2015 - Cardinal Glennon

Transcription

SSM Cardinal Glennon Children’s Medical Center
A closer look at some of
the specialties that make
SSM Cardinal Glennon
Children’s Medical Center
the very best in pediatric
patient care
PEDIATRICS
FOCUS ON
TM
2015
cardinalglennon.com
Medical news from SSM Cardinal Glennon Children’s Medical Center
and SLUCare Physician Group
Every one of us is part of an enduring, 143-year heritage of care and
compassion. Together through our Mission and healing ministry, SSM
Cardinal Glennon Children’s Medical Center continues to provide the best
care available, which is one reason why our love for kids just keeps on growing.
This past year, we continued to grow both as a hospital and a strong
community member. Our team connected with more than 30,000 families at
the Boo at the Zoo event at the St. Louis Zoo and we hosted our first drivethru flu shot clinic. We offered complimentary flu shots to more than 450
members of our community in just four hours on a Saturday morning. We
continue to press forward with advances in medicine, including 3D heart
models, imaging, research and much more. At SSM Cardinal Glennon, we
recently finished the new Pediatric Sleep Lab which is able to accommodate
more patients. The Knights of Columbus Developmental Center received an
Autism Treatment Network designation. We continue to be pediatric leaders
in three specialties as ranked by the U.S. News and World Report.
2015 is a very exciting year for SSM Cardinal Glennon. We have additional
renovations coming to our atrium to complement our new Costas Center and
Pediatric Intensive Care Unit (PICU). Our team will continue to improve our
best-in-class imaging services. Outreach to both Missouri and Illinois will be
even more robust as we implement new telemedicine opportunities to serve
new patients. As always, we will continue to provide exceptional care to all of
our patients and their families. It is a year we are excited to share it with you!
Sincerely,
Kate Becker, President
[email protected]
Robert Wilmott, MD, Chief of Pediatrics, SLUCare Pulmonologist
[email protected]
Dennis Vane, MD, Surgeon-in-Chief, SLUCare Surgeon
[email protected]
Dennis Vane, MD,
Surgeon-in-Chief
1
Kate Becker,
President
Robert Wilmott, MD,
Chief of Pediatrics
PEDIATRICS
FOCUS ON
TM
Since 1956, SSM Cardinal Glennon Children’s Medical
Center has offered the highest level of care as the country’s
only free-standing, non-profit Catholic children’s hospital.
Located in St. Louis, MO, SSM Cardinal Glennon is a
pediatric medical care destination. Every year, the medical
center provides hope to thousands of children with
complex medical conditions from Missouri, Illinois and
beyond.
SSM Cardinal Glennon is a 195-bed teaching hospital
affiliated with Saint Louis University School of Medicine.
In every way, SSM Cardinal Glennon lives out the SSM
Health Care mission, “Through our exceptional health care
services, we reveal the healing presence of God.”
SSM Cardinal Glennon is home to:
Physician experts in more than 60 medical specialties
Missouri’s first Level I Pediatric Trauma Center, at
the Dan Dierdorf Pediatric Emergency and Trauma
Center. SSM Cardinal Glennon’s Level I status is
granted in both Missouri and Illinois.
The Dana Brown Neonatal Intensive Care Unit, a
Level IV NICU (the highest level of designation) with
a dedicated transport team, private rooms for every
family and staffed 24/7 by attending neonatologists
The Dorothy and Larry Dallas Heart Center, home to
St. Louis’ only pediatric hybrid catheterization suite
and the most experienced pediatric cardiothoracic
surgery team in the region
The Costas Center includes a 16-bed inpatient unit,
day hospital and stem cell transplant unit
The Pediatric Intensive Care Unit, staffed 24 hours a
day by in-house, critical care attending physicians
The St. Louis Fetal Care Institute, one of the leading
comprehensive fetal care programs in the country,
providing diagnosis and treatment from advanced
ultrasound to fetoscopic procedures and even open
fetal surgery
The Missouri Poison Center, which responds to more
than 75,000 child and adult poison exposure calls in
Missouri each year
The St. Louis Cord Blood Bank, one of the world’s
largest and one of only five FDA licensed public banks
of life-saving and noncontroversial cord blood stem
cells (derived from the umbilical cord and placenta)
Recognized by The Joint Commission as a “Top
Performer in Key Quality Measures” for three years
2015
cardinalglennon.com
Medical news from SSM Cardinal Glennon Children’s Medical Center
and SLUCare Physician Group
Table of Contents
Message from Leadership...........................................................1
Hospital Overview.........................................................................2
Procedural Sedation Program .................................................3
Diagnostic Imaging......................................................................4
Cardiology and Cardiothoracic Surgery..........................5–6
Critical Care Medicine (PICU)...............................................7–8
Emergency Medicine............................................................9–10
Endocrinology.........................................................................11–12
Gastroenterology / Hepatology......................................13–14
Hematology / Oncology .....................................................15–16
Neonatology...........................................................................17–18
Nephrology............................................................................19–20
Neurosurgery..............................................................21–22
Nuclear Medicine................................................................23–24
Pulmonology.....................................................................25–26
Surgery...................................................................................27–32
The St. Louis Fetal Care Institute..................................33–34
Transport and Trauma.......................................................35–36
Additional Pediatric Specialties...................................37–38
Modern, Kid-Friendly Facilities....................................39–42
For comments and suggestions, please email
[email protected].
2
Procedural Sedation Program
SLUCare Procedural
Sedation Physicians
Lia Lowrie, MD
Director, Pediatric Procedural
Sedation Service
Professor of Pediatrics at Saint
Louis University School of
Medicine
Gordon Gale, MD
Procedural Sedation
Christina Mannix, MD
Procedural Sedation
David Wathen, MD
Procedural Sedation and
Hospital Medicine
Aline Tanios, MD
Hospital Medicine
Marta King, MD
Hospital Medicine
Infants and children are often developmentally unable to hold still for long noninvasive tests, such as an MRI or tolerate brief, mildly painful procedures including
a simple fracture reduction or lumbar puncture in the same manner as older
children or adults. The Procedural Sedation Service at SSM Cardinal Glennon
provides sedation services for children undergoing tests and procedures as part of
their diagnosis and treatment plan. In conjunction with a specially trained nursing
staff, the faculty provide moderate and deep sedation for children undergoing the
following procedures on an outpatient and inpatient basis:
MRI and CT scanning
Nuclear medicine scanning
Lumbar puncture
Radiation therapy
Bone marrow
Abscess drainage
Solid organ biopsy
Simple fracture reduction
Botox injections
PICC line placement
Auditory evoked potential testing
The program follows all the myriad safety regulations put forth by the American
Academy of Pediatrics, American Society of Anesthesiologists and as mandated by
JCAHO, is overseen by the director of pediatric anesthesiology at SSM Cardinal
Glennon. The sedation service works closely with Child Life and the SSM
Cardinal Glennon pain and palliative care teams as appropriate. The service also
works closely with the emergency medicine faculty to provide sedation services
under emergency services condition and to ensure availability of scheduled
sedation services on some off hours.
Highlights of The Procedural Sedation Service
In 2013, more than 2,500 children received moderate or deep sedation at SSM
Cardinal Glennon in the Department of Radiology, Emergency Room, Costas
Center or Special Procedures Unit.
Data from the medical literature suggest that 4-5% of sedation events, even when
managed by skilled clinicians, include complication. SSM Cardinal Glennon
Procedural Sedation Service has a rigorous Quality Improvement program that
tracks complications. Only 2.5% of patients experienced a moderate or deep
sedation related complication in 2013.
Because of increased availability and efficiency of sedation services, the wait time
for an MRI with sedation at SSM Cardinal Glennon went from three to four
weeks to less than seven days in 2013, despite a large increase in the number of
ordered MRI’s. The new CT and MRI Suite was opened in 2013.
The risk for complications during sedation is decreased when each child’s specific
medical conditions needs are prescreened. Experienced sedation nurses serve as
radiology schedulers, allowing a skilled assessment of each child’s needs at the
time of scheduling to prevent cancellations or multiple scheduling hassles and to
find the appropriate level of sedation or anesthesia services needed for a particular
situation. This team of skilled RNs won an SSM Cardinal Glennon exceptional
service award within one year of starting the program.
3
Diagnostic Imaging
Lowest dose, most advanced technology in
diagnostic imaging is at SSM Cardinal Glennon
Kid-Friendly Space
Interactive suites include personalized lighting, music and image
displays that help reduce the need for sedation.
Technology
1.5T and 3.0T MRI: Detailed image quality, feet-first imaging and
wide bore access for larger and critically ill patients.
Two 128-Slice CT Scanners: Lowest dose technology (up to five
times less than standard pediatric doses), quicker scan times and
spectral imaging.
To make an appointment, please call: 314-577-5652, opt. 1
Fax orders to: 314-268-6472
4
Cardiology and Cardiothoracic Surgery
3000
300
2000
200
1000
0
2009
2010
2011
2012
2013
100
0
306
400
289
4000
170
500
160
5000
163
CGCMC Major Cardiac
Operations
4,886
survival rate for patients
who received treatment
for congenital heart
defects in 2010 – 2013
CGCMC Outpatient
Clinic Visits
4,366
97.3
%
4,242
Most experienced
pediatric cardiothoracic
surgery team in the St.
