CHOC’s PICU Earns Gold Beacon Award for Exceptional Patient Care

CHOC Children's Earns Beacon Award for ExcellenceDid you hear our good news? The dedicated physicians, nurses and staff in our pediatric intensive care unit (PICU) at CHOC Children’s Hospital have earned a gold-level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN)!

The Beacon Award for Excellence recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

“The entire team in our pediatric intensive care unit is dedicated to the highest standards of patient safety and care. We are entrusted with caring for some of the sickest and most medically fragile patients, and our goal is to deliver the best possible outcomes for them and their families,” says Melanie Patterson, DNP, MHA, RN, vice president, patient care services and chief nursing officer, CHOC Children’s Hospital. “While getting our patients better is our greatest reward, we are truly honored to receive this high distinction from AACN.”

CHOC’s PICU earned a gold award, the highest designation, by meeting the following evidence-based Beacon Award for Excellence criteria: leadership structures and systems; appropriate staffing and staff engagement; effective communication, knowledge management, learning and development; evidence-based practice and processes; and outcome measurement.


In the Spotlight: W. Nathan Holmes, MD and Azam Eghbal, MD

Their paths may have diverged after completing pediatric radiology fellowships together at Boston Children’s Hospital, but not for long. Dr. W. Nathan Holmes and Dr. Azam Eghbal have teamed up once more to refine Orange County’s only truly pediatric radiology department. Among their accomplishments is a 90 percent reduction in radiation exposure.

An enduring fellowship. Pediatric radiologists Dr. Azam Eghbal, left, and Dr. W. Nathan Holmes have made CHOC Children’s the regional resource for pediatric imaging excellence. Some of their techniques may surprise you.
An enduring fellowship. Pediatric radiologists Dr. W. Nathan Holmes, chair, department of radiology at CHOC Children’s, left, and Dr. Azam Eghbal, medical director, CHOC Children’s radiology department have made CHOC the regional resource for pediatric imaging excellence. Some of their techniques may surprise you.

A pet therapy dog recently trotted into the CHOC Children’s Radiology Department. Waiting inside was a young patient about to undergo a CT scan. A few minutes later, the radiology team at CHOC produced a clear scan without anesthesia, thanks to the dog’s calming influence on the patient.

Pet therapy is just one of many techniques the department utilizes to get the best images with the least radiation possible. And that ability to do things a little

Dr. W. Nathan Holmes
Dr. W. Nathan Holmes

“outside the box” is what drew Dr. W. Nathan Holmes to CHOC in 2008 after completing his fellowship training at Boston Children’s Hospital. CHOC was on its way to opening a stand-alone radiology department, and Dr. Holmes could not resist the opportunity to help design and equip a truly pediatric-specific and friendly environment.

“Most children are imaged in adult facilities, and it is not uncommon to see radiation doses that are 50 percent higher than what we do here,” Dr. Holmes said. “One of our goals has been to acquire and fine-tune the best equipment to get the diagnostic quality we need with minimal radiation.”

The CHOC CT delivers extremely low-dose radiation with scanners that are so fast, repeat scans are rarely needed. Other hospitals have begun transporting neonates to CHOC for imaging because of these capabilities.

CHOC has reduced radiation associated with fluoroscopic procedures by up to 90 percent by using pulse dose technique and image capture compared to continuous fluoroscopy and full-image acquisition. Additionally, the CHOC X-ray technologists and ultrasonographers understand the pediatric disease process and are experienced at getting the highest quality of key images. Dr. Holmes also credits the department’s dedicated child life specialists for providing distractive techniques that have greatly reduced the need for anesthesia.

Increasing Applications for MRI

After her fellowship at Boston Children’s Hospital, Dr. Azam Eghbal’s career took an administrative turn. As vice-chair of the radiology department and MRI division director at Akron Children’s Hospital, Dr. Eghbal was integrally involved with the acquisition and accreditation of the hospital’s 3 Tesla MRI magnet. She subsequently developed all neuro and body MRI protocols.

Dr. Azam Eghbal
Dr. Azam Eghbal

Dr. Eghbal also became Lean Six Sigma-certified, and initiated several MRI-related performance and quality improvement initiatives. Those were some of the specific skills Dr. Holmes was looking for when he contacted his former colleague in 2013.

“Dr. Holmes has done an amazing job,” Dr. Eghbal said. “My goal is to increase image quality and utilize MRI equipment to maximum capacity.”

CHOC is equipped with two MRIs, including one with a 3 Tesla magnet. As MRI technology is continually undergoing upgrades, Dr. Eghbal and Dr. Holmes work closely with other radiologist colleagues and CHOC departments to expand imaging options. In the near future, the following services will be available:

  • Functional MRI and brain mapping
  • Cone-beam CT for orthognathic surgeries

Additionally, monthly interdepartmental meetings have addressed MRI pathways for stroke, osteomyelitis and trauma. Dr. Eghbal recently contributed a textbook chapter about trauma, and brings considerable perspective to the pediatric-focused trauma center that opened earlier this year inside the Julia and George Argyros Emergency Department.

