Genomics of sudden cardiac arrest; athletes with implantable cardioverter defibrilators (ICDs); and ECG screening and automated external defibrilators (AED) in schools — the role of the primary care physician, are just some of the topics that will be featured at an upcoming CHOC conference, featuring the country’s top cardiac experts.
The Sports Cardiology & Sudden Cardiac Arrest in the Young Conference will be held on Jan. 20-21, 2017, at Disney’s Grand Californian Hotel, in Anaheim. The anticipated biennial event will create an opportunity for those involved in the care of athletes and young individuals, to gain the latest education related to athletic training and the diagnosis and management of inherited cardiac diseases, in the hope of preventing tragic young sudden deaths in the future.
CHOC designates this live activity for a maximum of 12.0 CME hours of AMA PRA Category 1 Credits™.
I would like to wish you a very happy and healthy new year. As we leap into 2017, I’d like to take a few moments to reflect on just a few of the milestones that were achieved at CHOC Children’s in 2016. Each year we raise the bar in providing the best care possible to the children and families that we serve, and 2016 was no exception. We added faculty and staff, launched several programs and services, broke ground on two new inpatient units, and made great strides in clinical research.
Many of you are aware that CHOC was once again named a “Top Children’s Hospital” by the Leapfrog Group for providing the safest and highest quality services to our patients. This is a highly prestigious designation, as CHOC is one of only nine children’s hospitals in the nation and the only children’s hospital on the West Coast to receive this honor.
This distinction helps us to recruit the best and the brightest to CHOC, and in 2016, we welcomed nearly 40 new medical staff members representing 22 specialties. While this allows us to better serve Orange County families, we continue to treat patients traveling to CHOC from other counties, states and even countries, seeking our expertise through specialized programs such as our world class feeding, epilepsy/neurosciences, and orthopedic surgery programs, just to highlight a few. The Pediatric Subspecialty Faculty (PSF) and CHOC Children’s Specialists (CS) alone is now comprised of over 150 medical and surgical specialists.
In April, we opened our Adolescent and Young Adult (AYA) Cancer Unit within the Hyundai Cancer Institute. Our new AYA Unit provides an inpatient treatment setting designed to meet the needs of our adolescent and young adult patients. CHOC recently added oncologists specializing in the unique needs of adolescent and young adult patients.
In September, we formally broke ground on the CHOC Children’s Mental Health Inpatient Center. This will be an 18-bed mental health unit with outdoor recreation space, serving children from ages 3 through 18 years old. When this unit opens in early 2018, it will be the only inpatient program in Orange County serving children under the age of 12.
In 2016, we also began the build out of our state-of-the-art, expanded Neonatal Intensive Care Unit (NICU). Scheduled to open in the summer of 2017 on the fourth floor of the Bill Holmes Tower, the NICU will offer 37 rooms, of which 36 will be private, designed to allow parents to comfortably remain at the bedside while we care for their critically ill newborns. The new unit will also contain our recently expanded neurocritical services, offering increased capacity for whole body cooling and long-term video EEG monitoring for prevention and early detection of seizure activity in newborns.
We also expanded our outpatient adolescent/teen program, now located in the Centrum North Building. By adding services, offered by both male and female physicians specializing in adolescent medicine, CHOC is able to better meet the unique needs of our teenage patients.
In 2016, CHOC clinicians published more than 330 manuscripts and delivered more than 200 lectures. The CHOC Research Institute had 369 active IRB-approved clinical research studies across multiple specialties. A prime example of our emphasis in research is the recruitment of Dr. Jeff Huang, a PhD scientist, who is partnering with Dr. Raymond Wang, a physician scientist. Together, they hope to advance the understanding of Pompe Disease. Through our partnership with UC Irvine and the Institute for Clinical and Translational Science, we awarded five promising pilot research grants. And the Hoag Foundation awarded CHOC Principal Investigator Phil Schwartz, PhD with a three-year $1,048,168 grant to advance pediatric stem cell research with the goal of filing a “Pre-Investigational New Drug” application with the FDA.
The Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) at CHOC continues to grow, advancing the culture of innovation and supporting thought leaders from around the world to join together in pursuit of innovative approaches to improve the lives of children. This year, MI3 launched the first innovation education/training program at CHOC, which included an innovation challenge. The first place challenge winners were invited to present at the International Peds2040 Conference in Miami this month. Institute director, Anthony Chang, MD, leads with the philosophy that “The best and fastest way to innovate, is to collaborate.” The result of this philosophy was the creation of The International Society for Pediatric Leadership (iSPI), now comprised of 33 children’s hospital members (and growing). Last summer, nearly 100 future healthcare innovators participated in MI3’s Intern Program. Also in 2016, Dr. Chang became the president of the OC/SD Chapter of the Society of Physician Entrepreneurs (SoPE). To close a successful year, MI3 hosted the AIMed Conference in December, with over 400 participants.