Louis region
All-encompassing cardiac care with special focuses:
Cardiothoracic surgery and heart transplantation
Fetal echocardiography testing
Interventional cardiology and hybrid procedures
Transcatheter pulmonary valve placement
Electrophysiology - state-of-the-art arrhythmia management including
fluoroless ablations and placement of pacemakers and ICDs
Cardiac MRI and CT
Adult congenital heart disease program
Collaboration with obstetrics, maternal-fetal medicine and neonatology to
deliver babies with congenital heart defects in need of immediate intervention
at SSM Cardinal Glennon
3,852
Only pediatric hybrid
cardiac catheterization
suite in the St. Louis
region
The SSM Cardinal Glennon Children’s Medical Center and SLUCare Physician
Group’s cardiology and cardiothoracic surgery team is ranked among the country’s
top pediatric heart programs in U.S. News & World Report’s 2014-15 Best
Children’s Hospitals. The growing group includes 10 pediatric cardiologists and
the most experienced cardiothoracic surgery team in the region.
3,459
Ranked among the
country’s top pediatric
heart programs in U.S.
News & World Report’s
2014-15 Best Children’s
Hospitals
2009
2010
2011
2012
2013
2013 Diagnostic testing and cardiac imaging
Echocardiograms
7,684
Fetal echocardiograms
552
Electrocardiograms
3,775
Holter® monitors
396
Stress tests
52
Total
12,459
2013 Cardiac catheterizations
SLUCare
Cardiothoracic Surgeons
Dr. Charles Huddleston and
Dr. Andrew Fiore
5
Interventional cardiac
catheterizations
150
Diagnostic cardiac
catheterizations
120
Electrophysiology cases
42
Total
312
2010-13 Survival rates at discharge
(all operations)
catheterizations
Interventional
cardiac
Diagnostic cardiac
catheterizations
catheterizations
150
120
Diagnostic
cardiac cases
Electrophysiology
catheterizations
120
42
Total
Electrophysiology
cases
312
42
Total
312
SLUCare Cardiology
and Cardiothoracic
Surgery Physicians
(all operations)
(all operations)
100%
100%
Kenneth Schowengerdt, MD
Director
Wieck-Sullivan Professor of
Pediatrics at Saint Louis
University School of Medicine
50%
50%
97.3%
96.5%
97.3%
96.5%
Cardinal Glennon
Society of Thoracic Surgeons (STS)
national averages
Cardinal Glennon
national averages
0
Saadeh Al-Jureidini, MD
0
2010-13 Survival rates by discharge (all operations)
2010-13 Survival rates by discharge (all operations)
100%
Susan Haynes, MD
SD
re
pa
SD
100%
A 100%
96% 96%
TG
0
A
0
TG
50%
91.5%91.5%
re
pa
ir 100%
ir 100%
V
V
SD
SD 100%100%
re
re
pa
pa
ir 100%
ir 100%
TO
TO 99% 99%
F
F
re
re
pa
pa
100%
100%
ir
ir
C
C
oa
oa 98.2%98.2%
rc
rc
t
t
re ati re ati
o
on
pa n pa100%
100%
ir
ir
98.5%98.5%
(C
(C
om C om C
A
A
pl VS pl VS
et D et100%
e)
e) D 100%
97% 97%
N
N
or
or
w
w
oo
oo
d 85.7%
d 85.7%
84.3%84.3%
re S re S
se ub se ub
ct A ct A
io S io100%
S 100%
n
n
99.7%99.7%
pr
pr
oc
o
ed Ro ced Ro
s
ur ss u100%
re s 100%
R
Re
os
os
91%
91%
pr s- pr soc Ko oc Ko
ed nn ed nn
o
ur o u100%
100%
re
e
50%
A
Andrew Fiore, MD
CV Surgeon
Jason Garnreiter, MD
100%
A
Saar Danon, MD
Charles Huddleston, MD
CV Surgeon
Wilson King, MD
Renuka Peterson, MD
M. Babak Rahimi, MD
Cardinal Glennon
national averages
Angela Sharkey, MD
Cardinal Glennon
national averages
Jamie Sutherell, MD
Advanced technology in state-of-the-art facilities:
SSM Cardinal Glennon is home to St. Louis’ only pediatric hybrid cardiac
catheterization suite, where diagnostic tests and surgical procedures are
performed in one space.
The Dorothy and Larry Dallas Heart Center at SSM Cardinal Glennon
enables the team to provide comprehensive care in one location.
SSM Cardinal Glennon unveiled the area’s most advanced imaging center that
includes a 3.0T MRI for detailed cardiac images interpreted by a dedicated
pediatric cardiac radiologist and pediatric cardiologist.
Fetal Echocardiogram (ECHO):
As early as 18 weeks gestation, doctors at the Fetal Heart Program can accurately
detect heart conditions through a fetal echocardiogram (Fetal ECHO). This
detailed ultrasound focuses on the intrauterine growth and development of the
heart and great vessels.
Appointments:
314-577-5674
Service Locations:
Child ren’s Med ical Center
St. Louis, MO
SSM Health St. Mary’s Hospital
Jefferson City, MO
SSM St. Joseph Hospital West
Lake Saint Louis, MO
Anderson Hospital
Maryville, IL
Good Samaritan
Regional Health Center
Mount Vernon, IL
6
Critical Care Medicine and
the Pediatric Intensive Care Unit
New state-of-the-art 18
room PICU with extensive
family space opened July
2014
Board-certified intensivist
in-house 24/7
Advanced technology
expertise:
Extracorporeal Membrane
Oxygenation (ECMO)
Advanced mechanical
ventilation techniques
Continuous renal
replacement therapies
Temperature regulation
therapies
Critical Care expertise for:
In 2013, 964 critically ill and injured children received critical care services in
the PICU at SSM Cardinal Glennon Children’s Medical Center.
The team that
ECMO
is necessary to provide this high intensity care30includes seven board-certified
pediatric intensivists, five nurse practitioners,25more than 80 registered
nurses,
27
86
20
more than 40 respiratory therapists, daily presence
of Child Life Specialists,
66
60
15
pediatric-trained occupational and physical therapists,
pharmacists with special
14
10 family support, palliative care
pediatric training, social workers, pastoral care
10
5
personnel, pain treatment team specialists, pediatric
nutrition support specialists
0
and the full complement of sub-specialty pediatricians
and pediatric surgeons
2013
2011
needed to provide quaternary care pediatric services. ECMO Run2012
Number
% Survival to Hospital Discharge
Every day in the PICU finds medical students, medical and surgical residents,
and students from Nursing, Respiratory Care, Occupational and Physical
Therapy, Pharmacy, Social Work and Pastoral Care learning about the allimportant team approach to PICU patient care. SSM Cardinal Glennon is
participating in an Accreditation Council for Graduate Medical Education
(ACGME) fellowship training program for physicians wanting to subspecialize
in Pediatric Critical Care Medicine.”
The PICU Patient (2013)
Solid organ and hematologicbased transplant program
Complex congenital heart
surgery
Age Range
Acute and chronic kidney
disease program
10
Complex airway surgeries
0
Provide education and
training in pediatric critical
care to pre-professionals,
professionals and support
staff at SSM Cardinal
Glennon and affiliated
institutions.
7
4.6 days
15
5
Complex neurosurgical
procedures
Provide the highest quality,
team-based pediatric
specialized minute-to-minute
monitoring, assessment,
technology support,
resuscitative and ongoing
proactive intervention for
infants, children and adults
with critical illness from any
Patient Program at SSM
Cardinal Glennon
33.4%
25
20
PICU Missions:
6
30
Technology-dependent
complex care patients
Critical endocrinology
emergencies
Length of Stay
35
18.3%
19.5%
18.9%
1.7 days
6.1%
<30
Days
4.2 days
3
3.8%
1-24
2-6
6-13
Months Years Years
13-19
>19
Years Years
0
Average
length
of stay
Median
length
of stay
Predicted LOS
adjusted by
PRISM severity
of illness
Admissions
100
61%
50
54%
52%
46%
39%
48%
0
Directly
from OR
Non-operative
Emergent
50% of SSM Cardinal Glennon
PICU patients receive care in the
PICU after complex surgeries.
50-60% of surgical admissions have
undergone complex congenital heart
surgery. The other surgical patients
have undergone tumor removal,
specialized cerebral spinal fluid
Pre-scheduled
with PICU
faculty
primary
service
Mortality
5
0
with PICU
faculty
concurrent
care
3.43%
3.23%
PI
predicted
mortality
PRISM
predicted
mortality
2.18%
Observed
mortality
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
management surgeries, complex airway surgery, complex spinal stabilization
surgeries or operative repair of injuries suffered after major traumatic events.
50% of PICU patients who do not require surgery are admitted for intensive
pulmonary support for asthma, bronchiolitis or pneumonia.
Other medical reasons for PICU admission or transfer are septic shock,
management of prolonged or persistent seizures, severe diabetes ketoacidosis
management, dehydration and major electrolyte derangements.
Extraordinary Technologies
SSM Cardinal Glennon offers ECMO (a prolonged form of cardiopulmonary
bypass) support to neonates and children for severe lung and heart failure.