“What works for one hospital, may not work for another,” she said. “However, most things are easy when you have a group of good people who are dedicated and willing to improve. We all share a common goal: to improve CHOC and better serve the kids.”

The CHOC Children’s Radiology Department has received full accreditation for both MRI and CT from the American College of Radiology, and is currently undergoing accreditation for ultrasound. Both Dr. Holmes and Dr. Eghbal welcome questions from the pediatric community.

To contact them, please call the CHOC Radiology Department at 714-509-9081.

Dr. Dean Jacobs Elected President of AAP Orange County Chapter

Dr. Dean Jacobs
Dr. Dean Jacobs

Congratulations to Dr. Dean Jacobs, who was recently elected as President of the American Academy of Pediatrics (AAP) Orange County Chapter.

Dr. Jacobs has been a pediatrician with CHOC Children’s Hospital since 2008, and is co-chair of the CHOC Ethics Committee and a member of both the CHOC Joint Leadership Committee and the CHOC Credentials Committee. He is also an assistant clinical professor at University of California, Irvine.

“I am honored and humbled to have been elected AAP Orange County President. It is incredibly special for me to have been selected by my peers and to have their trust and continued support as we work together as a team dedicated to the health of all children in Orange County and beyond,” Dr. Jacobs said.

This dedicated physician has been involved with the AAP Orange County Chapter since 2008, has served as chair of the Young Physicians Committee, and as a member of the board of directors since 2011. He was named AAP Orange County Young Physician of the Year for 2010-2011, and has received two national AAP Special Achievement Awards.

“As a chapter, our board of directors has numerous hopes and goals for the future to help the children of Orange County,” he explained. “A few of our key priorities include: helping children through direct services and advocacy efforts on the state and local levels to ensure that our kids are as healthy and safe as they can be; strengthening and building upon our great relationships with pediatric and community partners in Orange County to focus on areas with gaps in services to reach families and children in need; and pursuing a bright future by mentoring our young pediatricians into the future leaders of tomorrow while showcasing advances in pediatrics with continuing medical education and yet ensuring continued fiscal responsibility. With this plan, we strive to best protect our greatest assets in Orange County, our children.”

Dr. Jacobs completed his undergraduate education at the University of Pennsylvania, received his medical degree from the University of California, Davis, and did his pediatric residency post-graduate training at Los Angeles County + University of Southern California Medical Center.

The 32nd Annual Current Advances in Pediatrics Conference will be held on Sept. 25 -27, 2015, and offers 18 hours of CME credit and nationally acclaimed speakers. Registration is now open at

Dr. Mary Zupanc: Sharing My Story with Patients

Dr. Mary Zupanc

Undergoing brain surgery herself made Dr. Mary Zupanc a better, more sensitive clinician when working with epilepsy patients, the CHOC Children’s neurologist writes in The New York TimesWell Blog.

Following a late-night seizure and months of seemingly unrelated symptoms, Dr. Zupanc was diagnosed with a bifrontal meningioma in early 2014.

The questions and fear surrounding her subsequent surgery, as well as the recovery process, have clarified Dr. Zupanc’s understanding of the patient and family experience, she writes.

In The New York Times column, Dr. Zupanc tells her story and explains how becoming a patient herself has changed her practice and how she works with patients and families. Read the column to learn more.

ICD-10 Conversion – An Update from Dr. Bill Feaster, CHOC Children’s Chief Medical Information Officer

CHOC Children’s has just gone live with a new learning management tool, Healthstream, that is accessible to all CHOC physicians, non-physician providers and

Bill Feaster, William Feaster, MD, MBA, CHOC Children's Chief Medical Information Officer
William Feaster, MD, MBA, CHOC Children’s Chief Medical Information Officer

associates who have access to Cerner and CHOCPort. We intend to use Healthstream for all our education surrounding the electronic health record, as well as continuing education for our Clinical Documentation Improvement initiative (CDI), the transition to ICD-10 coding and other provider-focused education.

CHOC’s current information technology systems are designed around the ICD-9 CM code set. To get ready for ICD- 10, all of these systems are being remediated. This includes Cerner, SoftMed, NeoData and every other application at CHOC that codes a diagnosis or procedure, or supports sending out a bill. This change also impacts any applications currently running in community physicians’ private offices.

The initial educational offering will be “Precyse University” content surrounding the transition to ICD-10 coding. This education will be launched in phases starting this month. In August, more specialty specific educational courses will be offered, followed by a documentation simulator and review courses in September. In addition to taking a course, the Precyse content will be available for future reference when coding questions arise.

Access will be fairly simple. Your login and password will be the same as your current active directory password that you use for sign in to CHOCPort and Cerner.   The link to Healthstream is   This link will also be available on and PAWS intranet.

For any questions please contact Stephanie Murphy, ICD-10 Education and Training Lead at CHOC at, or me at

William Feaster, MD, MBA

Chief Medical Information Officer, CHOC Children’s