doctor’s digest
A MONTHLY NEWSLETTER FOR ST. LOUIS CHILDREN’S HOSPITAL
ATTENDING AND REFERRING MEDICAL STAFFS
[clinical focus]
February 2013
_________________________________________________________
In this issue
2
Schlaggar Honored
for Pediatric Research
3
Energy Drinks in Children
and Adolescents
7
Television Series
Highlighting Children’s
Hospital Debuts March 16
Hearing Loss in 13 Year Old Caused by Cholesteatoma
At age 13, Collin Burk, son of Barb Burk,
a physician liaison for St. Louis Children’s
Hospital (SLCH), continued having ear infections
more commonly seen in younger children. In
addition, Collin began exhibiting signs of hearing
loss—having trouble hearing at school, saying
“what” frequently, and turning up the volume
or sitting close to the television.
“Collin had tubes inserted in his ears when he
was a toddler, but the ear infections continued.
He’s our fourth child, so we were familiar with
ear infections—his just didn’t seem normal
to us,” says Burk. “When it became obvious he
was having hearing loss, we knew it was time
for him to see an otolaryngologist at Children’s.”
Collin was diagnosed with a cholesteatoma
in his left ear, a condition that occurs in
approximately one in 10,000 children. It can
result from a congenital defect, trauma to the
eardrum or, as in Collin’s case, a dysfunction
of the Eustachian tube.
“Most of the time, the Eustachian tube is closed
by soft tissue, but it opens and receives outside
ventilation whenever a person swallows or
yawns,” says Washington University pediatric
otologist Timothy Hullar, MD. “When this
ventilation does not occur, the negative pressure
can pull part of the eardrum into the middle
ear and create a cyst that fills with debris like
old skin cells. Eventually, the cyst begins to
erode surrounding structures, usually the small
bones or ossicles in the middle ear, particularly
the middle bone or incus. In rare cases, the
cholesteatoma also can erode the cochlea,
resulting in significant hearing loss that can’t be
fixed. Other rare complications are brain abscess,
profound imbalance and facial paralysis.”
Treatment for cholesteatomas relies on surgery.
Dr. Hullar describes the procedure by comparing
it to surgery performed
for other tumors such
as skin cancer.
“For melanoma,
surgeons resect
a margin of tissue
around the growth
to ensure all of it is
removed,” he explains.
“That’s not possible
with a cholesteatoma
Timothy Hullar, MD
since removing
surrounding tissue and structures means patients
would unavoidably lose their hearing and balance
and experience facial paralysis.”
For that reason, otolaryngologists must
underestimate the amount of tissue to remove.
The first step is to make an incision behind the
ear to better visualize the cholesteatoma.
“In Collin’s case, his cholesteatoma had extended
into the nooks and crannies of the middle ear,
which meant removing a lot of the bone along
with the tumor,” says Dr. Hullar. “It is then
standard procedure to perform a second surgery
to remove whatever remains of the cholesteatoma
and repair the ossicles in order to restore as much
hearing as possible. In most cases, artificial bones
made of titanium can be used to bridge the gap
left by the missing bone.”
Collin recovered quickly from both the initial
and follow-up surgery, spending one night in
the hospital and then a few days at home before
returning to school. Restrictions for the first week
were to avoid causing pressure changes in the
middle ear, meaning he couldn’t blow his nose,
lift heavy objects or sneeze with a closed mouth.
Once healed, however, Collin returned to his
normal school activities and sports.
The delicate nature of the middle ear structure
continued on next page
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[1]
Share Your Ideas
Should you have ideas or
suggestions you would like
brought before the Children’s
Medical Executive Committee
(CMEC), contact one of your
CMEC private physician
representatives:
Joseph K. Goldenberg, MD
314.576.1616
David Hartenbach, MD
314.567.7337
Catherine Remus, MD
314.842.5239
Christina M. Ruby-Ziegler, MD
314.535.7855
Robert Strashun, MD
314.991.1217
_________________________________________________________
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Digest, or if you would like
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contact:
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St. Louis, MO 63108
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fax: 314.747.8644
[email protected]
_________________________________________________________
Doctor’s Digest
Published for the attending
and referring medical staffs of
St. Louis Children’s Hospital.