Survival after ECMO nationally
runs between 40 and 75%
depending on the reason the
patient needs ECMO support.
SSM Cardinal Glennon ECMO
survival has continued to
match or exceed outcomes
reported by the Extracorporeal
Life Support Organization.
ECMO
30
25
27
86
20
15
10
5
66
60
14
10
0
2011
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2013
2012
SLUCare Critical
Care Physicians and
Providers
Lia Lowrie, MD,
Division Director of Critical
Care Medicine
Professor of Pediatrics
Saint Louis University School
of Medicine
Robert Ream, MD,
PICU Medical Director
Teresa Andreone, MD
Nandini Calamur, MD
Jeremy Garrett, MD
Jason Werner, MD
Michael Zahra, MD
ECMO Run Number
% Survival to Hospital Discharge
PICU Quality Program
Mary Beth Bevirt, CPNP-AC
The PICU Quality Improvement Program focuses on weekly interdisciplinary
reviews of all admissions and ongoing quality data. Data is pulled from several
multicenter databases useful for measuring SSM Cardinal Glennon’s progress
toward achieving quality goals and comparing to other PICUs across the
country. Mortality, medical device related infection, unintended extubation
rate, documentation and treatment of pain, quality of resuscitation processes and
The
PICUpathway
Patientare
(2013)
development of an ICU
asthma
all part of our QI Program.
Age Range
35
30
15
10
50
Kristina Scherrer, CPNP-PC
6
6.1%
<30
Days
4.6 days
0 ventilator associated pneumonia for more
than one year
4.2 days
3
19.5% line
Only one
central
18.9%associated infection for 2013
18.3%
Press Ganey satisfaction at 99th percentile
days
Risk adjusted mortality lower than predicted by two1.7scoring
systems
3.8%
1-24
2-6
6-13
Months Years Years
New PICU Opened
100
Michele Piole, CPNP-PC
33.4%
20
5
Mary Laffey, CPNP-AC
Length of Stay
Quality Program highlights:
25
0
Marian Dimovitz, CPNP-AC/PC
13-19
>19
Years Years
0
Average
length
of stay
Median
length
of stay
Predicted LOS
adjusted by
PRISM severity
of illness
Our remodeled and expandedAdmissions
18 room, 21 bed PICU has state-of-the-art
monitoring capabilities, improved infection control capabilities and new
communication technology allowing remote access to real-time patient
monitoring and electronic data. This new technology ensures real-time access
61%
for the multi-disciplinary team necessary
for quality intensive care. Beautiful,
54%
52%
48%
comfortable
family
support
facilities
provide
a more welcoming
and healing
46%
39%
environment.
0
Directly
Non-operative
Emergent
Pre-scheduled
with PICU
with PICU
Critical Care Medicine
Academic Office:
314-577-5395
8
Emergency Medicine
94%tile in patient
satisfaction in 2014
78 % of patients seen by
an emergency medicine
provider in less than 30
minutes from arrival in
2014
While providing exceptional care to more than 53,000 children every year, our
top priorities are: quick, easy access to the emergency department and satisfaction
for you and your patients.
Innovations
Input/Access – Call one number to speak with an attending physician 24/7, have
your patients seen quickly upon arrival and for emergent transfers.
is home to a Level I
Pediatric Trauma Center
and is a teaching hospital
affiliated with Saint Louis
University School of
Medicine.
Compassionate care
focusing on the entire
patient experience
Throughput – Immediate Bedding
In November 2011, “Immediate Bedding” was initiated so that patients would
have a shorter stay within our ER. The result is exactly that. Patients are walked
from the emergency department lobby to patient care rooms where triage
assessments are performed at the bedside. We “pull until full” 24 hours a day, 365
days a year.
Arrival to Room (Mean-Minutes)
20
15
10
5
0
17
7
11
2012
2013
2014
Door to Provider
(Percent of patients seen by provider in less than 30 minutes):
100
80
60
40
SLUCare Physician and
Emergency Department
Division Director Dr.
Robert Flood comforts
4-year-old Brandon who
has a high fever.
9
20
10
0
64%
84%
78%
2012
2013
2014
SLUCare Emergency
Medicine Physicians
Total Volumes
60,000
Robert Flood, MD,
Division Director,
Professor of Pediatrics,
Saint Louis University
School of Medicine 45,000
30,000
15,000
0
53,200
50,200
53,984
2012
2013
2014
Hemina Bailey, MD
Colleen Braun, DO
Rachel Charney, MD
Patient Satisfaction Press Ganey
Likelihood to Recommend (National %tile)
100
Kristen Covert, MD
Ann DiMaio, MD
Faye Doerhoff, MD
75
Jim Gerard, MD
50
Steve Laffey, MD
25
Renee Manley-Markowski, MD
0
71%
85%
94%
Al Nakanishi, MD, MPH
2012
2013
2014
John Peter, MD
Nadeem Qureshi, MD
Anthony Scalzo, MD
Teresa Schiff, MD
Trevor Tredway, MD, PhD
Jamie Velasco, MD
pediatricians are close
to home in the ER at:
SSM DePaul Health Center
Bridgeton, MO
SSM St. Clare Health Center
Fenton, MO
SSM St. Joseph Health Center
St. Charles, MO
St. Anthony’s Medical Center
St. Louis, MO
The Dan Dierdorf Emergency and Trauma Center
Missouri’s Longest Standing Level I Pediatric Trauma Center
Anderson Hospital
Maryville, Ill.
10
Endocrinology
Comprehensive care of
patients with growth
and complex endocrine
system disorders
One of 15 sites
participating in the
NIH-funded TODAY
(Treatment Options
for type 2 Diabetes in
Adolescents and Youth)
Study
Structured educational
program for high school
seniors with diabetes
transitioning to adult care
Focused clinical care and
research in Prader-Willi
syndrome
Multidisciplinary clinics
for patients with Turner
syndrome and lipid
disorders
7,000
outpatient visits
annually at SSM Cardinal
Glennon Children’s
Medical Center and four
outreach clinic locations
11
Growth Disorders
Children with a wide variety of growth disorders are evaluated by the
endocrinologists at SSM Cardinal Glennon and discussed in depth at the
Endocrinology Division’s weekly case conference. A full-time clinical nurse
performs specialized endocrine function testing and provides education in
endocrine disorders and instruction in rhGH therapy. For three decades,
members of the Endocrinology Division have participated in multi-center clinical
trials of growth hormone therapy and have contributed patient information to
post-marketing surveillance programs.
Turner Syndrome
The Way to Grow Turner Syndrome Clinic opened in June 2014 and provides
coordinated subspecialty care for girls in a centralized location. Meet and Greet
events are an important component of the clinic, offering girls and their families
opportunities to socialize, network and focus on topics of mutual interest.
Prader-Willi Syndrome (PWS)
Dr. Susan Myers in the Endocrinology Division and Barbara Whitman,
PhD, have collaborated for more than 20 years to study the effects of growth
hormone therapy in infants, children and adults with Prader-Willi Syndrome.
Affected individuals from newborns to adults are treated in a monthly, multidisciplinary PWS Clinic. Current research focuses on the effects of modern
medical management, including growth hormone therapy, on gonadal function
in adolescents with PWS. Drs. Myers and Whitman are active in the PraderWilli Syndrome Association USA, serving on the Clinical and Scientific Advisory
Committees.
Lipid Disorders
In 2012, the NIH-sponsored Expert Panel on Integrated Guidelines for
Cardiovascular Health and Risk Reduction in Children and Adolescents and the
American Academy of Pediatrics recommended universal screening of children for
lipid disorders to reduce risk of cardiovascular disease in adulthood. In response
to the increasing number of children screened for lipid disorders at their wellchild visits, the Endocrinology Division reviews records of patients with abnormal
blood lipids and recommends further testing and/or refers patients for evaluation
and intervention in the Lipid Disorders Clinic. There, the child and his/her
parent are seen by an experienced dietitian and Division faculty member or PNP
and receive recommendations on dietary changes and other lifestyle interventions.
Some cases then are prescribed medications and monitored.
Diabetes
The Diabetes Service at SSM Cardinal Glennon has grown rapidly in the last few
years. Currently, an average of ~125 patients/year with new onset diabetes are
referred for care and ~40 patients/year transfer their care to the Endocrinology
Division. Most of these children have type 1 diabetes, but ~15% have type 2
diabetes and 6% have cystic fibrosis related diabetes. Clinical nurse educators
and dietitians provide in- and out-patient diabetes education and instruct patients
in intensive regimens including CSII (insulin-pump) therapy and continuous
glucose monitoring programs. In addition, they maintain a high level of in-patient
diabetic care through education of the hospital nursing staff. A dedicated social
worker and a child psychologist are available to offer psychosocial evaluation and
therapy.
SLUCare Endocrinology
Physicians and
Providers
The Diabetes Team at SSM Cardinal Glennon initiated a state-of-the art Diabetes
Transition Program for high school seniors transitioning to adult care in 2011.
Seniors attend several education sessions with a diabetes nurse educator, dietitian
and, if needed, social worker. Many important topics are reviewed, such as
preparing for college life, handling sick days, safe driving and refilling prescriptions.
