealth of knowledge and an expansive background that has included leadership roles at the University of Nebraska Medical Center and St. Francis Medical Center in Cape Girardeau, Mo.
“I have been fortunate to have had many opportunities in my career and this one will be particularly exciting and rewarding,” says Dr. Willett. “I am looking forward to being a part of such a tremendous organization with so many experienced and knowledgeable professionals, especially the other providers of subspecialty services.”
Dr. Willett is joined by John Grebe, M.D., Bonnie Lees, M.D. and John Sparks, M.D. This team will oversee and coordinate the medical management of newborns with complex care needs that necessitate their transfer to Children’s Hospital & Medical Center.
The Children’s NICU is the only unit in the state meeting all guidelines for a level IIIC designation, the highest set forth by the American Academy of Pediatrics. The top tier units, according to the AAP, possess both the capability to provide ECMO and the surgical repair of complex congenital cardiac malformations that require cardiopulmonary bypass.
Over the past five years, newborns from 21 states and 415 communities required intensive care at Children’s. In 2009, the NICU received patients from 43 referring hospitals across Nebraska, Iowa, South Dakota and Missouri.
“We firmly believe that critically ill newborns need to be at Children’s. We see a spectrum of conditions present at birth and our specialists are uniquely qualified to treat these children. They have the training, they have the experience,” explains Dr. Willett.
Children’s NICU is the only unit that provides immediate access to nearly every pediatric subspecialty available in the region. Children’s Specialty Physicians, formerly known as the Nebraska Pediatric Practice, Inc., operates on-site. With more than 120 specialists representing a full complement of subspecialty care including cardiac services, comprehensive pediatric surgery, neurology, gastroenterology, endocrinology and more, it is the largest group practice of pediatric subspecialists in the area.
To streamline efficiency and augment urgent response needs, Children’s has recently enhanced its transport service, putting the expertise of the Children’s Transport Team in the air and onboard a medical helicopter. Eleven members of the team have earned
new neonaTology TeaMleads children’s nicU
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transport certification; the only medical professionals in the region to have achieved this level of training. The inclusion of neonatal nurse practitioners on the Children’s Transport Team is another unique attribute.
“When transport is needed, we understand the urgency and the importance of appropriate medical intervention for that child. Our team is able to provide the most advanced, cutting-edge care even before the newborn reaches our hospital,” says Pam Carlson, chief nursing officer and vice president of patient services.
As Children’s looks to the increasing needs of critically ill newborns in the region, the role of its transport team has expanded. It is now available to attend deliveries – upon physician request - and assist in the stabilization of those infants who have been identified as needing immediate support prior to transport. The early intervention for newborns in distress or suffering from a complex congenital malformation, says Carlson, facilitates
rapid assessment and communication with Children’s NICU control center team.
While an average stay in the Children’s NICU is about three weeks, some babies require months to develop. Developmental specialists, working with the medical team, carefully monitor the infants. Joined by occupational and physical therapists, a multidisciplinary approach ensures immediate intervention when concerns over development or feeding issues arise.
Children’s offers nearly all babies who graduate from the NICU an opportunity to participate in its neurodevelopmental NICU Follow-Up Clinic. Research shows that babies requiring NICU care are at risk for some degree of developmental delay. The NICU Follow-Up Clinic specializes in identifying neurodevelopmental delay problems early on and provides early intervention therapies to reduce long-term developmental issues.
Whether a newborn has already been admitted or additional evaluation is required, communication with referring physicians is a key component of service at Children’s. Surgeons routinely provide consultation and pediatric cardiologists are on-site to review echocardiograms transmitted from regional hospitals equipped with the technology and training provided by the Children’s team.
To utilize the transport service, talk to a specialist, make a referral, or request an
admission, call the
Physicians’ Priority Line 888.592.7955
Your exclusive link to Children’s services.
• 23 years of experience as a level iii nicU medical director.
• director of ecMo program which treated 120 infants regionally with vv/va bypass.
• More than 30 peer-reviewed articles published.
• senior editor, The Perinatal newsletter, an aaP publication.
• Past editor, neoreviews Plus, an aaP publication.
• served on the national aaP perinatal executive committee, 1992-present.
• fellowship trained in neonatal-perinatal medicine, University of north carolina (Unc) school of Medicine.
• developed body cooling for hie program at Unc.
• special interest in hypoxic ischemic encephalopathy.
• Masters degree in health care administration in progress.
• initiated bubble cPaP initiative to improve chronic lung disease at Unc.
