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2019 U.S. News & World Report's Best Children's Hospital

Ranked in all 10 specialties

Cancer

At-A-Glance Chemo Care Dashboard

Alexandra Walsh, MD, and the team at Phoenix Children's Center for Cancer and Blood Disorders have launched a new, one-of-a-kind color-coded approach to managing chemotherapy-induced nausea and vomiting. Developed by Phoenix Children's Chief Medical Information Officer, Vinay Vaidya, MD, our Chemotherapy Induced Nausea & Vomiting (CINV) Dashboard has shown early and promising success.
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Cardiology and Heart Surgery

Q&A with Wayne J. Franklin, MD, co-director of the Phoenix Children’s Heart Center

The rise in the number of children with congenital heart disease surviving to adulthood presents an exciting new challenge. With the recent hire of Wayne Franklin, MD, one of the top adult congenital heart disease specialists in the country, we've positioned ourselves as a pioneering pediatric heart center in the U.S. focusing our work on improving the transition of patients from the care of pediatric cardiologists to an adult congenital heart disease specialists.
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Phoenix Children’s Earns Sixth Consecutive Three-Star Rating from The Society of Thoracic Surgeons

For the sixth time in a row, Phoenix Children’s has earned the top rating of three stars by the Society of Thoracic Surgeons (STS). The newest rating is based on congenital cardiothoracic surgery outcomes data for the period from July 2014 to June 2018. The Cardiothoracic Surgery team at Phoenix Children’s is one of just 10 programs in North America to earn this rating out of 118 participating programs.
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Neurology & Neurosurgery

Changing the Guidelines for Treating Traumatic Brain Injuries

Barrow Neurological Institute at Phoenix Children's researchers are changing the national protocol for the treatment of traumatic brain injuries (TBI) in children. Our work is now being integrated throughout the country to help hundreds of thousands of children who suffer from TBIs each year.
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First Federally Funded Grant to Research Genetic Causes of  Cerebral Palsy

Dr. Michael Kruer, MD, director of the Cerebral Palsy and Pediatric Movement Disorders Program at Barrow Neurological Institute at Phoenix Children’s Hospital received a $3 million grant from the National Institutes of Health for his project,“Genomic Insights Into the Neurobiology of Cerebral Palsy” conducted at the University of Arizona.
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Breakthrough Surgery Changes Life for Epilepsy Patient

Barrow Neurological Institute at Phoenix Children's, a Level 4 NAEC epilepsy center, is at the forefront of providing life-changing neuromodulation therapies for drug-resistant epilepsy. Responsive neurostimulation (RNS) is giving patients like 18-year old Kate, who's had seizures since age 2, a new outlook on life.
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Neonatology

NICU Staff Implements New Extubation-Safety Process

All patients-especially neonatal-are at high risk for endotracheal tube (ET) dislodgement during changes in activity. They are most vulnerable during position changes, movements, transfers and procedures-even with multiple caregivers present.

Understanding this, an extubation-safety process was developed by Phoenix Children's quality team and NICU through a designated taskforce whose singular goal was to reduce the rate of unplanned extubations (UE). Spearheaded by nurse managers, the taskforce standardized the securement method for ET tubes and created a "bundle" of prevention actions for the NICU.

VE Prevention Bundle preventative measures

The UE Prevention Bundle was adopted across the NICU with the aim of improving processes and patient outcomes. The following preventative measures were implemented with a focus on the Airway Guardian and Airway Guide:

  • Standardized assessment of tube security.
  • Use of an Airway Guide that displays pertinent airway information visible to any caregiver who may enter the room.
  • Use of an Airway Guardian in high risk situations to protect the patient from an UE.
  • Increase awareness of the importance of appropriate sedation and pain control and the significance of timely planned extubation.
  • Event monitoring and review to detect trends and identify actions to improve patient safety.
  • Focus on identifying ET tube position on CXR for RNs and RCPs to broaden the safety net for catching ET tubes in poor position increasing the risk of an UE event.
  • Standardized head position during all CXRs with an RN or RCP present.