Lee F. Fetter
President
Perry L. Schoenecker, MD
Medical Staff President
Joseph K. Goldenberg, MD
Medical Staff
President-Elect
[2]
[Faculty update]
Schlaggar Honored for Pediatric Research
Bradley L. Schlaggar, MD, PhD, has been awarded
the E. Mead Johnson Award for Pediatric Research.
Dr. Schlaggar is the A. Ernest and Jane G. Stein
Professor of Neurology at Washington University
School of Medicine (WUSM) and pediatric
neurologist at St. Louis Children’s Hospital (SLCH).
The award, among the most prestigious
in pediatric research, is given by the Society
for Pediatric Research for outstanding research
achievements in pediatrics. Dr. Schlaggar is being
honored for his contributions to basic and
translational research using brain imaging, such
as functional MRI, to understand the development
of human cognition.
“Dr. Schlaggar has made tremendous contributions
to the study of developmental cognitive
neuroscience,” says Alan L. Schwartz, MD,PhD,
chairman of the university’s Department
of Pediatrics. “We are pleased his outstanding
efforts are being recognized with such an
esteemed award.”
and executive control.
Dr. Schlaggar has
investigated these
issues in healthy
children and those
whose cognitive skills
are delayed by strokes
or illness, including
Tourette Syndrome.
Further, he and his
Bradley L. Schlaggar, MD, PhD
colleagues have used
advanced computational tools with functional MRI
data to make predictions about individual children,
including the functional maturity of a child’s brain
or whether he or she has a particular neurologic
diagnosis. The abilityto use information in a brain
scan to say something specific about an individual
is critically important for using functional MRI
as a clinical tool.
Dr. Schlaggar will receive the award in May at
the Pediatric Academic Societies annual meeting
in Washington.
Dr. Schwartz and Larry J. Shapiro, MD, executive
vice chancellor for medical affairs and dean
of the School of Medicine, nominated Dr. Schlaggar
for the honor. Drs. Schwartz and Shapiro are both
previous winners of the E. Mead Johnson Award.
Dr. Schlaggar came to WUSM in 1986 for the
MD/PhD program. He remained at the university
for a pediatric neurology residency and fellowship,
and joined the faculty in 1999.
Dr. Schlaggar’s research has advanced
the understanding of cognitive development
in children. He has created and implemented
cutting-edge functional neuroimaging methods
to investigate basic mechanisms in the
development of language, reading, attention
Dr. Schlaggar is also director of the Pediatric
Neurology Residency Training Program at the
School of Medicine and SLCH, director of the
university’s Pediatric Movement Disorder Program
and associate director of the Division of Pediatric
and Developmental Neurology.
Hearing loss continued from page 1
means even with reconstruction totally restored
hearing usually is not possible following the
removal of a cholesteatoma. The goal is to restore
as much hearing as possible; in Collin’s case, more
than 50 percent of his hearing loss was restored,
and that percentage continues to improve over
time.
“Following Collin’s diagnosis, he began using a
temporary hearing aid, which he no longer needs,”
says Burk. “His greatest concern was being able to
converse with his peers and be fully involved in
high school. The surgery helped him with that.”
Collin soon will undergo surgery for a
cholesteatoma in his right ear. It is likely he will
continue seeing an otolaryngologist for the rest
of his life.
Children’s Direct Line 800.678.4357 • StLouisChildrens.org
“Patients with ear disease need to be monitored
continuously because even when the middle ear
is well repaired, it needs to breathe. If any
problem with this occurs, there’s the possibility
of another cholesteatoma developing. And in
some cases, a part of the original cholesteatoma
may be well hidden and begin growing again,”
says Dr. Hullar. “Since these growths are
sometimes difficult to diagnose, we recommend
that children with repeated ear infections, ear
drainage or a perforation be referred to an
otolaryngologist specializing in pediatric ear
diseases for evaluation.”
To speak with Dr. Hullar or a member of the
otolaryngology team, contact Children’s Direct
at 800.678.4357.