• Participated in research on pain management, caffeine administration, and other policy and practice parameters.
• More than 28 years in medical director positions at washoe Medical center, reno, nevada, rogue valley Medical center (rvMc), Medford, or, and via-christi regional Medical center, wichita, Ks.
• regional instructor, neonatal resuscitation program.
• numerous peer-reviewed articles published in neonatal journals.
• special interests in short term morbidity in the neonatal intensive care nursery, limits of viability issues, nursing education, and regional outreach education.
• chair, UnMc department of Pediatrics.
• 31 years of experience as a neonatologist.
• served 10 years as chairman of Pediatrics in houston, Tx.
• served five years as council chair of the largest neonatal system in Texas.
• More than 80 peer-reviewed articles published.
• expert panel participant for the institute of Medicine.
• founded ecMo program at Memorial herrman children’s hospital, houston. This is the largest program in Texas.
• Master Teacher award from University of Texas (UT), houston.
• board member, ronald Mcdonald foundation.
• Past director, neonatal fellowship Program, UT, houston.
• special interests include nutrition and metabolism, and medical ethics.
bonnie lees, M.d. John sParKs, M.d.lynne willeTT, M.d.neonaTologisT
children’s sPecialTy Physicians clinical service chief, nicU
John grebe, M.d.
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Physician’s PrioriTy hoTline 1.888.592.7955
Surgery to remove a brain tumor from an adult patient requires delicate expertise. But what if the patient is a newborn whose brain is smaller than a baseball – and the tumor is the size of a pea?
If that baby was your patient – or your child – you’d want every technology and medical tool available, and you’d want it in the hands of the most-skilled pediatric neurosurgeon in the region.
All are available at Children’s Hospital & Medical Center.
One of about 150 active members of the American Society of Pediatric Neurosurgeons worldwide, Mark J. Puccioni, M.D., assistant professor of neurosurgery at the UNMC College of Medicine, is the only board-certifi ed pediatric neurosurgeon in Nebraska.
Dr. Puccioni is an expert at performing electromagnetic image-guided neurosurgery on children, including newborns. Dubbed Stealth surgery for the “StealthStation” imaging device fi rst used, the technology was originally employed about 15 years ago for adult spinal surgery patients but only in the past fi ve years has been utilized for pediatric patients, especially very young children.
By combining computer technology with advanced imaging technology and infrared optics, Stealth surgery gives neurosurgeons a three-dimensional view inside a patient’s head and pinpoints the exact position of features within the cranial cavity, including tumors.
Dr. Puccioni says that while there are two forms of image-guided systems for neurosurgery, one involving a frame being attached to the skull through the insertion
of pins and the other a frameless, “pinless” electromagnetic version, only the latter application is a viable tool for very young children, especially those under age 3. “At that age, the skull is so malleable that adult systems don’t work,” he says.
The original method would require the placement of a clamp on the child’s head with pins that could perforate the skull and compress it, changing the skull from the round form it was in during the preoperative MRI to oval. “That would make the 3-D picture distorted,” Dr. Puccioni says. “If the image is off by even a few millimeters, the register conversion is completely inaccurate.”
At Children’s, Dr. Puccioni uses the state-of-the-art AxiEM electromagnetic tracking device developed by Medtronic Navigation. It works by generating an electromagnetic fi eld around
PediaTric neUrosUrgery aided by innovaTive iMaging Tools
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the patient’s head that can be tracked to triangulate the positioning of instruments.
For pediatric patients, the AxiEM device uses a small patient tracker affixed directly to the head, allowing mobility of the patient’s head throughout the procedure while still maintaining registration and navigational accuracy. “I can gently move the head from side to side and subtly manipulate it so that I have the space I need to work,” he says.
The AxiEM system is ideal for patients whose skulls will not withstand traditional head clamps. Also, the AxiEM system does not require line-of-sight infrared optics, which can be disrupted by movement of the operating team.
To begin, Dr. Puccioni uses a hand-held “wand” to trace the face of his patient. The information is put into the computer, which utilizes the thin-sliced study from an MRI to “build” a 3-D model of the patient’s head, including the skin.
“The wand is the instrument that talks to the computer,” he says. “As I trace the child’s face, I am basically painting the image of the head on the screen. It only takes a minute or less.”
Also, unlike the original Stealth system, there is no need to mark the reference points with feducial markers in the form of stickers that can shift – or be pulled off by the child prior
to sedation. “Your face has its own feducials that are far more accurate than any stickers,” Dr. Puccioni says. “There are more points of reference and they are not changeable.”
