CHOC Children’s Community Partner, Theodore J. Caliendo, MD, A Medical Corporation

Dr. Caliendo CHOC- croppedCHOC Children’s – and our pediatric subspecialists – are proud to partner with pediatricians throughout Southern California to enhance the delivery of pediatric care.  Together, we’re committed to securing bright futures for children.  We’d like to take a moment to introduce you to one of our community partners, Dr. Theodore Caliendo.  In today’s Q & A, we learn more about Dr. Caliendo, including his views on the latest advances in pediatric medicine; his perspective on the impact technology has had on his practice; and more.

What excites you most about practicing pediatric medicine?

I am most excited about having the ability to practice preventative medicine and encourage healthy habits in children.

What do you see as the latest advances in pediatric care?

Immunizations and their ability to eradicate serious infections in children have played a tremendous role in advancing pediatric care.

How has technology enhanced your practice?

Electronic technology has made it easier and quicker to store, track and retrieve patient data in my practice. It also helps create a greener office by eliminating excess paper and toner waste.  Recycling and green living are important parts of our daily office practice.

How is teamwork encouraged in your practice?

Teamwork is important in our office.  It’s why our busy office runs so smoothly.  Each employee has a primary role, but I feel it is equally important for all of my employees to be cross trained in all areas of the practice.  By doing this, the practice runs more efficiently. There is always someone ready and willing to help out when needed.  There is also a better understanding of each person’s workload, which is important in helping everyone feel respected and appreciated.

What does your team do to release stress?

My employees relieve stress in several ways.  First, they relieve stress by taking short breaks so they can sit and relax for a few minutes.  We celebrate throughout the year with themed potlucks.  Sharing food, laughter and good conversation are great stress relievers and allow my employees to get to know each other better on a personal level. A lifestyle of healthy food choices and weekly exercise is encouraged in my practice, and also helps to relieve stress outside of the office setting.

Dr. Caliendo is in solo practice with an office in Mission Viejo. He is board certified in both pediatrics and neonatal-perinatal Medicine. In addition to providing the full spectrum of general pediatric care, he offers counseling for pediatric obesity. Also, Dr. Caliendo serves on the board of directors for CHOC Health Alliance as well as the Physician Advisory Council (PAC) for CalOptima.


Dr. Katherine Andreeff Discusses Bacterial, Viral Infections

Patient history and physical examinations are sometimes not enough to determine whether an infection is viral or bacterial, Dr. Katherine Andreeff, a hospitalist at CHOC Children’s, tells “American Health Journal.”

In these cases, blood work and imaging may be required to make an accurate diagnosis, says Dr. Andreeff. Hand-washing and vaccination can help prevent infections, whether bacterial or viral.

Learn more about infections and key questions parents should ask physicians in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit

Katherine Andreeff, M.D., attended medical school at Wayne State University in Detroit. She completed her pediatric training including a chief residency at CHOC Children’s. She is active in meningitis research and has published a chapter on renal tubular acidosis.

Get more information about referring patients to CHOC, including a referral information directory, services directory and referral guidelines.

Medical Intelligence and Innovations Institute (MI3) Draws International Interest, Collaboration

Anthony Chang, MD, MBA, MPH, Medical Director, CHOC Children's Heart Institute
Anthony Chang, MD, MBA, MPH, Medical Director, CHOC Children’s Heart Institute

His vision has gone viral in the best possible way. In leading hospital-wide innovation and intelligence at CHOC Children’s, Dr. Anthony Chang, medical director, CHOC Children’s Heart Institute, has galvanized a collaborative, international team of physicians and researchers to transform pediatric medicine.

Representatives from close to 100 pediatric institutions attended last October’s inaugural “Pediatrics 2040” conference of the Sharon Disney Lund Medical Intelligence and Innovations Institute (MI3). An attendee from Bambino Gesù Hospital was so inspired by the conference, he returned to Rome to organize the European version of “Pediatrics 2040” for this fall.

“I never dreamed the meeting could launch a whole new international coalition of pediatric leadership,” said Dr. Chang, who is consulting on the European conference. “It is becoming a universal language to make a difference in pediatrics, and we’re excited that CHOC gets to be a facilitating institution.”

In June, MI3 will sponsor a two-day pediatric innovation leadership forum, the first of its kind among hospital innovation centers, which number fewer than 12. Most of them have confirmed, including Cleveland Clinic, Boston Children’s, Stanford, Children’s at Egleston (Atlanta), Toronto Sick Kids, Children’s Hospital of Michigan and Bambino Gesù Hospital.