A binder with relevant handouts and websites is provided to each senior.
Sherida E. Tollefsen, MD
Director
Type 2 Diabetes
In response to the growing epidemic of type 2 diabetes in childhood, the
Endocrinology Division is participating in industry-sponsored trials investigating
drugs for type 2 diabetes and in the NIH-funded, multi-center TODAY
(Treatment Options for type 2 Diabetes in Adolescents and Youth) Study.
David P. Dempsher, MD, PhD
Mark C. Eddy, MD
Susan E. Myers, MD
Margaret K. Siska, MD
Matt Lunneen, PNP-BC, CDE
Bonnie Wolff, PNP, CDE
1 of 15 centers in the TODAY Study
The Saint Louis University site is led by Dr. Sherida Tollefsen, PI, and Dr. David
Dempsher, co-investigator. The research protocol was designed to evaluate
the efficacy of three treatment regimens (metformin alone, metformin plus
rosiglitazone and metformin, plus intensive lifestyle intervention) on time to
treatment failure based on glycemic control. Nationwide, 1,211 subjects were
screened, 927 subjects proceeded to run-in and 699 subjects were randomized into
one of the treatment regimens and were treated for at least two years. The figure
below compares the performance of the SLU site with the entire TODAY Study
group. The percentages of screened participants entering run-in, of participants
successfully completing run-in and of randomized participants that have been
retained were higher at the SLU site. Overall, 72.2% of screened participants were
randomized at SLU (compared to 57.7% study-wide) and 94.9% of randomized
participants have been retained (compared to 80.4% study-wide).
SLU Site Comparison with TODAY Study Group
Study Group
Appointments:
314-577-5648
CGCMC/SLU
100
Service Locations:
St. Louis, MO
80
St. Luke’s Hospital
Chesterfield, MO
40
South St. Louis
0
Screened
participants
entering run-in
Participants successfully
completing run-in
and randomized
Randomized
participants
retained
94.9
80.4
81.2
75.4
10
88.9
20
76.5
Percent
60
Southeast Missouri Hospital
Cape Girardeau, MO
Anderson Hospital
Maryville, IL
12
Gastroenterology and Hepatology
One of seven pediatric
hospitals taking part
in the Non-alcoholic
Steatohepatitis Clinical
Research Network to find
treatments for obesityrelated liver disease.
Inflammatory Bowel Disease (IBD) – Crohn’s Disease and Ulcerative Colitis
Multidisciplinary team
includes two dedicated
GI PNPs, adolescent
psychologists, dietitians,
and feeding and weight
management specialists.
Alpha-1-Antritrypsin Deficiency
Active celiac disease
program with diagnostic,
patient care, and
educational programs.
Focused clinical care and
research in eosinophilic
esophagitis and other
aspects of food allergy.
3 year graft survival and
patient survival rate of
liver transplant patients
has been 100%.
The gastroenterology and hepatology team includes a dedicated IBD coordinator
and follows more than 200 patients with IBD. An IBD diagnosis involves an indepth evaluation when one or more signs are present. The department is an active
member of ICN, a national database registry of IBD patients.
For two decades, Department Director Dr. Jeffrey Teckman has studied basic liver
chemistry and led Alpha-1 research efforts. SSM Cardinal Glennon and Saint Louis
University are part of a leading network of pediatric hospitals across North America
sponsored by the National Institutes of Health to study and develop treatments
and cures for a range of cholestatic liver diseases including Alpha-1. Due to the
common misdiagnosis of Alpha-1, the GI team tests for Alpha-1 during all liver
evaluations and sometimes even when evaluating failure to thrive or poor growth.
Fatty Liver Disease
With funds from the National Institutes of Health, SSM Cardinal Glennon
and Saint Louis University are one of seven pediatric hospitals taking part in the
nationwide Non-alcoholic Steatohepatitis Clinical Research Network to find
treatments and diagnostic modalities for pediatric non-alcoholic steatohepatitis
(NASH) and non-alcoholic fatty liver disease (NAFLD).
Liver Transplant
For more than 20 years, pediatric liver transplant outcomes at SSM Cardinal
Glennon have been consistent with or above national transplant benchmarks.
This successful program is staffed by physicians UNOS-certified in transplant
medicine and specialized nurse coordinators with national accreditation. The
transplant program is CMS certified and is a member of the United Network for
Organ Sharing.
Waiting list mortality rates
(Jan. 2013-Dec. 2013)
SLUCare Physician and GI
Division Director Dr. Jeffrey
Teckman visits with his
patient Gabe Heller who
is receiving a Remicade
infusion for Inflammatory
Bowel Disease.
13
Rate per 100
Person Years
2.0
1.5
1.0
0.5
0.0
0.0
1.6
Scientific Registry of
Transplant Participants
First-year pediatric graft and patient survival
(Jan. 2011-June 2013)
100%
80%
Rate
Pers
0.5
0.0
0.0
1.6
First-year pediatric graft and patient survival
(Jan. 2011-June 2013)
100%
80%
0%
Graft Survival
(7 transplants)
Hepatitis B
87.30%
20%
100%
100%
40%
87.88%
60%
Patient Survival
(6 transplants)
In an effort to better diagnose and treat pediatric patients with Hepatitis B, SSM
Cardinal Glennon and Saint Louis University are part of the national Hepatitis
B Research Network (HBRN), which consists of seven leading pediatric
hospitals and is funded by the National Institutes of Health.
SLUCare
Gastroenterology and
Hepatology Physicians
and Providers
Jeffrey H. Teckman, MD
Professor of Pediatrics and
Biochemistry and Molecular Biology,
Director
Thomas M. Foy, MD
Ajay Jain, MD
Assistant Professor of Pediatrics
Nisha Mangalat, MD
Helen Pappa, MD, MPH
Short Bowel Syndrome
SSM Cardinal Glennon has a multidisciplinary team of GI physicians, surgeons
and therapists who provide intestinal rehabilitation, bowel lengthening and
nutritional management as well as home nutrition technology and appliance
placement for pediatric patients with short bowel syndrome.
Neurogastroenterology
The department addresses the “gut-brain connection” through guided imagery
with specially trained staff, availability of dedicated psychologists and special
consultations for pediatric motility.
Hepatitis C
The only pediatric center in Missouri offering updated Gilead during trials.
There has been a revolution in the treatment of hepatitis C infection, however,
some new medications are not available to all children. Our center offers access
to the newest treatments, which in many cases are available at no other pediatric
center in Missouri.
Jerry Rosenblum, MD, MPH, MBA
Laura Hotle, RN, CPNP
Kathleen Spranaitis, RN, CPNP
1 of 7
pediatric hospitals
taking part in the
nationwide Non-alcoholic
Steatohepatitis Clinical
Research Network
Appointments:
314-268-4010
Service Locations:
SSM Card inal Glennon
St. Louis, MO
St. Luke’s Hospital
Chesterfield, MO
The gastroenterology
and hepatology team at
South St. Louis
Anderson Hospital
Maryville, IL
14
Hematology/Oncology
Serves as a sickle cell
treatment center for both
Missouri and Illinois
First federally designated
pediatric Comprehensive
Hemophilia Treatment
Center in the St. Louis
area
89% survival rate for
blood and marrow
transplant procedures
The hematology-oncology team treats children and adolescents with a wide
variety of malignant tumors. We also have a large sickle cell/hemoglobinopathy
program and the oldest federally-designated pediatric Comprehensive Hemophilia
Treatment Center in the St. Louis area. Because of continued improvement in the
treatment of children with cancer, their cure rate now approaches 90%. Especially
for children with solid tumors, this success is dependent upon the coordinated
efforts of multiple medical specialties, and recent recruitments have allowed us to
increase the breadth of our multi-disciplinary treatment teams.
Higher cure rates also bring new challenges: currently more than 1 in 640 young
adults is a cancer survivor, and these individuals have a higher rate of medical
problems than the population at large. Our Long-Term Follow-Up program
is designed to help these individuals transition their medical care as they enter
adulthood, and has expanded to include special clinics to help survivors of brain
tumors and those who have undergone stem cell transplantation.
Bone and Soft Tissue Sarcomas
Children with bone tumors or soft tissue sarcomas benefit from a treatment team
that can focus on both maximizing the chance of cure as well as optimizing future
function. Dr. William Ferguson has been active in the design and implementation
of national protocols for the treatment of bone tumors for over 25 years and has
participated in many of the trailblazing clinical trials in this field. Working closely
with Dr. David Greenberg (Orthopedic Oncology) and Dr. John Dombrowski
(Radiation Oncology), this team provides a highly integrated approach to treating
these complex patients.
Neuro-Oncology
Children with brain tumors often present unique challenges since both disease and
treatment can place them at risk for long-term cognitive issues. Implementing
a highly coordinated multi-disciplinary approach is essential for helping these
children not only survive, but thrive. Dr. Mohamed Abdel-Baki recently joined
SSM Cardinal Glennon from Texas Children’s/Baylor School of Medicine, which
has one of the largest brain tumor training programs in the country. Drs. Samar
Elbabaa of Neurosurgery, John Dombrowski of Radiation Oncology, and Thomas
Geller of Neurology are primary members of this team, which also draws heavily
on the expertise provided by highly experienced providers in physical therapy,
occupational therapy, developmental pediatrics, and stem cell transplantation.