With an antenna or “tracker” attached to the patient’s head with a tiny eyeglass screw or adhesive, the computer maps the suggested trajectory for the surgery. It also has the ability to “see” structures within the cranium that cannot be seen physically by the surgeon.
“A tumor can distort the natural anatomy,” Dr. Puccioni says. “This system gives me an idea where other features, such as the carotid artery for example, are situated. It helps you know where you can be more judicious with less risk, and where you have to slow down because something lies around the corner that you can’t yet see.”
The imaging does not replace the neurosurgeon’s vision or judgment. “I use the 3-D image to plan, then while operating I use it for reference,” he says. “It’s like having a GPS in your car. The GPS is a tool, but as you’re driving, you’d better be looking at the road.”
Of the approximately 350 pediatric neurosurgeries he performs each year, Dr. Puccioni uses AxiEM imaging 30 to 40 times. “It does add some cost and time, but when the case requires it, it’s an extraordinarily valuable tool.”
Computerized 3-D imaging can help reduce complications, which in turn reduces morbidity and length of hospital stay, he says. “It doesn’t guarantee safety, but it certainly aids in it.”
He says that while few pediatric hospitals use the Stealth system, even fewer use the AxiEM system. “When Children’s purchased it, we were the seventh hospital in the nation,” he says. “Image-guided neurosurgery is becoming a standard of care, but its use with pediatric patients is unfortunately sparse.”
Its availability is good news for referring physicians, and especially for parents shocked and frightened by the words “brain tumor.”
“It’s awful for parents to come into a doctor’s office thinking their child has a headache and leave thinking they may have life-threatening cancer,” Dr. Puccioni says. “Knowing that this kind of technology and the expertise to use it exists here at Children’s can go a long way in providing them the hope they desperately need.”
“A TUMOR CAN DISTORT THE NATURAL ANATOMY. THIS SYSTEM…HELPS YOU KNOW WHERE YOU CAN BE MORE JUDICIOUS WITH LESS RISK, AND WHERE YOU HAvE TO SLOW DOWN BECAUSE SOMETHING LIES AROUND THE CORNER THAT YOU CAN’T YET SEE.”
MarK J. PUccioni, M.d.PediaTric neUrosUrgeon
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Physician’s PrioriTy hoTline 1.888.592.7955
children’s leads efforT To PUT aeds in schools sTaTewide
ProJecT adaM
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“AEDS AREN’T JUST FOR STUDENTS WHO SUFFER SUDDEN CARDIAC ARREST. GRANDPARENTS, FRIENDS AND FAMILY MEMBERS OF ALL AGES ATTEND THESE EvENTS AND ARE JUST AS LIKELY, IN SOME INSTANCES EvEN MORE LIKELY, TO BENEFIT FROM THE PRESENCE OF AN AED AND PEOPLE TRAINED TO USE IT.”
chrisToPher c. ericKson, M.d.cardiologisT, children’s sPecialTy Physicians direcTor of elecTroPhysiology and PacingProfessor, deParTMenT of PediaTrics and inTernal Medicine, UnMc college of Medicine
With little warning, the high school track star slows and then drops to one knee. His face is covered in sweat. His vision is blurred and he seems confused. His heart is beating erratically – and then suddenly, it stops.
The apparently healthy 16-year-old is suffering sudden cardiac arrest. Coaches, family members, friends and other bystanders rush to his side. Someone dials 911 and requests an ambulance. They check his pulse and find none. A coach begins cardiopulmonary resuscitation (CPR).
And they wait.
As each minute passes, the young man’s chances of survival shrink dramatically. And without immediate access to an automated external defibrillator (AED) to shock his heart back to a normal rhythm, this is a race against time he won’t likely finish.
Whether in the middle of a city or in a rural community, readily accessible AEDs can save lives.
In an 18-month period in Nebraska, four children suffered sudden cardiac arrest while at school or school-related events – and all four were resuscitated by people using AEDs, says pediatric cardiologist and electrophysiologist Christopher C. Erickson, M.D.
“There’s no question in our minds that AEDs work,” says Dr. Erickson, “and no question that if not for AEDs, those four kids would have died.”
Dr. Erickson is cardiologist, Children’s Specialty Physicians director of Electrophysiology and Pacing, and professor, Department of Pediatrics and Internal Medicine, UNMC College of Medicine. He also is the director of the Genetic Arrhythmia Clinic, a collaborative service of Children’s and the UNMC Adult Cardiology division.