[SLCH News]
Otolaryngology Team Expands, Improving Access to Care
In October, David Leonard, MBBCh, and Maithilee Menezes, MD,
joined the Department of Otolaryngology at Washington University
School of Medicine and St. Louis Children’s Hospital medical
staff. According to Keiko Hirose, MD, division chief of pediatric
otolaryngology, these two new pediatric specialists are a tremendous
addition to the team.
“We now are a group of five pediatric otolaryngologists and one
pediatric nurse practitioner who focus exclusively on ear, nose
and throat conditions in children, in addition to two general
otolaryngologists and two otologists who see children and adults,”
says Dr. Hirose. “Increasing our number of dedicated pediatric
otolaryngologists allows us to provide improved access to
appointments. We see common conditions including ear infections,
speech and language concerns, hearing loss and noisy breathing.
We also provide care for medically complex children who have more
challenging needs, including children with the cleft and craniofacial
team, the cochlear implant team or the multidisciplinary airway
service.”
She adds, “The recruitment of two new pediatric otolaryngologists
means we can meet the needs of our patients in a more timely
manner—within 24 hours of a referral.”
“I missed the environment where I was constantly challenged
to learn more, both by my colleagues and my patients,” says
Dr. Menezes. “Every time I saw a child in the office, he or she was
the highlight of my day. I consider pediatric patients my natural
‘pick-me-up’—they make me smile, and I feel fortunate to be the
one to care for them.”
Dr. Menezes’ clinical and research interests are vascular
malformations of the head and neck, and cleft and craniofacial
anomalies. She also is part of the multidisciplinary Cleft Palate
and Craniofacial Clinic, which includes members of pediatric plastic
surgery, speech therapy, dentistry/orthodontics and audiology.
“My research during residency and fellowship involved a multicenter
trial for treatment of lymphatic malformations, both in Iowa and
in California,” she says. “I am looking forward to participating
in the vascular anomalies clinic here at St. Louis Children’s Hospital
and finding more effective treatments for our patients.”
David Leonard, MD
Dr. David Leonard, assistant professor of
otolaryngology at Washington University
School of Medicine, received his medical
degree from the National University of
Ireland, University College Dublin School of
Medicine. He completed his residency
in Otolaryngology-Head and Neck Surgery
at the Higher Surgical Training Scheme,
Dublin, and a pediatric otolaryngology
fellowship at Boston Children’s Hospital,
David Leonard, MBBCh
affiliated with Harvard Medical School. He
also holds a Masters of Science in Health Policy and Management
from the Harvard School of Public Health. Prior to joining Children’s
Hospital, he served as senior registrar in Otolaryngology-Head
and Neck Surgery at the Irish Higher Surgical Training Scheme.
Maithilee Menezes, MD
Dr. Menezes, assistant professor of
otolaryngology at Washington University
School of Medicine, received her medical
degree and completed her residency at the
University of Iowa. Her training included
a seven-year surgeon-scientist program,
that included five years of surgical training
and two years of NIH-sponsored research
in the genetics of hearing loss.
Dr. Menezes initially pursued a position
in private practice as a general
otolaryngologist in Washington D.C. before deciding to return
for further training in pediatrics. She then completed a pediatric
otolaryngology fellowship at Rady Children’s Hospital, San Diego.
Maithilee Menezes, MD
Dr. Menezes entered medical school with the goal of becoming
a pediatric neurosurgeon like her father. However, when she began
her rotation in otolaryngology as a fourth-year medical student, she
recognized her true calling.
“Otolaryngology encompassed the region of the human body that
I found the most interesting: the anatomy of the head and neck.
Otolaryngology also has the advantage of providing a wide variety
of patients and illnesses, from those who were healthy to those who
were gravely ill,” she says. “Also, as a medical student in otolaryngology,
I found something fascinating to learn every day, so it was an easy
decision to go into our field.”
While she was in private practice for two years after residency,
Dr. Menezes realized that academic medicine was where her heart
was and that pediatric otolaryngology was her passion. She was
accepted to a pediatric fellowship in San Diego where she completed
additional training.