And finally, this year CHOC launched our refreshed 2020 Strategic Plan, which will serve to guide us in 2017 and beyond as we continue to reach new goals in expansion and enhancement of patient care. One of the major initiatives in the strategic plan is our population health strategy. With the creation of the CHOC Children’s Network, we are taking transformative steps toward seamless integration of specialty and primary care providers, with primary care as an increasingly important part of the continuum of care. As one of only 29 healthcare recipients nationwide and the only pediatric institution, CHOC received a four-year Center for Medicare and Medicaid Innovation (CMMI) Transforming Clinical Practice Initiative Grant totaling $17.8 million. Working in partnership with Rady Children’s Hospital, we are launching new care model designs across the care continuum for enhanced coordination of inpatient, primary, emergency, urgent care and specialty care services.
While I wish that I could list all of our accomplishments from calendar year 2016, it is simply not possible, as there are far too many to mention here. Suffice it to say, we should all be very proud. With everything else going on in the world around us, we can say that we continue to focus on the health and well-being of the children and families that we serve, providing expanded, higher quality care, setting the stage for a great 2017. I would like to congratulate you all on a job well done. The future at CHOC is bright!
The Cherese Mari Laulhere Foundation, whose mission is to provide funding and support to charitable organizations that enrich the lives of children and families, has donated $5 million to endow the child life department at CHOC Children’s Hospital. In recognition of the foundation’s generosity and to honor the memory of Cherese, the department will be named The Cherese Mari Laulhere Child Life Department.
Cherese is remembered by many for her compassion, sincerity and zest for life. An elementary school assignment revealed her dream for peace. As she matured, she continued to nurture that vision by focusing her attention on causes that improved the lives of others, especially children. A bus accident in India tragically ended Cherese’s life when she was 21 years old, but her family and friends make sure her dream lives on through the work of the foundation they created in her name.
“Our donation is truly a gift from Cherese, who was committed to making a difference in people’s lives. Supporting CHOC’s child life department and the inspiring ways its specialists and programs positively impact patients and families each and every day is a wonderful tribute to our daughter and her dream to make the world a better place for children,” says Cherese’s parents, Chris and Larry Laulhere.
The Cherese Mari Laulhere Child Life Department at CHOC Children’s Hospital offers comprehensive education and support services to help normalize the hospital experience for patients and their families. From pre-surgery preparation and therapeutic medical play to developmental stimulation and specialized programs, such as art and music therapy, the department addresses the unique needs of children who are facing the most challenging moments in their young lives.
“We are incredibly grateful to the Cherese Mari Laulhere Foundation for their generous support of our child life department, which is committed to transforming the hospital experience for our patients and their families. Our child life specialists and programs, such as art and music therapy, play crucial roles in our patients’ healing and recovery, helping them focus on what’s most important: their childhood,” explains CHOC President and CEO Kimberly Chavalas Cripe. “Hearing of Cherese’s kind and giving spirit, particularly where children were concerned, we are especially touched by this gift and proud to honor her memory by naming the department the Cherese Mari Laulhere Child Life Department.”
The commitment and dedication of CHOC Children’s clinicians will ensure happy holidays for many families – including the McLeods.
This will be the first holiday season for the new family of four, only recently reunited at home following son Ryan’s 17-week stay in CHOC Children’s Small Baby Unit (SBU).
Ryan was born this past winter at just 27 weeks gestation and weighing only 2 pounds and 1 ounce.
The care for babies of his size and age is the very specialty of the SBU. A portion of CHOC’s neonatal intensive care unit (NICU), the unit is dedicated to the care of babies born with extremely low birth weights – those born at less than 28 weeks gestation or weighing less than 1,000 grams, or about 2 pounds and 3 ounces.
There, “micro-preemies” like Ryan receive coordinated care in a developmentally appropriate environment. A trailblazer in neonatal care nationwide, the unit is saving babies who just decades ago wouldn’t have likely survived.
“With its coordinated care in an environmentally appropriate location, the Small Baby Unit is designed to care specifically for babies like Ryan,” says Dr. Kushal Bhakta, Ryan’s neonatologist and medical director of the SBU. “When he came to the unit, he required significant ventilator support due to an ongoing infection, and he had a long road ahead of him.”
Danielle’s breezy pregnancy took a sudden turn early in her second trimester when her doctor found in her womb a subchronic hematoma, an indicator that she might deliver her baby early.
Danielle was put on bed rest, but a few weeks later, bleeding and signs of labor showed. At the hospital, doctors were able to stop the labor and admitted Danielle to keep it from beginning again too early. But about six weeks later, Danielle’s water broke and she underwent an emergency cesarean section.
On Valentine’s Day, after two weeks of ups and downs, Ryan was transferred to the SBU at CHOC and the McLeod family began their four-month journey.
“I don’t think people understand the pain that comes with having a child and not being able to hold him immediately or not being able to take him home shortly after delivery and share him with the world,” Danielle says.