He says the effort to place AEDs in all schools in Nebraska was sparked by his familiarity of Project ADAM (Automated Defibrillators in Adam’s Memory) through his colleague Stuart Berger, M.D., at the Children’s Hospital of Wisconsin.
Project ADAM began in 1999 after a series of sudden deaths among high school athletes in southeastern Wisconsin. Many of these deaths appeared to be due to ventricular fibrillation, a condition in which the heart’s electrical activity becomes disordered.
After Adam Lemel, a 17-year-old Whitefish Bay, Wis. high school student collapsed and died while playing basketball, his parents, Patty and Joe, along with Adam’s childhood friend, David Ellis, collaborated with Dr. Berger and
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Physician’s PrioriTy hoTline 1.888.592.7955
others at Children’s Hospital of Wisconsin to create the program in Adam’s honor.
The intention is for Children’s to become an affiliate of Project ADAM and raise awareness of the importance of public access defibrillation (PAD) programs. The project also is involved in research and pediatric health advocacy efforts.
Thanks to the efforts of the local chapter of the American Heart Association, the school districts and other private sources, AEDs have been added to all metropolitan Omaha high schools as well as some districts’ middle schools and some elementary schools.
“The concern now is shifting to smaller school districts and rural schools,” Dr. Erickson says.
The issue with rural schools is the availability of emergency medical personnel to respond to incidents of sudden cardiac arrest. Unlike a metropolitan area, where paramedics and other trained emergency personnel are within minutes of most schools, rural areas commonly rely upon volunteers to staff their fire departments and ambulances.
The additional minutes it would take for volunteer responders to reach the scene of a cardiac arrest make it even more essential that AEDs are present at rural schools and housed within a reasonable distance from event venues like gymnasiums and sports fields, Dr. Erickson says.
“AEDs aren’t just for students who suffer sudden cardiac arrest,” he says. “Grandparents, friends
and family members of all ages attend these events and are just as likely, in some instances even more likely, to benefit from the presence of an AED and people trained to use it.”
LuAnn Mill, R.N., B.S.N., is the nurse coordinator for the Genetic Arrhythmia Clinic and plays a key role in Children’s initial efforts to promote Project Adam.
“Several states actually require high school students to know how to use basic life support and to be trained in CPR in order to graduate,” she says. “In Nebraska, it’s considered an elective. We think it should be required here as well.”
Mill says Children’s educational efforts would include:
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➜ Spreading awareness of the value of having AEDs at all high schools,
➜ Determining that there are enough AEDs at larger schools so they can be accessed quickly,
➜ Checking that there is a process in place to maintain the AEDs with non-expired chest patches and fully charged batteries.
➜ verifying that a person or persons are responsible for maintaining the AEDs, and
➜ Ensuring that students and adults at the schools know how to provide basic life support and are trained in using the AEDs.
“Having an AED is ideal,” Mill says, “but it won’t help anyone if it doesn’t work or if no one knows how to use it.”
Proper training will help anyone overcome fears they might have of using the AED improperly, Dr. Erickson says. “There are built-in safety features, for example, to ensure that no shock will be given the patient if none is needed.”
And while shrinking school budgets may be a concern, AEDs are becoming more affordable, Dr. Erickson says. He suggests the purchase would be an ideal project for a booster club or parent organization.
“We can’t pick in advance the day and time an AED will be needed,” he says. “But when it is, it’s an investment that would definitely save a life.”
“THE CONCERN NOW IS SHIFTING TO SMALLER SCHOOL DISTRICTS AND RURAL SCHOOLS.”chrisToPher c. ericKson, M.d.
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Physician’s PrioriTy hoTline 1.888.592.7955
nehii goal is beTTer TreaTMenT ThroUgh shared inforMaTion
nehii
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In January 2009, NeHII focused on testing and exchanging data in preparation for the pilot program, which went live in a production environment the following March. Children’s was one of four Omaha health care organizations participating in the pilot program. A fi fth health care organization joined two months later.
The pilot phase was completed June 30, and in early July 2009 the NeHII Board of Directors determined the initiative was ready to expand statewide. The fi rst hospital to join NeHII after completion of the pilot was Mary Lanning Memorial Hospital in Hastings.
Because of the age of its patients, Children’s has added many unique facets to the data exchange program, says Stephanie Taylor, RHIA, Manager of Health Information Management. “Rather than having the patient agree to be included in the information exchange, we have to incorporate the parents or legal guardians,” she says.