Although Dr. Leonard worked in a bank and law offices, he settled
on medicine because of the immediate positive impact on people’s
lives. He liked the head and neck component of ENT, which guided
his choice of otolaryngology, but it was a six-month resident rotation
at Boston Children’s Hospital that convinced him to go into pediatrics.
“When you are working with children in the medical field, the
patient is innocent and a victim of circumstance. Their innocence
and their needs inspired me to be a pediatric specialist,” says
Dr. Leonard. “Kids are a joy to work with. Once they begin
feeling better, you know it; they are honest about their emotions.
In pediatrics, by making a positive impact on a child’s health,
we generate potential for them for the rest of their lives. It is so
rewarding for us as his or her doctors see them thrive.”
continued on page 6
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[3]
[SLCH news]
Hospitalist PNPs Provide Continuity, Serve as Knowledgeable Resources
The hospitalist pediatric nurse practitioner (PNP) program
at St. Louis Children’s Hospital began in 2010 as a one-year pilot
on 8E. The goal was to develop a model that would address gaps
in patient care resulting from new standards governing resident duty
hours established by the Accreditation Council for Graduate Medical
Education. Those standards prohibit residents from working more
than 80 hours a week and no more than 30 hours consecutively.
The pilot’s success resulted in an expansion of the program in 2011
to add coverage to 8W and 12 as well.
“Our aim was to fill the gaps left by the residents’ reduced hours
with hospitalist pediatric nurse practitioners whose special training
would ensure patients continued receiving the same high level
of quality care expected from Children’s Hospital,” says Peggy
Gordin, RN, MS, NEA-BC, FAAN, Children’s Hospital vice president
of patient care services. “What has developed is a collaborative
relationship between the hospitalist PNPs and the residents, faculty
and subspecialty fellows. The PNPs have proved to be a source
of continuity on the floors. They’ve also provided rotating residents
with another resource for a variety of information, from navigating our
information systems to whom to contact for particular patient needs.”
A hallmark of hospitalist PNPs is that they enjoy working in the
acute care setting and have the training needed to succeed in that
environment.
“Most of our PNPs began as staff nurses at Children’s who wanted
to further their training by completing master’s degrees and in some
cases doctorates,” says Gordin. “As hospitalist PNPs, they receive
additional on-the-job training that ensures they are thoroughly
familiar with the types of orders needed by patients in an acute
setting.”
According to Cheryl Grave, PNP, manager, hospitalist pediatric
nurse practitioner, a strength of the program is that as patients
are admitted, they are assigned to the resident or hospitalist PNP
next in line, rather than admissions assigned based on diagnosis.
“This means we may be assigned a subspecialty patient with sickle
cell disease or a general peds patient with asthma,” she explains.
“The variety of patients we treat contributes to the breadth of our
knowledge and our flexibility. This also has helped solidify the team
dynamic because we are working with attendings and fellows from
a number of subspecialties.”
As the hospitalist PNP program enters its second full year of
operation, Gordin believes acceptance and confidence in the role
will continue to grow.
“The experience our hospitalist PNPs have gained from working with
these patient populations on a daily basis adds a consistency of care,”
Gordin says. “They provide another dimension of knowledge to
complement an outstanding team of caregivers.”
SLCH Clinical Laboratories
Launch New Website
[LAB News]
A new St. Louis Children’s Hospital’s (SLCH) clinical laboratory
website makes accessing laboratory testing information easier
for physicians. The new website—http://SLCHLabtestguide.bjc.org
—includes a search engine, links to useful information such
as the Weekly Virus/Mircobiology Updates, educational guides
and additional lab-related information.
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Your Input
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find of value, please complete a short
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Access the survey via a link at
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[4]
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[ADOLESCENT UPDATE]
Energy Drinks in Children and Adolescents
By Chung A. Lee, MD, PhD; edited by Katie Plax, MD,
director, division of diagnostic and adolescent medicine.
The Adolescent Center is an outpatient clinic developed
to assist health care providers in the prompt assessment
and care of patients 12-21 through consultations, evaluation,
treatment and education. The center may be reached
at 314.454.2468.