“It was difficult knowing that there were many obstacles for Ryan to overcome before he could even think about coming home,” she says. “Simple things like eating by mouth, a task that should come naturally, are challenging for babies born premature.”
During that time, while also focusing on growing, Ryan also battled chronic lung disease and a brain bleed, and learned to eat and breathe on his own. Meanwhile, Danielle and husband, Jared, learned how to care for a baby born more than three months early.
“I’ll never forget our first day at CHOC,” she says. “I was so overwhelmed, scared, and nervous. Once Ryan was settled in the SBU, his nurse came in to do his very first set of cares. I sat and watched, afraid to touch him. He was so fragile. His nurse said, ‘Get in there, mama. You can do it.’ She had me put my hand on him, my hand covering his whole little torso. She talked me though what to do when caring for an extra small baby. From then on, I felt confident to be close to my little fighter.”
After 17 weeks in the SBU, Ryan finally went home to join his parents and brother. He still receives oxygen treatment and undergoes physical therapy twice a week, but is doing well.
“During his stay in the unit, Ryan overcame great obstacles, thanks to the partnership between his care team and his parents,” Dr. Bhakta says. “Our goal in the unit is to get our patients home with the best possible outcomes. Today, Ryan is doing well and has a bright future ahead.”
Overall, Ryan is doing well. Small but mighty, he is doing great at rolling over and pushing himself up, and is working toward sitting up by himself.
“He also loves smiling and laughing, especially at his big brother,” Danielle says.
“We’re moving in the right direction,” she says. “We are so grateful to all the wonderful nurses and doctors who cared for Ryan. I know he is doing so well because of the amazing care he received while in the SBU. We love our little fighter. He’s such a good baby. He is truly a miracle and we are blessed to be able to witness this little guy’s journey.”
By: M. Tuan Tran, infectious disease pharmacist at CHOC, and Dr. Negar Ashouri, infectious disease specialist at CHOC
With the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission set to require the adoption of core elements of antimicrobial stewardship in 2017, CHOC Children’s will continue to uphold the appropriate use of antimicrobial agents through its existing antimicrobial stewardship program.
Optimizing selection, dosing and duration of therapy
Reducing adverse events including secondary infection (e.g. clostridium difficile infection)
Improving patient outcomes
Slowing the emergence of antimicrobial resistance
Preserving supply especially during critical shortages and reduce health care expenditures
The collaborative’s strategies include:
Pre-authorization of broad spectrum agents such as meropenem, cefepime, vancomycin, daptomycin and linezolid
Daily review (prospective audit with feedback) of antimicrobial orders
Development of care guidelines, dosing protocols and order sentences in the electronic health record
Dose optimization based on PK/PD principles (e.g. prolonged infusion of beta-lactams)
Document indication and duration for all antimicrobial orders
Antibiotic time-out at 48-72 hours to: reevaluate need to continue treatment; streamline, de-escalate based upon culture result; convert intravenous to oral route when appropriate; reassess optimal treatment duration
Track trends and share antibiotic utilization data as well as resistance trends
Provide education for staff, patients and family of optimal antimicrobial therapy use
Changes to clinical practice patterns to promote the appropriate use of antibiotics is a patient safety issue and public health imperative: Antibiotics are the second most commonly used class of drugs in the United States, and studies indicate that 30 to 50 percent of antibiotics prescribed in hospitals are unnecessary or inappropriate. Further, antibiotic exposure is the single most important risk factor for the development of clostridium difficile infection.
“Through education and teamwork we can reduce the unnecessary use of antibiotics, therefore minimizing the risk of potential side effects to ensure we have effective antibiotics available for the generations to come.”
– Dr. Negar Ashouri, infectious disease specialist at CHOC
The Centers for Disease Control and Prevention (CDC) estimates that 2 million illnesses and 23,000 deaths are caused annually by drug-resistant bacteria in the U.S. alone. Avoidable costs from antibiotic misuse range from $27 billion to $42 billion per year in the U.S. At the same time, the discovery and development of new antibiotics have dropped precipitously from the 1980s onward. All antibiotics approved for use in patients today are derived from a limited number of classes of agents that were discovered by the mid-1980s (see figure 1).
Source: A Scientific Roadmap for Antibiotic Discovery. The Pew Charitable Trusts, May 2016.
Here are some common reasons for misuse of antibiotics in health care settings:
Use of antibiotics when not needed
Continued treatment when no longer necessary
Use of broad-spectrum agents when more targeted/narrower options are available
Wrong antibiotic given to treat an organism/infection
Incorrect dosing and frequency
Antibiotics can also affect beneficial bacteria that are part of our normal flora:
An average child receives 10 to 20 courses of antibiotics before age 18
Antibiotics affect microbiota flora which may not fully recover after a course of antibiotics
Overuse of antibiotics may be contributing to obesity, diabetes, inflammatory bowel disease and asthma
For information about the appropriate use of antibiotics for your patients and families, please visit ourCHOC Blog.