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5 CFO-Friendly Pediatric Care Strategies

Joe Cantlupe, for HealthLeaders Media, December 15, 2010
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"This is an approach that relies on synergies among a team of colleagues from diverse disciplines," Newman says. "By bringing teams together and giving them the resources and support they need to tackle big problems in creative ways, we can intentionally accelerate discovery and get new treatment."
With the collaboration, the anticipated benefit is to patients and their families, specifically with the focus on reduction of pain. "We're not only advancing the science of pain management and treatment, we're working on bioengineering, immunology, and molecular and cellular research that will reduce the need for invasive procedures and in some cases pre-empt the need for cutting surgery," Newman says. "That will be a great leap forward in the comfort and well-being of all patients."

The hospital has worked to overcome procedural flaws in communication that often hamper healthcare in surgical settings, particularly for pediatrics, according to Nabile Safdar, MD, principal investigator for the bioengineering initiative at the institute.

The hospital institute, which is just more than a year old, is still collecting and evaluating its data, but anticipates greater patient outcomes, Safdar says.

"IT adoption in hospitals and operating rooms has been slow because you need trained, devoted teams working on problems, and that requires IT specialists and engineers on site to work side by side with surgeons to devise solutions to IT challenges," Safdar says.

With the team approach, patient care is enhanced, because surgeons would use the best imaging tools possible to better assess patients presurgery and navigate their bodies more accurately during procedures. The approach is "quickly translated to the actual bedside," he says, "because we have engineers and physicians working closely---bringing solutions to the bedside much quicker than we would otherwise."

Newman says the hospital plan is an "unprecedented arrangement" in which surgeons, anesthesiologists, and radiologists are working side by side with bioengineers in an institute concentrating on important clinical issues."

The hospital design plan makes it easier for such collaboration. "Our engineers' workspace is just one floor removed from the institute's lead researchers, so they'll be close to the medical research space and the operating rooms," Safdar says.

"You see this approach in industry and business, and you see some aspects of this approach in various academic medical centers, but pulling together so many disciplines into one institution is highly unusual in academic medicine," Newman says.

"You'll see more hospitals and institutions adopt our integrated team model and approach toward innovation," he adds.

Success Key No. 4: Coordinated care between children, adults
The director of Children's Hospital Los Angeles trauma center is leading an effort to establish a national program to improve research and standardize trauma care and pediatric surgery, which has lacked uniformity, often depending on size of the hospitals.

Child injury is one of the top public health problems, and should be addressed through a coordinated effort, says Jeffrey S. Upperman, MD, director of the trauma and pediatric resources and training center at Children's Hospital Los Angeles.

While there are a select group of trauma centers nationwide, hospitals are inconsistent in providing care to pediatric patients, especially involving surgery, Upperman says. "It's a problem and there are gaps that exist in care," he says.

While trauma centers compile and share data on pediatric surgery, for instance, there is insufficient data in community hospitals without trauma facilities, Upperman says.  Studies have shown that children treated at trauma centers have better outcomes, he adds.

"We know that children who go to trauma centers do better," Upperman says. "We have a lot of adult facilities taking care of children, and there is a disparity in outcomes when [children] are treated at adult facilities."

Upperman and his trauma center colleagues nationwide have issued a call to action to advance a national program for pediatric care, to examine "why children's hospitals are doing a better job in trauma [than are the rest], looking at systems of care. Research needs to be done that we desperately need. There is a serious and significant health problem."

For years, he said, there have been discrepancies in the manner in which children's hospitals and adult hospitals have handled care, such as for accidents. He noted that crashes that led to abdominal injuries led to too many spleens being removed from children, when possibly they shouldn't have been. There are a "whole host of things out there that demonstrate this gap in care," he says.

A pediatric emergency department may see 50,000 to 70,000 pediatric patients a year, with only 10% being injured. Because the number is relatively small, Upperman says, there lacks a research network to focus on severe pediatric injury.

Upperman is the lead author of a report for the Journal of Pediatric Surgery that notes the Institute of Medicine has identified critical deficiencies in pediatric trauma care, and insufficient research to address the deficiencies. Despite the problems, a comprehensive national pediatric trauma research agenda is lacking in this country, and there is no infrastructure to support such a network, Upperman says.
Upperman and others in the pediatric trauma community have recommended a national pediatric trauma research network to consider the possibilities because current efforts, they say, are "neither focused nor comprehensive."


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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