Energy drinks have become one of the fastest-growing items
in the U.S. beverage industry. Americans spent $5.4 billion on energy
drinks in 2006, and its market presence has nearly doubled since
then. Not surprisingly, approximately half of the market consists of
those under age 25, with a significant portion of the demographic
comprised of children and adolescents. Unlike soft drinks, with
caffeine content limited to 71 mg of caffeine per 12 fluid ounces
of soda by the Food and Drug Administration (FDA), energy drinks
are classified as “dietary supplements” and are not stringently
regulated. As such, energy drinks often contain far higher amounts
of caffeine (up to five times greater than average soft drinks), as well
as a multitude of additives marketed to increase energy or burn fat.
Caffeine affects numerous molecular pathways, acting as
an adenosine and benzodiazepine receptor antagonist,
phosphodiesterase inhibitor and central nervous system (CNS)
stimulant. Physiologically, this translates into coronary and cerebral
vasoconstriction, smooth muscle relaxation, as well as cardiac
chronotropy and inotropy. Caffeine also acts as a mild diuretic,
although intake of <500 mg/day should not cause dehydration.
Though few studies have investigated safe levels of caffeine
in children, toxicity in adults begins at 1 gram. A lethal dose
is considered to be 200-400 mg/kg.
Energy drinks commonly contain additional ingredients that
purportedly increase one’s energy and/or metabolism. Guarana
is a South American plant commonly boasted in energy drinks.
It contains significant quantities of caffeine (1 gram of guarana
can contain 40-80 mg of caffeine), theobromine (a chronotrope)
and theophylline (an inotrope), and its physiologic effects reflect
this. Taurine is another common additive to energy drinks and
is an organic acid derived from cysteine. Its role in the body is
widespread, including cardiovascular function, development
of skeletal muscle, the retina and the CNS. Studies have shown
a cardiac inotropic effect in adults, with one study abandoned
secondary to patients becoming dizzy. L-carnitine is synthesized
from lysine and methionine involved in the oxidation of fatty acids.
At high doses it has been shown to cause nausea, vomiting, diarrhea
and abdominal pain, as well as seizures. Yohimbine is an alkaloid
extracted from the bark of the West African evergreen pausinystalia
yohimbe. Marketed to increase energy and metabolism and purported
to be an aphrodisiac, it can cause hypertension, tachycardia, seizures
and even death at high doses.
Only since 2010 has the United States specifically tracked adverse
effects of energy drinks. One recent case report describes a 17-yearold male who ingested 3L of energy drink mixed with 1L of vodka.
This equated to 4,600 mg of taurine, 780 mg of caffeine and 380
grams of alcohol. He presented in acute renal failure and spent
a total of 10 days hospitalized before being discharged. Several
other countries, including Germany, Ireland and New Zealand, have
documented outcomes attributed to the consumption of energy
drinks, including liver and kidney damage, respiratory disorders,
agitation, seizures, rhabdomyolysis, tachycardia, hypertension, heart
failure, arrhythmias and even death. Because of these potentially
severe outcomes, many countries have elected to ban some or all
energy drinks (e.g., Australia, Denmark, Germany, Turkey), while
others have instituted restrictions on their sale based on age
or caffeine content.
A review published in 2011 by the American Academy of Pediatrics
concluded that energy drinks have “no therapeutic benefit, and both
the known and unknown pharmacology of various ingredients,
combined with reports of toxicity, suggest that these drinks may
put some children at risk for serious adverse health effects.” As
pediatricians, our role is to be mindful that use of energy drinks is
rising and potentially dangerous for those children with pre-existing
cardiac or renal conditions. Further research is required to elucidate
the long-term effects of energy drink consumption.
References
1.Seifert, S.M. et al. Health Effects of Energy Drinks on Children,
Adolescents and Young Adults. Pediatrics. 2011; 127(3):511-528.
2.Committee on Nutrition and the Council on Sports Medicine
and Fitness. Sports Drinks and Energy Drinks for Children
and Adolescents: Are They Appropriate? Pediatrics. 2011;
127(6): 1182-1189.