Airway Guardian: An Airway Guardian is an RN or RCP whose sole responsibility is to maintain the security of the ET tube in all instances where someone must move the patient. This ensures two staff members are present for all position-changing events (including examinations,  linen  changes, transfers, procedures) with one person specifically dedicated to maintaining ET tube security at all times. An "Airway Guardian" is required to monitor the ET tube during:

  • X-rays, weights, linen changes, baths.
  • High risk patient position changes, transfers to gurneys, parents lap, etc.
  • Procedures such as LPs, surgeries, etc.
  • Repositioning patients with an Airway Alert precaution or HFOV patients.
  • Any time the patient may be moved, active, or vulnerable

Airway Guide: An Airway Guide is a standardized form posted at the head of the bed that displays pertinent airway information that is visible to any caregiver who may enter the room:

  • The Airway Alert Precaution is used to identify a patient that has already experienced an unplanned extubation or has a known difficult airway, both increasing their risk of complication.
  • The depth at which the ET tube is secured is displayed. The lip is the standard reference point.
  • The Airway Guide is updated whenever the ET tube is re-secured or repositioned.
  • ET tube manipulations must be approved by an attending, fellow or NP.
    Bundle Results:
    These new processes have been put into practice and are performed collectively, reliably and continuously across the NICU. The UE Prevention Bundle has been so successful in the NICU, Phoenix Children's has adopted this new standard of care for their PICU as well.

 

Gastroenterology & GI Surgery

A Comprehensive Approach to Treating Inflammatory Bowel Disease

IBD requires nutritional and gastrointestinal (GI) treatment, occasional surgical interventions as well as specialized attention to bone, skin and psychological health. At Phoenix Children's Hospital, we have come to recognize this single disease, which impacts each of these aspects of health, requires coordinated care. As a result, in early 2018, Phoenix Children's launched a new multidisciplinary clinic program to provide complete pediatric care to patients with IBD.

This new multidisciplinary approach, coordinated by Nurse Specialty care coordinator Teresa Hammarback and directed by pediatric surgeon Dr. Lisa McMahon, MD, and myself, allows Phoenix Children's patients who have been diagnosed with Inflammatory Bowel Disease to meet with their GI physician, a dietician, psychologist, and, should their treatment require it, their GI surgeon, all in one visit. Rather than addressing these individual disciplines separately, this collaborative approach allows for physicians to focus on treating their patients in concert with their peers. This annual or semi-annual visit gives specialists a deeper dive into the distinct needs of each child. From here, specialists directly coordinate with the patient’s primary GI provider and share recommendations a week ahead of the patient's routine appointments through Pre-Visit Planning meetings.    

This has become the model for other pediatric IBD clinics and shows promising results. Phoenix Children's offers the only program of its kind in the region, and the organization regularly treats patients from beyond the Southwest. To date, remission rates in this program have outperformed the network average of IBD centers enrolled in Improve Care Now- a collaborative care network that aims to improve disease and share best practices.

Coordination among specialties proves to be the key to success for multidisciplinary clinics, and the future of IBD treatment hinges on collaboration between GI clinics through organizations like ICN. Thanks to established relationships through ICN, Phoenix Children's is in the process of coordinating efforts with top programs on the West Coast to establish a regional consortium. This would allow for future collaboration and education opportunities.

Our patients’ well-being is top priority at Phoenix Children's. We continue to build our Mayo Clinic relationship to develop a critical transition program for patients as they outgrow pediatric healthcare. Our shared goal is to ensure these patients begin treatment through an adult healthcare provider, receive a Transition Toolkit and have regular assessments at clinics. As IBD presents our patients with new challenges, our approach to their care continues to evolve. The greater GI community intends to meet each of these new challenges together, head on.

Article written by Brad A. Pasternak, MD.  Dr. Pasternak’s specialties include IBD, Nutrition and Eosinophilic Disorders.  He is currently medical director of the IBD Program and Fecal Microbiota Transplant Program.  In addition, he serves on the North American Society for Pediatric Gastroenterology IBD Committee and is a member of the Fecal Transplant special interest group.  Dr. Pasternak is also a member of the medical advisory committee for the southwest chapter of the Crohn’s and Colitis Foundation.

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