When describing NeHII to parents at Children’s, admissions personnel follow a very detailed script, Taylor says.
“We explain what would happen with their records, and what information would not be accessible,” she says. “Everyone is
automatically opted-in, but it’s made clear that they have the option to opt-out.”
The mission and goals of NeHII explicitly state that a secure exchange of information is essential, with the understanding that information security involves protecting the integrity and confi dentiality of the data, and that access permissions conform to HIPAA guidelines.
Taylor says parents and guardians tend to be younger adults who have a variety of personal records already online, such as banking and bill-paying accounts. They are more likely to understand and accept the security procedures and encryption that are a part of the NeHII system.
“We have less than fi ve percent choose to opt out,” she says.
The initiative’s software vendor, Axolotl, Inc., was selected based on its ability to integrate with third-party Electronic Medical Records (EMRs), as well as to provide EMR functionality for physicians without this technology.
And while the pilot phase went “extremely well,” Worthing says the issues that did surface fostered collaboration among participating health organizations. “There would be a
call from one of the hospitals saying, ‘This aspect isn’t working for us,’ or ‘We’re having a problem with such-and-such,’” she says, “so we’d discuss potential solutions during our conference calls. It was exciting to be part of the statewide process.”
The federal government is offering billions in American Recovery and Reinvestment Act funds to medical facilities and hospitals that implement and demonstrate “meaningful use” of an EMR system. The next steps for NeHII include bringing more health care providers online statewide, as well as a continuing effort on the part of Executive Director Deb Bass and her Omaha fi rm, Bass & Associates, to work with the Offi ce of the National Coordinator in Washington, D.C. to establish the defi nition of “meaningful use” for the government.
While NeHII’s success has not yet been measured, the usage and number of provider participants, including doctors who pay a monthly fee to access and input information, continue to increase, Worthing says.
“Once we have hospitals up across the state,” she says, “it’s going to be pretty impressive.”
More information may be obtained at www.nehii.org.
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Children’s Specialty Physicians provide valuable and unparalleled collaboration bringing together the academic resources and research strengths of the University of Nebraska Medical Center College of Medicine with the clinical and pediatric expertise of Children’s Hospital & Medical Center, the only children’s hospital in Nebraska and the region’s leader in the care and treatment of children.
Incorporated in 2008, Children’s Specialty Physicians grew out of an Institutional Affi liation Agreement between Children’s and the UNMC College of Medicine. The affi liation aligned the two organizations in a way that allows a shared vision for the future of pediatric health care, and ensures children have access to world-class clinical care, treatments infl uenced by cutting-edge research and a future generation of well-educated and highly trained medical professionals.
children’s sPecialTy Physiciansa collaboraTive PediaTric resoUrce for The region
ANESTHESIOLOGY
Diana Doyle, M.D.
Denise Drvol, M.D.
Cynthia Ferris, M.D.
David Hoy, M.D.
Jane Kugler, M.D.
Carol Lydiatt, M.D.
Rachel Spitznagel, M.D.
Marika Stone, M.D.
David (Alan) Tingley, M.D.
Guy Williams, D.O.
Jeffrey Yuskevich, M.D.
ANESTHESIOLOGY–CARDIAC
Kerri George, M.D.
Kim Hanson, M.D.
Kim Hissong, M.D.
Joby Varghese, M.D.
BEHAVIORAL HEALTH
Michelle Cassidy, M.D.
Martin Harrington, M.D.
CARDIOLOGY
David Danford, M.D.
Jeff Delaney, M.D.
Chris Erickson, M.D.
Carl Gumbiner, M.D.
John Kugler, M.D.
Shelby Kutty, M.D.
CARDIOTHORACIC SURGERY
Kim Duncan, M.D.James Hammel, M.D.
CRITICAL CARE
Robert Chaplin, M.D.
Jeff DeMare, M.D.
Kelly Kadlec, M.D.
Andrew Macfadyen, M.D.
Mohan Mysore, M.D.
Luke Noronha, M.D.
Bridget Norton, M.D.
George Reynolds, M.D.
Jayesh Thakker, M.D.
Edward Truemper, M.D.
DEVELOPMENTAL DISORDERS
Cynthia Ellis, M.D.
Howard Needelman, M.D.
EMERGENCY MEDICINE
Thomas Deegan, M.D.
Patrick Doherty, M.D.
Michael Dulac, M.D.
Susan Fellman, M.D.