3.Schoffl, I. et al. “Vodka Energy”: Too Much for the Adolescent
Nephron? Pediatrics. 2011; 128(1): e227-231.
Chief Resident Award
Each month, St. Louis Children’s Hospital’s
chief residents honor a resident who shows
exceptional dedication to his or her patients,
colleagues or profession. In January, the
SLCH Chief Resident Award was presented
to Jen Horst, MD, a third-year pediatric
resident. Dr. Horst was recognized for her
exemplary leadership of a multi-disciplinary
medical team during an incredibly busy
Jen Horst, MD
month. Dr. Horst will continue on at SLCH
next year as a pediatric emergency medicine fellow.
The February Chief Resident Award was
presented to Erin Casey, MD, a first-year
pediatric neurology resident. Dr. Casey
was recognized for exemplifying what
it means to “take ownership” of her patients
and for providing superior patient care.
Erin Casey, MD
Children’s Direct Line 800.678.4357 • StLouisChildrens.org
[5]
[Quality/safety news]
Joint Commission Survey Garners Praise for Hospital, Staff
One of St. Louis Children’s Hospital’s strategic objectives is being perpetually
ready for regulatory visits. In preparation for Joint Commission, a mock
survey was conducted, and consultants from Joint Commission Resources
met with physician groups to help them revamp the focused professional
practice evaluation (FPPE) and ongoing professional practice evaluation
(OPPE) process. A Joint Commission Fair was held in the cafeteria, with
representatives from areas like pharmacy, safety, public safety, hand hygiene
and interpretive services for demonstrations and to answer employees’
questions. The Children’s Medical Executive Committee was briefed on what
to expect when the Joint Commission representatives arrived.
On October 15—two days before the three-year deadline date—the Joint
Commission survey team consisting of a physician, nurse and life safety code
specialist arrived. For five days, they conducted patient tracers, reviewed
physician credentialing, interviewed staff members and inspected the hospital
for potential safety problems. Overall, they were impressed with the hospital
and the care provided, and they felt the staff was dedicated and knowledgeable.
“They commented that for the size of our facility, in which we care for so
many patients with complex medical conditions, the 12 citations we received
was truly a small number,” says Peggy Connelly, MA, RD, SLCH quality risk
specialist. “They were especially complimentary of our Managing for Daily
Improvement initiative, which is structured to identify and monitor unit
issues on a daily basis.” (See sidebar.)
The survey team also gave its approval to the physician FPPE and OPPE
process, that was just getting under way when the Joint Commission visited
in 2009.
“The medical staff office now has someone dedicated to helping physicians
select quality indicators to gauge their performance in such areas as patient
care and recordkeeping,” says Connelly. “We now need to set up a similar
system for our physician assistants and certified registered nurse anesthetists.”
The hospital has submitted its action plans for all of the citations, some
of which need to be monitored for four months. The results are then submitted
to the Joint Commission, which has set a goal of the hospital achieving at least
90 percent compliance.
“No follow-up visits are required, so our goal over the next three years will
be to continuously work on complying with Joint Commission requirements,
which will help us maintain the highest level of patient care possible,”
says Connelly.
Otolaryngology Team continued from page 3
Dr. Leonard’s professional interest is in pediatric airway abnormalities,
including narrowing of the airway at birth, acquired problems
of the voice box and trachea, and infants with breathing difficulties
resulting from long-term intubation. He looks forward to
investigating research opportunities in airway development.
Dr. Leonard also is interested in global issues in public policy
in health care.
A native of Ireland, Dr. Leonard has spent half of his life in his
homeland and half in the United States. He and his wife, Aisling,
an interior designer, are parents of three-year-old twin girls who
[6]
SLCH Strengthens a Culture
of Improvement Through MDI
Popularized by the manufacturing industry, Managing
for Daily Improvement (MDI) is a daily measurement/
problem solving mechanism largely driven by frontline staff members. The objective is to give all levels
of the organization the ability to work cooperatively
to eliminate the root causes of barriers that may inhibit
St. Louis Children’s Hospital (SLCH) from achieving
its goal of providing a Superior Patient Experience
to every patient, every family, every day.