Dr. Chang ultimately envisions “innovation engines” in all children’s hospitals. “We inherit good ideas from adult medicine and technology, but why not have innovation start in the children’s hospitals?” he said. “We have every right to expect high-level innovation for children.”

Embracing Technology, Innovation to Improve Care

From nurses to emergency room physicians, MI3 encompasses all CHOC departments and specialties. One possible project is using robotics to enhance patient rounding and parent education. Dr. Chang also has his sights set on the more ambitious goal of creating vast neural networks comprised of the world’s best experts on every pediatric topic.

As healthcare delivery systems and devices become “smarter,” community pediatricians also have a key role, including representation on the MI3 advisory board.

“We have received tremendous support from Michelle Lund and Robert Wilson of the Sharon D. Lund Foundation, and from CHOC, particularly Kim Cripe, Matt Gerlach, Dr. Maria Minon, Dr. Nick Anas, Dr. Jason Knight, Dr. Mustafa Kabeer and Dr. Sharief Taraman,” Dr. Chang said. “CHOC is the first hospital to incorporate intelligence with innovation, and I am grateful for this opportunity.”

Monthly MI3 Meetings

Open to all CHOC medical staff, meetings are held the third Monday of the month and feature updates on genomic medicine, regenerative medicine, nanotechnology, medical devices, artificial intelligence and robotics. For more information, contact Dr. Chang.

CHOC Children’s Community Partner, Pediatric and Adult Medicine, Inc.

CHOC Children’s – and our pediatric subspecialists – are proud to partner with pediatricians throughout Southern PAM_Christmas_Party_2012_086 (cropped)California to enhance the delivery of pediatric care.  Together, we’re committed to securing bright futures for children.  We’d like to take a moment to introduce you to one of our community partners, Pediatric and Adult Medicine, Inc. (also known as PAM).  In today’s Q & A, we learn more about what this group considers their best practices, among other things.

What excites you most about practicing pediatric medicine?

Serving as a guide for families in keeping their children healthy, strong and reaching their full potential is what excites us the most.

What is one of your group’s best practices?

We treat all of our patients as if they were members of our family.  We do for them what we’d want done for our own sons and daughters.  This ensures that our patients are given the best possible care, along with showing compassion for them and their families.  We think of our practice, including the staff, medical assistants, nurses and doctors, as one big family.  This is why we love working together and doing what we do every day.

What do you see as the latest advances in pediatric care?

Technology has greatly enhanced our practice in the last several years.  Our practice went on an electronic medical record (EMR) in early 2010.  There was a steep learning curve for the physicians and staff, and many hurdles to overcome, but today we are better able to serve our patients.  All prescriptions and lab orders are now sent electronically, which reduces error and is more convenient for our patients.  The EMR will also allow population-based health management with the implementation of clinical decision support that helps remind physicians about best practices for our patients.

Additionally, we have implemented a patient portal, which allows our patients/parents to communicate via secure email, obtain test results, view visit summaries, and schedule well visits.  With the EMR and our patient portal, we now have the ability to start to manage our patients and identify those patients who are in need of care and services. As our patient portal matures, this will allow enhanced communication and management of patient care, with reminders and ease of patient access to the practice.

We believe technology has made us better practitioners and improved patient satisfaction.  We will strive to continue to incorporate more technology into our practice.

How do you see health care reform impacting how you deliver care?

Health care delivery will remain the same in our office as far as we know.  The implementation of health care reform is still in its infancy, and we don’t truly know how it will affect us as medical providers with the exception of our young adults continuing to have insurance until they are 26 years of age. It is wonderful that people who previously had limited access to health care will now be able to get the care they need without burdening emergency rooms.

Fictional physicians have graced the small screen for years.  Which TV MD gets your group’s vote for “top doc” and why?

We couldn’t get a consensus on this one.  Dr. Mackey loves Dr. Leonard H. McCoy (“Star Trek”) for all of his cool gadgets and his service to Captain Kirk.  Dr. Turner grew up watching “The Cosby’s” and admired Dr. Huxtable’s amazing bedside manner and his ability to balance family life with a career, while valuing education.  And Dr. Bruner is fond of Dr. “Hawkeye” Pierce (“MASH”) for maintaining a sense of humor, while practicing medicine with a sense of caring and intelligence.

 Located in Tustin, Pediatric and Adult Medicine, Inc. includes the following board-certified pediatricians: Dr. Reshmi Basu; Dr. Dawn Bruner; Dr. Mike Cater; Dr. Angela Dangvu; Dr. Norah Gutrecht; Dr. Dan Mackey; Dr. Carlos Martinez; Dr. Priya Mody; and Dr. Marisa Turner.