Hematology/Oncology
Division Director
Dr. William Ferguson
jokes with Lauren Lee
during a checkup and
chemotherapy treatment.
15
Blood and Marrow Transplant Program
The transplant program continues to grow and maintain one of the highest survival
rates among similarly sized centers. The program is accredited by the Foundation
for Accreditation of Cellular Therapy (FACT) and is an approved transplant center
for the Children’s Oncology Group. We are also active in the Pediatric Blood and
Marrow Transplant Consortium research group.
Personalized Medicine
Despite having achieved high cure rates, there are still children whose tumors
relapse and for whom curative treatment is often elusive. As part of the
Neuroblastoma and Medulloblastoma Translational Research Consortium, SSM
Cardinal Glennon is one of a handful of centers in the United States offering an
innovative clinical trial that utilizes genomic analysis of tumors to guide therapy.
Part of a larger research program funded by Dell Computer, this study is designed
to help develop more individualized approaches to cancer treatment.
S
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Chemotherapy Safety Initiative
SSM Cardinal Glennon has a multi-step process for writing and verifying
chemotherapy orders that has almost eliminated the incidence of errors that
actually reach the patient (high-impact errors). However, we felt that lowimpact errors (such as clerical errors that would not cause an adverse effect on a
patient) and intermediate-impact errors (those that might have had an impact
if not corrected during the verification process) provide a window into process
issues that might increase the risk of high-risk errors reaching patients. Thus, we
instituted a program to meticulously review all orders and to flag all errors and
omissions, regardless of how minor, with feedback to the clinicians. As shown in
figure 1, after just 6 months this
Figure 1
has resulted in a greater than
Low
Intermediate
Low
80% decrease in the number of 35
low- and intermediate-impact
30
5
errors; during that time, the
25
20
only potentially high-impact
1
15
5
error was an inadvertent 2-day
3
2
1
3
7
10
delay in therapy that had no
5
28
14
9
9
10
4
5
adverse effect on the patient.
0
SLUCare Hematology/
Oncology Physicians
and Providers
William Ferguson, MD
Director
Professor of Pediatrics at Saint
Medicine
Deepika Bhatla, MD
Christopher Hugge, MD
John Puetz, MD
Shermini Saini, MD
Mohamed Abdel-Baki, MD
Leili Dolatshahi, MD
Aleksandar Babic, MD, PhD
Abigail Sharamitaro, RN, MSN,
CPNP, CPON
Lindsay Brefeld, RN, MSN,
CPNP
Lauren Delaschmit, RN, MSN,
CPNP
Robert Parker, RN, MSN, CPNP
We strive to provide
a friendly, comforting
environment where
patients and families
are not only treated
as individuals, but as
partners in working
toward a cure.
The Costas Center opened in 1998 and uses a team approach to
diagnose and treat children with cancer and blood disorders. It
provides a comfortable setting for children to receive prolonged
treatments, such as chemotherapy and transfusions without having
to be admitted to the hospital. Our physicians are leaders in the use
of umbilical cord blood stem cell transplants for cancer and lifethreatening blood and immune disorders.
- Dr. William Ferguson
Division Director
Appointments:
314-268-4000
16
Neonatology
Level IV Neonatal
Intensive Care Unit
(the highest level of
designation)
Extra Corporeal
Membrane Oxygenation
(ECMO) availability 24/7
In-house Neonatal
Attendings 24/7
Private room for every
baby
Recognized as a Neonatal Center of Excellence by the American Accreditation
Healthcare Commisison, the Dana Brown Neonatal Intensive Care Unit (NICU)
at SSM Cardinal Glennon Children’s Medical Center provides tertiary and
quaternary levels of care for the most acute patients. The neonatology team
includes 18 board-certified neonatologists as well as dedicated, specialty-trained
neonatal nurses.
Patients and their families benefit from the comfort of the NICU’s 65 private
rooms, personalized care guaranteed with a low patient-to-nurse ratio and
attending neonatologists in-house 24/7. Multidisciplinary teams of pediatric
specialists, including a skilled Extra Corporal Membrane Oxygenation (ECMO)
group, are also available around-the-clock to provide the highest level of care for
the most complex diagnoses. In addition, ongoing support is offered to families
and NICU graduates.
Mortality in babies ≤1000 gm
(compared to Vermont Oxford Network (VON) average)
35
30
25
20
15
10
5
0
22%
26%
2009
21%
26%
2010
19%
26%
2011
20%
26%
22%
2012
32%
2013
VON Average
Length of stay for babies <1000 gm
(compared to Vermont Oxford Network (VON) average)
112
Length of Stay (days)
110
108
106
104
102
100
98
96
94
105
92
111
112
2012
Neonatology Division Director
Dr. Farouk Sadiq and SLUCare
Physician and Division
Director of Cardiothoracic
Surgery Dr. Andrew Fiore
visit with Baby Cosmo who is
recovering from pacemaker
placement surgery.
17
VON Average
Dedicated Neonatal Transport Team
The specially trained neonatal transport team is available 24/7 to stabilize and
transport critically ill newborns from around the region to the Level IV NICU at
SSM Cardinal Glennon. A registered nurse and respiratory therapist, both with
extensive training in the stabilization, treatment and transport of neonates, staff
each transport. Physicians also accompany the transport team when appropriate
or requested.
Each member of the team has completed advanced training, such as:
Two years of critical care pediatric nursing in the Neonatal Intensive Care
Unit, Pediatric Intensive Care Unit or Emergency Department
Classroom training and eight to ten weeks of mentor/preceptor training with
an SSM Cardinal Glennon transport nurse
PACTS (Pediatric Advanced Life Cardiorespiratory and Trauma Support) for
Life and PALS (Pediatric Advanced Life Support) courses
SLUCare Neonatology
Physicians
Farouk Sadiq, MD,
Director
Associate Professor of
Pediatrics at Saint Louis
Mohamad Al-Hosni, MD
A minimum of eight hours of continuing education in trauma nursing
per year
Ayoob Ali, MD
One pediatric intubation per quarter
Thomas Bender, MD
Neonatal resuscitation
Connie Anderson, MD
Robert Brooker, MD
Laura Cerny, MD
The neonatal transport fleet includes a dedicated ambulance and helicopter,
“Cardinal Glennon Air.” Sole access to these mobile ICUs allows the most critical
patients to travel with the care they need, as quickly as possible.
Cathy Cibulskis, MD
SSM Cardinal Glennon NICU features privacy, comfort and access to resources:
Unrestricted visiting hours for parents, siblings and family
Noah Hillman, MD
Colleen Claassen, MD
Robert Fleming, MD
Justin Josephsen, MD
Private in-suite nursing areas, breast pumps, lactation consultants and
personal refrigerators in each suite for nursing moms
William Keenan, MD
In-hospital Ronald McDonald Room and nearby Ronald McDonald House
for families and guests
Shakir Mohamed, MD
Dedicated social workers, pastoral services and mental health services
available for families
Kimberly Spence, MD
NICU Benchmarking Collaborate
Each year, the NICU actively participates in a number of benchmarking
collaborative and data sharing organizations which guide our quality initiatives
and allow for benchmarking with similar NICUs to improve key outcome
measures. The NICU participates in the following:
Vermont Oxford Database: This is an international database that collects and
analyses data from almost 90% of low birth weight babies born in the U.S.
and 27 countries around the world.
The Illinois Perinatal Collaborative is focused on measures to improve the
care delivered to babies during the “Golden Hour” after birth.
The Perinatal Quality Collaborative North Carolina is focused on improving
care given to babies with neonatal abstinence and their families.
Solutions for Patient Safety is a data sharing and collaborative that studies re-admissions, central line associated bloodstream infections (CLABSI), catheter associated urinary tract infections, ventilator associated pneumonia
and pressure ulcers.
Research
The SSM Cardinal Glennon neonatology team continues to expand its research
with NIH-funded researchers in the fields of neonatal immunity, iron
metabolism, preterm lung injury, inborn errors of metabolism and liver disease.
Joyce Koenig, MD
Akihiko Noguchi, MD
Marya Strand, MD
Contact:
314-577-5663
Service Locations:
St. Louis, MO
SSM DePaul Health Center
Bridgeton, MO
SSM St. Clare Health Center
Fenton, MO
SSM St. Joseph Health Center
St. Charles, MO
SSM St. Mary’s Health Center
Clayton, MO
South St. Louis
Memorial Hospital
Belleville, IL
18
Nephrology
Comprehensive care of
patients with Kidney
Disease, including a
dedicated Pediatric
Dialysis Unit and active
Renal Transplant
program
Comprehensive
Hypertension Program
Participation in
Multidisciplinary Fetal
Care Consultation for
Serious Kidney Disease
One of 32 Pediatric
Centers participating
in the NIH funded
Cure GN Study (Cure
Glomerulopathy
Network)
The Renal Team is specially trained to treat a variety of conditions
from Recurrent Urinary Tract Infections to Hypertension to Acute and
Chronic Kidney Failure requiring dialysis and/or transplantation. This
multidisciplinary team includes physicians, renal nursing, dialysis nursing,
a renal dietician, renal social worker, play therapist and school teacher. Our
team works closely with other specialists, particularly Pediatric Urology,
Radiology, Pediatric Surgery and the Surgical Transplant team from Saint
Louis University.