SLCH’s MDI initiative was introduced in summer 2012.
To date, it has been rolled out to all patient care areas,
pharmacy and laboratory. It is structured to involve
front-line staff in identifying issues needing
improvement.
To achieve these goals, “gemba” walks are conducted
throughout the hospital from 10:15 a.m. to 11:15 a.m.,
two to three times a week. In business, “gemba”
is a Japanese term that refers to “where the work
is done.” At SLCH, that’s at the bedside, in patient
care units, and in the departments supporting patient
care in the hospital. SLCH executives, directors
and managers participate in these daily walks,
interacting with front-line staff members to identify
areas of possible improvement and ways to achieve
solutions. Many times issues identified in one area
are present in others, which means solutions can
be shared throughout the hospital.
“During their visit, the Joint Commission survey
team was quite impressed with our gemba walks
and the breadth of participation and commitment
they saw,” says Peggy Connelly, MA, RD, SLCH quality
risk specialist. “It was an effective demonstration
to them of our dedication to continually improving
our patients’ experience.”
began life in the newborn intensive care unit (NICU) at Boston’s
Brigham and Women’s Hospital as premature infants. Their eightweek stay in the NICU is partly responsible for Dr. Leonard’s interest
in pediatric airway.
“Our girls are perfectly healthy now, but the experience of being
a NICU parent gave me insight into the emotions of my own patients
and their families,” he says. “I feel privileged to share that experience
in an environment like Children’s, where there is always
a willingness—a ‘can-do attitude’—with regard to providing the
best care possible for patients.”
To speak with a member of the otolaryngology team or to refer
a patient, contact Children’s Direct at 800.678.4357.
Children’s Direct Line 800.678.4357 • StLouisChildrens.org
[SLCH news]
Television Series Highlighting Children’s Hospital Debuts March 16
“The Frontline for Hope” features patients, families and hospital staff
A documentary-style series highlighting the patients of St. Louis
Children’s Hospital will debut March 16 on NewsChannel 5
in St. Louis, Missouri.
“The Frontline for Hope,” will run in six
half-hour weekly episodes Saturdays
at 6:30 p.m., starting March 16th. The
series follows several patients, families
and hospital staff throughout their personal
hospital journeys. The entire series was shot
and produced locally as a co-production
between St. Louis-based Coolfire Media and Coolfire Originals,
which currently has six shows in production on television networks,
including Oprah’s OWN, the Discovery Channel and NickMom.
Coolfire’s team set up an office at the hospital in July 2012, that
became their on-site production hub while they documented
the stories of nearly two dozen patients from as close as St. Louis
city and St. Charles county, and as far away as Dublin, Ireland.
Camera crews observed what really happens when a child
is transported to the ER after a critical injury; they spent months
at bedsides learning how families cope with profound illness,
and how bravely children fight through those illnesses; they spoke
candidly with physicians and staff about their personal triumphs
and losses.
“Unless you have a sick child and experience it firsthand, it can be
difficult to comprehend the situations or extent of what occurs here
every day,” says Steve Kutheis, director of marketing at St. Louis
Children’s Hospital. “We wanted something that gave a true-to-life,
in-depth and very personal view of our staff and Washington
University physicians, and how they help
patients and families. But it was important
that it be an authentic portrayal of life at the
hospital. We didn’t want anything scripted.”
While it captures real life moments for
dozens of families and staff over the course
of eight months at St. Louis Children’s
Hospital, producers prefer to use the term
“docu-series” over “reality show.”
“The best programs or series have a setting where the stories walk
through the door each day. In this case they walk in, fly in by
helicopter, are transported by ambulance and more. The families
and staff are amazing and courageous every step of the way.
We are privileged to tell their stories,” says Tim Breitbach, vice
president, story & series development, Coolfire Originals.
Further collaboration between the hospital and the Coolfire
companies led to the group’s decision to bring Joe Buck on
as an Executive Producer. Buck has a long-standing relationship
with both the hospital and Coolfire. He will also narrate the series.