CHOC Leads the Way to Safer Breast Milk Handling with New Tracking Process

Breastmilk TrackingCHOC Children’s is gaining recognition for a new breast milk handling process that is proving to be safer for patients and more efficient for physicians and staff.

With very few government regulations in place, hospitals across the country struggle to establish best practices in handling breast milk, and CHOC is no different. Busy nurses are often tasked with collecting, labeling, inventorying and distributing dozens of bottles during a shift, amid other critical responsibilities.

“Our nurses are doing a multitude of highly important things, often being pulled in many directions at once,” said Caroline Steele, director of CHOC’s Clinical Nutrition & Lactation Services. “Without good support and a better system in place, there was potential for interruptions and errors.”

In June 2011, CHOC’s Joint Leadership Committee formed a process improvement team, including physician co-chair Dr. Christine Bixby and representatives from each inpatient nursing unit, Clinical Nutrition and Lactation, Quality and Transport. The team reviewed data from the previous 12 months and identified 282 potential points where the existing process could fail, and 85 of those were named as top priorities to be addressed in a complete redesign of the system.

A New Method

In January 2013, the team moved milk preparation to a centralized location. The existing formula room was repurposed to accommodate both formula and breast milk preparation. Now referred to as the Nutrition Lab, it houses a breast milk freezer and a commercial dishwasher, and is staffed with registered dietetic technicians. CHOC also operates a satellite nutrition lab in the NICU at St. Joseph Hospital.

CHOC then secured a $190,000 grant from UniHealth to purchase the Timeless™ Breast Milk Tracking system. The software uses unique barcode identifiers to ensure babies are matched with the correct milk, and that the milk has not expired. The system launched in November 2013 in the NICU, medical and surgical units, neuroscience unit, oncology unit, PICU and CVICU at the hospital’s Orange campus.

Nurses previously fortified and prepared milk themselves at the bedside – a contamination risk – and then had to ask a second nurse to verify the accuracy of it at every step. That accuracy check is now done automatically.

“It used to take at least an hour to make your shift’s worth of milk,” NICU nurse Jenn Landman said. “That’s an hour you can spend with a baby’s family or do extra things, like bath time or a ‘spa day’ with a baby. It’s much more meaningful work.”

Now, when a mother checks in with her baby, a nurse prints labels for the breast milk expressed during their stay and scans the baby’s armband to verify the labels are correct. The mother attaches a label to a filled bottle, which is transferred to the Nutrition Lab for inventorying and storage. The lab’s technicians fortify the milk per doctor’s orders and deliver 12 hours worth of feedings back to the units twice a day. All information about the milk is documented in the baby’s medical record and synced with their Cerner medical record.

The process is also easier for physicians, who now only write one feeding order for a patient, rather than multiple orders to cover variations in a baby’s feeding needs.

Dr. Bixby credits Steele for implementing the new process over a long period of time, making sure staff had input and any kinks were ironed out.

“Rolling it out in stages was really smart. It allowed for real-time adjustment and response to every issue that came up,” Dr. Bixby said. “From the bedside, concerns were brought forward, and immediately we were modifying the system.”

In the first three months of the barcode program, 19,989 breast milk feedings were prepared by the Nutrition Lab, with 100 percent compliance to scanning in the lab and 99 percent compliance on the units. The software identified 35 near misses when milk would have been given to the wrong patient, and 78 near misses when expired breast milk would have been given.

Next Steps

CHOC’s efforts have been noticed. The California Department of Public Health has commended the program and has asked Steele to train registered dietitian surveyors across the state on proper breast milk handling. Dr. Bixby has received calls from other physicians across the state, inquiring about the process and asking to tour the Nutrition Lab.

Plans are being made to implement the barcode system at CHOC Children’s at Mission Hospital, and the team hopes to purchase software to track formula, as well. They are seeking additional grant funding.

Meanwhile, two new studies are also looking closely at breast milk production in the NICU. One study uses an analyzer to identify the components of a mother’s milk, rather than assuming it contains generalized amounts of nutrients. That will make the fortification process more accurate, making sure babies get exactly what they need. The second study will track milk production in moms who wear a hands-free bustier pump and use their hands to help express milk, along with a traditional breast pump.

“We are always looking at ways that we can make our hospital safer and ultimately a better experience for the patient and family,” Steele said.

CHOC neonatologists are overseeing a number of other quality initiatives, including efforts to:

Learn more about breast milk health at CHOC Children’s Pediatric Health Library.