Alan Fuss, M.D.
Jay Hinkhouse, M.D.
Scott James, M.D.
Duane Jensen, M.D.
Corey Joekel, M.D.
Linda Matson, M.D.
David Tolo, M.D.
Debra Tomek, M.D.
Jayan Vasudevan, M.D.
Emily Vuchetich, M.D.
ENDOCRINOLOGY/DIABETES
Monina Cabrera, M.D.
Kevin Corley, M.D.
Jean-Claude Desmangles, M.D.
GASTROENTEROLOGY
Dean Antonson, M.D.
Ryan Fischer, M.D.
Ruben Quiros, M.D.
Fernando Zapata, M.D.
GENERAL PEDIATRICS
David Finken, M.D.
Susan Hollins, M.D.
Amy LaCroix, M.D.
Sheryl Pitner, M.D.
Tina Scott-Mordhorst, M.D.
Patricia Seivert, M.D.
John Walburn, M.D.
Laura Wilwerding, M.D.
GENETICS
Bruce Buehler, M.D.
Ann Olney, M.D.
HEMATOLOGY/ONCOLOGY
Minnie Abromowitch, M.D.
Jill Beck, M.D.
Peter Coccia, M.D.
Donald Coulter, M.D.
David Gnarra, M.D.
Bruce Gordon, M.D.
James Harper, M.D.
Elizabeth Thompson, M.D.
HOSPITALISTS
Stephen Dolter, M.D.
Heidi Killefer, M.D.
Gary Lerner, M.D.
Lisa Sieczkowski, M.D.
Joseph (Jay) Snow, M.D.
Sheilah Snyder, M.D.
Sharon Stoolman, M.D.
Cassandra Susman, M.D.
Yohanna Vernon, M.D.
INFECTIOUS DISEASE
Shirley Delair, M.D.
Kari Simonsen, M.D.
Jessica Nichols-Snowden, M.D.
INHERITED METABOLIC DISEASES
Richard Lutz, M.D.
William Rizzo, M.D.
NEONATOLOGY/
NEWBORN MEDICINE
Ann Anderson-Berry, M.D.
David Bolam, M.D.
Garth Fletcher, M.D.
John Grebe, M.D.
Bonnie Lees, M.D.
Howard Needelman, M.D.
Richard Olney, M.D.
John Sparks, M.D.
Lynne Willett, M.D.
NEPHROLOGY/KIDNEY DISEASE
Pascale Lane, M.D.
Helen Lovell, M.D.
NEUROLOGY
Paul Larsen, M.D.
Janice McAllister, M.D.
James Nelson, M.D.
Young Oliver, M.D.
Ivan Pavkovic, M.D.
Rhonda Wright, M.D.
ORTHOPAEDICS
Paul Esposito, M.D.
Glen Ginsburg, M.D.
Brian Hasley, M.D.
Susan Scherl, M.D.
PULMONOLOGY
John Colombo, M.D.
Paul Sammut, M.D.
Heather Thomas, M.D.
Mark Wilson, M.D.
RADIOLOGY
Sandra Allbery, M.D.
Anne Marie Hubbard, M.D.
Travis Kruse, M.D.
Bruce Schroeder, M.D.
John Wendel, M.D.
Lisa Wheelock, M.D.
RHEUMATOLOGY
Adam Reinhardt, M.D.
SURGERY
Shahab Abdessalam, M.D.
Kenneth Azarow, M.D.
Robert Cusick, M.D.
Stephen Raynor, M.D.
F A C U L T Y P H Y S I C I A N S O F T H E U N I V E R S I T Y O F N E B R A S K A M E D I C A L C E N T E R C O L L E G E O F M E D I C I N E
p. 19
new
Ph
ysic
ian
sradiologyTravis Kruse, M.D.dr. Kruse received his medical degree from creighton University school of Medicine and completed his residency in diagnostic radiology at creighton University Medical center. he completed his fellowship in pediatric radiology at children’s Memorial hospital in chicago.
heMaTology/oncologyJill BecK, M.D.dr. beck received her medical degree at case western reserve school of Medicine in cleveland, ohio. she completed her pediatrics residency at rainbow babies & children’s hospital, also in cleveland. dr. beck completed her fellowship in pediatric hematology/oncology at the University of Minnesota hospital and clinic in Minneapolis.
hosPiTalisTYohanna vernon, M.D.dr. vernon received her medical degree from the Medical college of wisconsin in Milwaukee. she completed her pediatrics residency at the creighton-nebraska Universities health foundation.