Information about the docu-series, physician profiles, featured
families and complete episodes—posted the day after airing
on NewsChannel 5—can be found at ChildrensforHope.com
beginning March 1.
Plastic Surgery Expands
to West County
[SLCH news]
Kamlesh Patel, MD, Washington University pediatric plastic
surgeon at St. Louis Children’s Hospital, now has weekly
office hours at Barnes-Jewish West County Hospital on Friday
afternoons. Patients requiring initial plastic surgery consults
and follow-up care are seen at Medical Office Building 3,
Suite 110.
Additionally, Dr. Patel and Washington University pediatric
plastic surgeons Albert Woo, MD, and Alison Snyder-Warwick,
MD, perform surgery at Barnes-Jewish West County Hospital
the third Friday of each month on a rotating schedule.
NEW PHYSICIANS
Maggie S. McCormick, MD
Instructor in Clinical Pediatrics
Specialty: Pediatrics
Children’s Clinic, Inc.
Education/Training:
• Residency in pediatrics, University
of Massachusetts School of Medicine,
Worcester, MA
• Medical degree, University
of Massachusetts School of Medicine,
Worcester, MA
Call Children’s Direct at 800.678.4357 to schedule an
appointment.
Children’s Direct Line 800.678.4357 • StLouisChildrens.org
[7]
Non-profit
Organization
U.S. Postage
PAID
St. Louis, MO
Permit No. 617
One Children’s Place
St. Louis, MO 63110
Marketing and Communications
314.286.0324
Fax: 314.747.8644
In this issue
___________________________________________________________________________________________________________
1 Hearing Loss in 13 Year Old Caused
by Cholesteatoma
3
Otolaryngology Team Expands, Improving
Access To Care
6 Joint Commission Survey Garners Praise
for Hospital, Staff
[kiddos News]
First Phase of Electronic Documentation Under Way at SLCH
St. Louis Children’s Hospital has implemented the first phase
of an electronic documentation project that eventually will eliminate
the need for paper patient charts. From January 29 to February 11
a pilot was conducted on 8 West of the KiDDOS electronic history
and physical exam (H&P) documentation form. During that time,
the KiDDOS team monitored, assessed and optimized the note to
support clinician workflow. With the pilot complete, the H&P form
is now available for use by all house staff and advance practice nurses
on units throughout the hospital, except in the ICUs.
“This is the first step in achieving the hospital’s goal of totally electronic
patient charts,” says Feliciano Yu, Jr., MD, SLCH chief medical
information officer and medical director, Washington University
Pediatric Computing Facility. “Electronic charts are the most effective,
efficient means of ensuring a structured approach to recording patient
information. The standardized forms are designed to prompt users
to gather specific information, which means guaranteeing accurate
and complete charts for every hospitalized patient.”
Throughout the next 12 months, additional electronic documentation
forms will be introduced, including those for progress notes, divisionspecific consultation notes, discharge summaries and brief operative
notes. As each is introduced, written notes for that category will no
longer be available, but instead will be available only through KiDDOS.
[8]
“This effort is bringing us in line with regulatory requirements set forth
by agencies such as the Joint Commission, as well as helping us meet
the guidelines of the Medicaid Electronic Health Records Incentive
Program,” says Dr. Yu. “It also will provide us with significant quality
improvement opportunities because of our ability to easily capture
measurement data vital to measuring outcomes and performance.”
The electronic documentation forms are being developed by the
KiDDOS Provider Documentation Project Team, which includes
physician champions representing each hospital division. Within that
team, two groups are working on specific aspects of the electronic
forms: one to research the impact of online notes to existing physician
workflow, and another to develop templates that ensure the notes
are effective in gathering the information needed by various users.
Training in the use of the H&P documentation form is available
as follows:
• One-to-one training sessions may be arranged with KiDDOS
representatives. E-mail [email protected] or call Lisa Fraser,
314.454.2083, to coordinate a session.
• Shortened, pre-recorded versions of web training sessions are
available for review and may be accessed at www.slchemr.org/
For more information about these changes contact the KiDDOS Team
at [email protected].
Children’s Direct Line 800.678.4357 • StLouisChildrens.org SLC14757 2/13