Hypertension
As obesity rates in the US have increased, so has the frequency of hypertension
related to this major public health issue. The Renal Division is fortunate
to have the expertise of Dr. Craig Belsha, to lead the Comprehensive
Hypertension program at SSM Cardinal Glennon. Dr. Belsha has a weekly
hyptertension clinic located in the Dorothy and Larry Dallas Heart Center
and leads the ambulatory BP monitoring (ABPM) program.
Fetal Care, Nephrology
SSM Cardinal Glennon has a multidisciplinary team of high-risk obstetrical
specialists, pediatric nephrologists and pediatric urologists that provide care
to mothers in the St. Louis Fetal Care Institute. In the St. Louis Fetal Care
Institute, Dr. Rich Feldenberg, pediatric nephrologist, evaluates unborn
babies with congenital, structural and genetic defects of the kidneys and
urinary tract, and is able to better determine which babies will require a higher
level of care immediately following delivery. Common problems managed
in the St. Louis Fetal Care Institute include bladder outlet obstruction,
hydronephrosis, renal dysplasia and Autosomal Recessive Polycystic Kidney
Disease. Babies born with kidney failure can often be offered life-saving
therapies, including dialysis and eventually kidney transplantation, both of
which are offered by the SSM Cardinal Glennon Nephrology team.
Pediatric Nephrology was ranked among the
Top 50 Centers providing Nephrology Care in 2014 by
US News and World Report.
SLUCare Physician Dr.
Elizabeth Abraham, Director
of Continuous Acute Dialysis
Treatments, leads the team
for continuous venovenous
hemofiltration with or
without dialysis.
19
Diabetes
Dr. Ellen Wood, Medical Director of the SSM Cardinal Glennon Pediatric
Dialysis Unit, leads a staff of specially trained pediatric dialysis doctors and
nurses. Additionally, the team is supported by a social worker, dietician, child
life therapist and in-house school teacher. The team provides Hemodialysis
and Peritoneal dialysis, including a CMS-certified PD training program.
The desired treatment plan for HD patients is to surgically create an AV
fistula, if at all possible. However, babies and young children as well as
patients presenting with renal failure often do not have that option. For that
reason, dialysis catheters are often needed in this population and infection is a
complication of these lines, just like any central line.
We monitor infection rates monthly:
SLUCare Nephrology
Physicians and Providers
HD Catheter associated BSI/patient months
2.0
Ellen G. Wood, MDr
Division Director Pediatric
Nephrology, Medical Director
of Pediatric Dialysis and Renal
Transplantation
1.5
1.0
0.5
1.2
100
1.35
100
2011
2012
0
100
0
100
2013
2014
0.0
Craig W. Belsha, MD
Director Hypertension Program
The Division received a $200,000 Grant from the Deaconess
FoundationHD
over
the next
five yearsBSI/patient
to provide months
needed dialysis
Catheter
associated
equipment
for
better
treatment
of
our
dialysis
patients.
2.0
1.5
Transplant 1.0
1.2
1.35
0 transplant in
0 the state of
In 1984, the0.5
youngest 100
child ever to 100
receive a kidney
100
100
Missouri to date
was
transplanted
at
SSM
Cardinal
Glennon.
The
following
0.0
KidneyGlennon
Graft Survival
Patient
year, SSM Cardinal
dialyzed the first babyKidney
from birth
whoSurvival
received a
Living Donor and Deceased Donors
Living Donor and Deceased Donors
2014
2012
2011
2013
kidney transplant at 10 months old. Since the 1980’s, SSM Cardinal Glennon
1/1/2011-6/30/2013
1/1/2011-6/30/2013
has had an active Kidney Transplant program and includes combined Liver-Kid100%
ney100%
Transplant in collaboration with our GI
team led by Dr. Jeff Teckman and
Dr. 75%
AJ Jain and our Organ Transplant team75%
led by Dr. Betsy Tuttle-Newhall.
This50%
multidisciplinary team also includes Transplant
Coordinators, a Transplant
50%
Pharmacist, Social Worker, Dietician, Play Therapist and School Teacher. Our
25%
25%
current
patient
and90graft survival
are
comparable
to100national
data. 99.6
The program
93.3
96.9
88.2
100
98.3
is CMS
0 Network for Organ Sharing
0 certified and is a member of the United
1 year 3 years
1 year 3 years
1 year 3 years
1 year 3 years
(UNOS).
CG
US-SRTR DATA*
CG
US-SRTR DATA*
Kidney Graft Survival
Kidney Patient Survival
1/1/2011-6/30/2013
1/1/2011-6/30/2013
*SRTR- Scientific
Registry of Transplant
recipients
Living Donor and Deceased
Donors
Living Donor
and Deceased Donors
100%
100%
75%
75%
50%
50%
25%
25%
0
93.3
1 year
90
3 years
CG
96.9
1 year
88.2
3 years
US-SRTR DATA*
0
Elizabeth Abraham, MD
Assistant Professor of Pediatrics,
Director of Acute Renal
Replacement Therapies
Renal/Hypertension Nursing:
Kathy Leible, RN
Amy Stultz, RN
Amy Weston, RN
Dialysis Nursing:
Pam Brouder,RN;
Director PICU, TCU and Dialysis
Services
Lynn Yates, RN, Head Nurse
Jacque Tanquary, RN,
Vascular Access Coordinator
Francine Graham, RN
Carolyn Berwin, RN
Susan Fleming, RN
Mary Huffman, RN
100
100
99.6
98.3
1 year
3 years
1 year
3 years
CG
L. Richard Feldenberg, MD
Assistant Professor of Pediatrics,
Primary Nephrologist for the
St. Louis Fetal Care Institute
US-SRTR DATA*
*SRTR- Scientific Registry of Transplant recipients
Clinical Research Studies
The division is participating in several multi-center studies with the Midwest
Pediatric Nephrology Consortium Study Group as well as pharmaceutical trials.
As a division, it is also participating in two multi-center NIH studies including
the CKID Study and Cure GN Study.
Transplant Coordinators:
Michelle Romano, RN,
Director of Transplant Services
Erin Foristal, RN, Head
Coordinator
Julie Feldenberg, RN
Kate Hoerchler, Financial
Coordinator
Contact:
314-577-5306
20
Neurosurgery
Experts in minimally
invasive neurosurgery
One of the fastest growing
fetal myelomeningocele
repair programs in the
United States
The Pediatric Neurosurgery Department at SSM Cardinal Glennon
Children’s Medical Center is equipped with state-of-the-art technology,
providing specialized care for patients near and far. Our team of physicians
are trained to provide exceptional care for problems related to a child’s brain,
spinal cord or central nervous system.
Excellent outcomes are dependent on
surgical planning, coordination and collaboration.
The neurosurgery team at SSM Cardinal Glennon
Children’s Medical Center works tirelessly,
collaborating with multiple pediatric subspecialties
in preparation for surgery to achieve the best
outcomes for patients and their families.
Pediatric Brain Tumor Clinic
This multidisciplinary clinic meets bi-monthly to continue care of patients
who have had brain tumors removed. Following diagnosis and surgery,
patients are typically seen once every three months for a year, depending on
the patient. Specialists from a variety of fields are available to help care for
our patients with brain tumors, including:
Neurosurgery
Neurology
Neuro-Psychology
Radiation-Oncology
AudiologySocial Services
Neuro-Oncology
Endocrinology
Minimally invasive neurosurgery
In the last 10-15 years, the practice of minimally invasive neurosurgery
has grown and become standard of care for the management of certain
conditions at institutions with proper surgical expertise and technology.
Neurosurgery Division
Director Dr. Samer Elbabaa
removes a posterior fossa
cerebellar tumor from a
16-year-old boy.
21
In contrast to an open neurosurgical procedure, minimally invasive
neurosurgery requires just a few small incisions, shortens recovery time and
reduces pain, blood loss and scarring. The surgery, which typically lasts only
30-60 minutes, requires a tiny endoscope, small pump, video camera and a
special light source. Dr. Elbabaa’s clinical and research specialties involve the
practice of minimally invasive neurosurgery.
Endoscopic applications performed by the team include:
Endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus
SLUCare Neurosurgery
Endoscopic tumor biopsy and removal for intraventricular tumors
Endoscopic fenestration of arachnoid cysts
Endoscopic placement of ventricular catheters in shunts
Samer Elbabaa, MD, FAANS, FACS
Director
Associate Professor of
Neurosurgery at
School of Medicine
Endoscopic trans-sphenoidal surgery for sellar and supra-sellar tumors
Saleem Abdulrauf, MD, FACS
Endoscope-assisted microsurgery
Richard Bucholz, MD, FACS
Endoscopic resection of colloid cysts
Endoscopic simplification of multi-loculated hydrocephalus
Endoscopic strip craniectomy for craniosynostosis
Endoscopic choroid plexectomy
Anne Gildehaus, RN, MSN,
CPNP-AC
Endoscopic aqueductoplasty
Theresa Willard, RN, BSN
Endoscopic spinal surgery
Fetal Myelomeningocele Repair
In partnership with the St. Louis Fetal Care Institute at SSM Cardinal
Glennon, Dr. Elbabaa performs open fetal operations on babies with the most
severe form of spina bifida. Prenatal treatment helps reduce, or even eliminate,
the major complications of Myelomeningocele, which include hydrocephalus,
Chiari malformation and lack of movement in the lower extremities. The St.