infecTioUs diseaseshirleY Delair, M.D.dr. delair received her medical degree from Universidad ces Medellin institute of health sciences in Medellin, columbia. she completed her pediatrics residency at st. Joseph’s hospital & Medical center in Paterson, nJ. dr. delair completed her pediatrics fellowship in pediatric infectious disease at Ucla Medical center – Mattel children’s hospital in los angeles.
p. 20
neUrologyJaMes nelson, M.D.dr. nelson received his medical degree from the University of illinois college of Medicine in carbondale, ill. he completed pediatrics residencies at the University of Miami – Jackson Memorial hospital and at the University of illinois college of Medicine at Peoria. dr. nelson completed his pediatric neurology fellowship at st. louis University school of Medicine. Prior to joining children’s, dr. nelson was in group practice at Presbyterian Pediatric neurology – PMg in charlotte, nc.
Bonnie lees, M.D.dr. lees received her medical degree at Queens University at Kingston, ontario and her residency at the hospital for sick children in Toronto, ontario. she completed fellowships in neonatology at baylor college of Medicine in houston, Texas, and the hospital for sick children in Toronto.Prior to joining children’s, dr. lees was in group practice at Perinatal intensive care specialists, P.c. in andover, Kan.
lYnne WilleTT, M.D.dr. willett received her medical degree from the University of nebraska Medical center college of Medicine and completed her pediatrics residency at the University of nebraska Medical center, where she also completed her neonatal/perinatal fellowship. dr. willett previously served as medical director of the neonatal intensive care Unit at st. francis Medical center in cape girardeau, Mo.
neonaTologyJohn GreBe, M.D.dr. grebe received his medical degree from the University of nebraska Medical center college of Medicine. he completed his pediatrics residency at shands hospital at University of florida in gainesville. dr. grebe completed his fellowship in neonatal/perinatal medicine at the University of north carolina school of Medicine in chapel hill.
p. 21
Physician’s PrioriTy hoTline 1.888.592.7955
1.888.592.7955Physicians’ PrioriTy line
Carl Gumbiner, M.D., has been named the new senior vice president of Medical Affairs and chief medical officer for Children’s Hospital & Medical Center.
Dr. Gumbiner has spent 27 years at
Children’s as a pediatric cardiologist.
“Dr. Gumbiner’s passion for medicine and dedication to children and families are well known throughout the hospital and amongst his peers on the medical staff,” said Gary A. Perkins, FACHE, president and CEO. “His experience and organizational knowledge are significant benefits as we look to the future.”
“With the Children’s Specialty Pediatric Center opening soon and other program enhancements in development, this is a time of growth and change for Children’s. I am honored to have this opportunity to help determine our course at such a pivotal point,” Dr. Gumbiner said.
Dr. Gumbiner is a graduate of Yale University and earned his medical degree from Northwestern University School of Medicine in Evanston, Ill. He completed his residency in pediatrics at the University of Colorado Medical Center in Denver, and a fellowship in pediatric cardiology at Baylor College of Medicine and Texas Children’s Hospital. In addition to his current clinical schedule, Dr. Gumbiner also holds academic appointments at Creighton University School of Medicine and University of Nebraska Medical Center College of Medicine.
Dr. Gumbiner will continue his outpatient pediatric cardiology practice. His duties as senior vice president and Chief Medical Officer begin Sept. 1.
Shelby Kutty, M.D., a Children’s Specialty Physicians cardiologist who specializes in imaging (Echocardiography and cardiac MRI), won the American
Society of Echocardiography‘s 2010 Arthur E. Weyman Young Investigator’s Award for his research titled “Sonothrombolysis of Intra-Catheter Aged venous Thrombi In-vitro Using Microbubble Enhancement and Guided Three Dimensional Ultrasound Pulses.”
In addition to his role at Children’s, Dr. Kutty is an assistant professor of Pediatrics
at the University of Nebraska Medical Center College of Medicine and a clinical assistant professor at the Creighton University School of Medicine. He will present his award-winning research at the December 2010 European Association of Echocardiography (EUROECHO) meeting in Copenhagen, Denmark and the April 2011 Japanese Society of Echocardiography meeting in Kagoshima, Japan.
Young investigators under the age of 40 who are no more than five years from the end of their training are eligible to participate in the annual competition, supported by the National Board of Echocardiography in honor of the board’s first president, Arthur E. Weyman, M.D., FASE.
children’s cardiologisT wins naTional research award
John D. Wendel, M.D. has been appointed clinical service chief of Radiology, Children’s Specialty Physicians. Prior to joining Children’s in 2009, Dr. Wendel practiced at Utah Radiology Associates in Provo. He received his medical degree from Mayo Medical School in Rochester, Minn., and completed residencies in diagnostic and pediatric radiology at the University of Texas Medical Branch Hospital in Galveston. Dr. Wendel is also assistant professor in the Department of Radiology at the University of Nebraska Medical Center College of Medicine.
wendel aPPoinTed chief of radiology aT children’s
new chief Medical officer annoUnced
Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and newborn transport service.
research award
p. 22
Physicians’ Priority Line (physician-to-physician consult and referral line)1.888.592.7955
Transport (Physicians’ Priority Line) 1.888.592.7955
Hospitalist Service402.955.5400 or 1.888.592.7955
PICU 402.955.4200
NICU 402.955.6230
children’s hosPiTal & Medical cenTer oUTreach clinics
oUTreach clinic schedUle
Clinic Location Rotation Frequency Phone
CARDIOLOGY
Carl Gumbiner, M.D. Norfolk, Neb Monthly 402.955.4350
North Platte, Neb Quarterly 402.955.4350
Kearney, Neb Quarterly 402.955.4350
Lincoln, Neb Semi-Monthly 402.486.1500
David Danford, M.D. Hastings, Neb Monthly 402.955.4350
Grand Island, Neb Quarterly 402.955.4350
Lincoln, Neb Semi-Monthly 402.486.1500
Scott Fletcher, M.D. Columbus, Neb Quarterly 402.955.4350
Sioux City, Iowa Semi-Annually 402.955.4350
Holdrege, Neb Semi-Annually 402.955.4350
Lincoln, Neb Semi-Monthly 402.486.1500
Christopher Erickson, M.D. Lincoln, Neb Semi-Monthly 402.486.1500
Shelby Kutty, M.D. Lincoln, Neb Semi-Monthly 402.486.1500
Jeffrey Delaney, M.D. Lincoln, Neb Semi-Monthly 402.486.1500
John Kugler, M.D. Lincoln, Neb Semi-Monthly 402.486.0500
ENDOCRINOLOGY
Monina Cabrera Sioux City, Iowa Semi-Monthly 402.955.3871
Kevin Corley, M.D. Lincoln, Neb Weekly 402.486.1500
Jean-Claude Des Mangles, M.D. Lincoln, Neb Monthly 402.486.1500
Sioux City, Iowa Semi-monthly 402.955.3871
HEMATOLOGY/ONCOLOGY
David Gnarra, M.D. Lincoln, Neb Weekly 402.486.1500
METABOLIC
Rose Kreickmeier, APRN Lincoln, Neb Monthly 402.486.1500
Clinic Location Rotation Frequency Phone
NEUROLOGY
Young Oliver, M.D. Sioux City, Iowa Monthly 402.955.5372
Ivan Pavkovic, M.D. Lincoln, Neb Weekly 402.486.1500
NEUROSURGERY
Mark Puccioni, M.D. Lincoln, Neb Monthly 402.486.1500
ORTHOPAEDICS
Paul Esposito, M.D. Lincoln, Neb Weekly 402.486.1500
Brian P. Hasley, M.D. Lincoln, Neb Weekly 402.486.1500
RESPIRATORY MEDICINE
Mark Wilson, M.D. Sioux City, Iowa Monthly 402.955.5570
Lincoln, Neb Weekly 402.486.1500
John Colombo, M.D. Lincoln, Neb Weekly 402.486.1500
Paul Sammut, M.D. Lincoln, Neb Weekly 402.486.1500
RHEUMATOLOGY
Adam Reinhardt, M.D. Lincoln, Neb Monthly 402.486.1500
SURGERY
Shahab Abdessalam, M.D. Lincoln, Neb Monthly 402.486.1500
Kenneth Azarow, M.D. Lincoln, Neb Monthly 402.486.1500
Robert Cusick, M.D. Lincoln, Neb Monthly 402.486.1500
Stephen Raynor, M.D. Lincoln, Neb Monthly 402.486.1500
p. 23
ChildrensOmaha.org
1.888.592.7955Physicians’ PrioriTy line
Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and neonatal transport service.
The Physicians’ Priority Line usage has increased by 40 percent during the past 12 months. In a recent survey of referring physicians, the majority of physicians rated their experience with the service as excellent.