Louis Fetal Care Institute has one of the fastest growing fetal myelomeningocele
repair programs in the country. See page 31 for more information.
Our skills and specialized
training allows our pediatric
neurosurgery team to
successfully perform complex
surgeries others won’t
attempt.
-Dr. Samer Elbabaa
Division Director
Contact:
314-577-5306
22
Nuclear Medicine
New $1.6 million Nuclear
Medicine Suite
Ambient lighting and
Child Life Specialist help
make the experience
more enjoyable for the
patient
Pediatric Nuclear
Medicine helps diagnose
childhood disorders that
are congenital or develop
through childhood
In March 2015, SSM Cardinal Glennon Children’s Medical Center built a
new $1.6 million Nuclear Medicine Suite featuring the newest technology
available in Nuclear Medicine. This state-of-the-art technology allows the
nuclear medicine images and computed tomography (SPECT/CT) imaging
to be performed at the same time. With this equipment, the information
from two different exams can be correlated and interpreted on one image,
therefore leading to precise information for diagnoses.
Nuclear medicine procedures are able to pinpoint molecular activity
within the body, offering the potential to identify disease in its
earliest stages as well as a patient’s immediate response to therapeutic
interventions.
Nuclear medicine imaging procedures are noninvasive and, with the
exception of intravenous injections, are usually painless medical tests that
help physicians diagnose and evaluate medical conditions.
Our ambient lighting and dedicated staff help make your child’s
experience as enjoyable as possible. Our Child Life Specialist is available
and provides age-appropriate distraction techniques to help ease anxiety
and avoid sedation whenever possible.
The
new Nuclear
Medicine suite
helps ease the
fears of patients
with the help of
the Child Life
Team.
23
Pediatric nuclear medicine imaging can be performed to help diagnose
childhood disorders that are congenital (present at birth) or that develop
during childhood.
Physicians use nuclear medicine imaging to evaluate organ systems,
including the:
Kidneys and bladder
Bones
Liver and gallbladder
Gastrointestinal tract
Heart
Lungs
Brain
Thyroid
Nuclear medicine scans are typically used to help diagnose and evaluate:
Urinary blockage in the kidney
SLUCare Nuclear
Medicine Physicians
Medhat M. Osman, M.D.,
Sc.M, Ph.D.
Professor of Radiology and
Nuclear Medicine at Saint Louis
Director of Nuclear Medicine
and PET/CT
Razi Muzaffar, DO
Assistant Professor of Radiology
at Saint Louis University
School of Medicine
Director of Pediatric Nuclear
Medicine
Jeffrey J. Brown, M.D., F.A.C.R.
Chair, Department of Radiology
Professor of Radiology at
School of Medicine
Shannon Farmakis, M.D.
Assistant Professor of Radiology
at Saint Louis University
School of Medicine
Director of Pediatric Radiology
Backflow of urine from the bladder into the kidney (reflux)
Bone cancer, infections and trauma
Gastrointestinal bleeding and motility
Tumors and the spread of cancerous cells in the body
Jaundice in newborns and older children
Epilepsy
Location, anatomy and function of the thyroid gland
Contact: 314-268-5652
24
Pulmonology
Asthma core measures
above 99% in 2014
Nationally recognized
and accredited care
center by the Cystic
Fibrosis Center
Accredited pediatricfocused sleep lab since
2009
National Quality Award
from the Cystic Fibrosis
Foundation recognizing
outstanding QI processes
and accomplishments
Partnership with Ranken
Jordan consisting
of monthly multidisciplinary rounding
At SSM Cardinal Glennon, our experienced pulmonology specialists provide
expert treatment for all pulmonary disorders from asthma to cystic fibrosis to
sleep disorders. No matter the severity, our specialists take the time to connect
with each patient at their routine checkups, making for lifelong bonds between
patient and caregiver.
3.2%
Asthma
Strict adherence to asthma protocols and admission order set ensures quality care
for pediatric patients.
Asthma Readmission Rate
Inpatient Asthma Core Measures
100
2.0
75
1.5
50
1.0
25
0
.5
99.4%
99.6%
97.87%
99.58%
2011
2012
2013
2014
0
0.82%
1.0%
1.8%
2011
2012
2013
1.9%
2014
(through July 4)
Asthma Pathway
In July 2012, an asthma pathway project was implemented to standardize care
and provide
3.2% efficient weaning of beta-agonists. Based on standard analysis
utilizing control charts, the pathway significantly decreased the length of stay
and decreased the variation in care for asthma patients. With this decrease in the
length of stay, the asthma patient readmission rate has remained essentially zero
and the assessment score has improved communications between physicians and
respiratory therapists.
50
37.5
25
12.5
43.4 hours
33.3 hours
0
Mean length of stay before
pathway implementation
Mean length of stay after
pathway implementation
Cystic Fibrosis
The pulmonology team is accredited by the Cystic Fibrosis Foundation and has
been recognized twice in the past five years for “Outstanding QI Processes and
Accomplishments.”
SLUCare Physician
and Division Director
Dr. Blakeslee Noyes with
cystic fibrosis patient,
Kyle Stewart
25
Quarterly visits are
recommended as part of the
CF national care guidelines.
Our goal is to establish
consistent quarterly clinic
visits for our CF patients.
Percent Quarterly CF Visits
100
75
50
25
0
60%
69%
88%
2012
2013
2014
Mean BMI percentile for patients
2-19 years
3.2%
60
OGTT Screening in Non-Diabetic
Patients 10 to 17 Years
55
Influenza Vaccination
in Patients
6 months to 17 years
100
100
75
75
50
50
25
25
0
54
41
2011
55
43
2012
87
50
0
50
92
2010
2013
2%
2011
2010
95
Average
100National
93
100
96
99
2011
2012
SLUCare Pulmonology
Physicians and
Providers
97
2013
National Average
Median weight percentile 2-19 years
Blakeslee Noyes, MD
SSM
Cardinal Glennon
Director
Children’s
Medicalof
Center
Professor
Pediatrics at
School of Medicine
Gary Albers, MD
50
Shalini Paruthi, MD
Director of Sleep Medicine
37.5
25
12.5
47.5
43.1
0
National Average
Supplemental feedings (oral or via gastrostomy tube) for
children 2-19 years of age with BMI <50th percentile
Kurt Sobush, MD
Robert Wilmott, MD
Chief of Pediatrics
Jamie Wooldridge, MD
Angela Orlando, PNP
84.4%
77%
National Average
2013
The Pediatric Sleep and Research Center is accredited by The American
Academy of Sleep Medicine, providing the highest level of sleep care. Clinicians
who specialize in sleep medicine, neurology, otolaryngology (ear, nose and
throat), pulmonary medicine, psychiatry, psychology and urology bring a
team approach to caring for your child’s sleep disorder. Sleep medicine clinic
evaluations can be arranged through any of these specialties or your pediatrician/
family physician.
A pediatric clinical nurse coordinates outpatient care. Specially trained sleep
technicians conduct the sleep tests using state-of-the-art equipment in the sleep
laboratory, similar to a home-like setting.
Appointments:
314-678-2173
Service Locations:
St. Louis, MO
SSM St. Mary’s Pediatrics
Jefferson City, MO
The Pediatric Sleep and
Research Center at SSM
Cardinal Glennon was
expanded in 2014 and
designed for children from
infancy to 21 years old.
And erson Hospital
Maryville, IL
Southern IL HealthcareFound ation
Belleville, IL
26
Surgery
Skilled surgeons in
general, minimally
invasive and 16 pediatric
subspecialties
Interdisciplinary
approach to patient care
Kid-friendly, state-of-theart operating rooms
10 high-definition
operating suites
6 Board Certified
Pediatric Surgeons
At SSM Cardinal Glennon Children’s Medical Center, we know surgery can’t
always wait. Patients in the womb through young adulthood have immediate
access to our team of pediatric surgeons, who are trained in a wide range of
state-of-the-art procedures and perform surgery in some of the nation’s most
advanced operating suites. Our expert surgeons specialize in 16 pediatrics
subspecialties. With an interdisciplinary approach, expertise from across
specialties is combined to provide personalized, patient-focused care.
Designed with Kids in Mind
Our 10 high-definition operating suites are both physician- and patientfriendly. With the only operating rooms in the region capable of real-time
consultation with pediatric surgery expertise anywhere in the world, our
surgeons can provide services not available anywhere else. Each 700-squarefoot OR provides increased mobility with portable monitors, and improved
traffic flow with equipment booms that are attached to the ceiling, keeping
floors clean and clear. Large flat-panel televisions that double as monitors
let patients fall asleep to a movie or program of their choosing and provide
surgeons imaging to navigate through three-mm incisions and provide
educational resources to any location of their choosing.
Parents are able to be with their child until the last moments before surgery.
During surgery, families wait comfortably in the brand new waiting room
with access to a surgery concierge and refreshments. Television screens
securely track patient progress and individual text messaging updates parents
throughout the procedure.
Cutting Edge Procedures
Fertility Preservation: Certain inherited medical conditions can slowly
damage a child’s reproductive organs, leaving them infertile before reaching
adulthood. Likewise, the treatment of other medical conditions, like cancer or
rheumatoid arthritis, can also impair a child’s fertility leaving them incapable
of reproduction later in life. In many conditions, there is a window of
opportunity to remove and preserve ovarian and testicular tissue and make
this available to the child in the future should they so desire. SSM Cardinal
Glennon offers these procedures to our patients, allowing young adult
patients to potentially conceive a child after defeating their condition, while
conforming to Catholic Ethical Teachings. Young patients who are eligible for
the fertility preservation treatment will have reproductive tissue removed in a
safe procedure by specially trained pediatric surgeons. This procedure occurs
prior to beginning treatment for their medical condition. The tissue will be
stored until the patient finishes treatment when it can safely be placed back
into the body.
27
Commitment to surgical quality and patient safety
In 2014, SSM Cardinal Glennon joined the American College of Surgeons
National Surgical Quality Improvement Program (ACS NSQIP). ACS
NSQIP is a nationally benchmarked program that uses risk-adjusted clinical
data to improve surgical quality and patient safety. It has been shown in
peer-reviewed studies to improve outcomes, reduce complications, and as a
result, reduce costs. Participation in ACS NSQIP is one way in which SSM
Cardinal Glennon demonstrates its commitment to providing the highest
quality of surgical care above our already exceptional standards.
Less Pain, Quicker Healing
Procedures that once required six-inch incisions can now be completed with
a half-inch incision thanks to minimally invasive surgical procedures like
single-port splenectomy, laparoscopic cholecystectomy and pyloromyotomy.
Pediatric patients who are candidates for this type of surgery have less pain,
less blood loss, less scarring and recover quicker. Many patients leave SSM
Cardinal Glennon the next day.
SLUCare Surgery
Physicians
Dennis Vane, MD, MBA, FACS,
FAAP, Surgeon-in-Chief,
Professor of Surgery at Saint
Medicine
Colleen Fitzpatrick, MD, FACS,
FAAP,
Division Chief of Pediatric
Surgery, Assistant Professor of
Surgery at Saint Louis University
School of Medicine
Richard Bower, MD, FACS
Assistant Professor of Surgery at
Saint Louis University School of
Medicine
Kaveer Chatoorgoon, MD
Medicine
Y. Jose Greenspon, MD, FAAP
Medicine
Gustavo Villalona*, MD
Medicine
*Joining Fall 2015
Appointments:
314-678-2180
Service Locations:
St. Louis, MO
The ten OR Suites are equipped
with the latest surgical technology, specifically installed
for minimally invasive procedures.
St. Anthony’s Med ical Center
South St. Louis
Anderson Hospital
Maryville, IL
28
Surgery
General Surgery
The Pediatric Surgery Department at SSM Cardinal Glennon is made up of six
Board Certified Pediatric Surgeons and provides comprehensive care for pediatric
patients from the newborn to teenage years. Newborn surgeries include the repair
of congenital disorders such as tracheoesophageal fistula, congenital diaphragmatic
hernia, congenital cystic lung anomalies, pyloric stenosis, intestinal atresias,
abdominal wall defects like gastroschisis and omphalocele, imperforate anus
and Hirschsprung’s disease among other problems. Additionally, our surgeons
provide fetal consultation to parents who are expecting a baby identified with a
developmental anomaly before birth. This prenatal consultation helps parents to
have a better understanding of their baby’s problem and helps them to understand
what to expect once their baby is born. This reduces the anxiety and uncertainty
of a complicated pregnancy.
Our older pediatric patients also benefit from the expertise of our surgeons
who understand the unique needs of children and teens. Common surgeries
performed by our surgeons on older patients include hernia repairs, appendectomy,
cholecystectomy, surgery for intussusception, correction of chest wall anomalies
including pectus excavatum and pectus carinatum and the surgical management
of inflammatory bowel disease including Crohns disease and ulcerative colitis.
Additionally, our surgeons provide expert care for our cancer patients removing
tumors that are unique to pediatric patients and providing access for the
administration of chemotherapy.
Many of the operations performed by our surgeons can be done through a
minimally invasive or laparoscopic approach. Often times the incisions are no
bigger than 3 mm and the minimally invasive approach can even by used on
newborn patients. This cutting edge approach minimizes pain, accelerates recovery
and minimizes the cosmetic impact of surgery.
Our surgeons provide coverage 24-hours a day, 7-days a week and are responsible
for covering our very busy Level I Pediatric Trauma Center ensuring our patients
receive the best possible care even under emergency circumstances.
Surgical Subspecialties
Our surgical subspecialists utilize the most advanced intraoperative imaging
techniques and minimally invasive procedures to provide the most advanced
surgical care available in the region. Our surgeons manage issues of reconstruction,
injury and advanced diseases in ways that not only provide surgical access to areas
thought previously to be inaccessible, but also minimize discomfort for children.
SLUCare Physician
and Surgeon-in-Chief
Dr. Dennis Vane
performs a laparoscopic
cholecystectomy to remove
two-year-old Corwin’s
gallbladder.
29
Cancer
Cardiac
Chest wall deformities
Cleft lip-nose-palate and craniofacial
Ear, nose and throat
Fetal
Minimally invasive
Neonatal
Neurosurgery
Ophthalmology
Orthopaedic
Plastic Surgery
Solid organ transplant
Trauma
Urology
ENT/Otolaryngology
The Pediatric Otolaryngology/ENT Department at SSM Cardinal Glennon offers
medical and surgical care for ear, nose and throat problems in children. The team
of surgeons and advanced practice nurses perform over 3,000 operations each
year. Minor procedures in the office include removing earwax from the ears,
clipping tongue tie in an infant or cauterizing a nose that bleeds too often. Other
operations require expertise and extensive planning and with our team of airway
surgeons, fetal care doctors, pediatricians, and anesthesiologists.
Treating children with airway problems require an understanding of the
individual patient and all available treatment options. Our surgeons use a
comprehensive approach including minimally invasive endoscopic techniques and
the latest technology to avoid large operations when possible.
Surgery to place tubes in ears and remove tonsils can greatly improve quality of
life for children and families. The high-volume ENT center at SSM Cardinal
Glennon ensures the very best care for all children. The care providers are
passionate about making decisions that are in the best interest of the patient.
Our team also has experience treating thyroid nodules, neck masses, and chronic
rhinosinusitis.
The surgeons work closely with audiologists to care for children with hearing loss.
Some children who are born deaf or develop severe hearing loss over time may be
candidates for a cochlear implant. When possible, we use the latest techniques to
attempt preservation of natural hearing in children undergoing cochlear implants.
Ophthalmology
The Division of Pediatric Ophthalmology at SSM Cardinal Glennon currently
provides a full range of ophthalmologic services for children. Three pediatric
ophthalmologists, a pediatric optometrist, and an orthoptist care for children
with numerous complex conditions including strabismus, amblyopia,
nasolacrimal duct problems, and refractive errors. Subspecialty care in pediatric
retina, oculoplastics, cornea, and glaucoma is also available.
The Division of Pediatric Ophthalmology coordinates appointments with other
services in order to provide more convenient care for children and their families.
Patients requiring retinopathy of prematurity screening are seen in Neonatology’s
nursery follow-up clinic. Children with rheumatologic conditions are able to be
screened for uveitis and other complications of immunosuppressive therapy on
the same day that they see their rheumatologist.
During the past year, as a result of generous support from the Cardinal Glennon
Children’s Hospital Foundation, a new operating microscope allows for state of
the art anterior segment and vitreoretinal surgery. A new photography unit, the
Retcam, will also allow documentation and expansion of research in pediatric
retinal disease and child abuse.
30
Surgery
Plastic Surgery
The Division of Plastic Surgery and the St. Louis Cleft-Craniofacial Center at
SSM Cardinal Glennon specializes in interventions designed to take the most
complex deformities and return the child to as normal a life as possible. Plastic
Surgery is the field that repairs the features that make us human: our speech
(involving the palate), our hands, and our faces. Each of these human functions
allow us to communicate: by speaking, by interacting with hands, and by looking
at each other’s faces -- and children need to communicate to grow. Our surgeries
range from intraoral surgery (palate, tongue, alveolus), hand surgery (syndactyly
or fused fingers, extra fingers, trauma to tendons and nerves and finger fractures),
body reconstruction and soft tissue surgery (breast, lesions, hemangiomas,
vascular malformations, trauma, tumor), Cleft lip-nose-palate and craniofacial,
craniofacial surgery (craniosynostosis, orbital repositioning, cranioplasty), babies
with small jaws with breathing problems (Pierre Robin sequence), facial surgery
(ears, eyelids, nose, lips), facial fractures and bone reconstruction (forehead,
orbits, cheeks, jaws).
Plastic Surgery is about innovation and solving complex problems, and the latest
technological advances are used to minimize surgery when the situation safely
allows. In patients with facial trauma, resorbable plates that slowly absorb in
the body are used when possible, rather than using permanent titanium plates
in a child who is still growing. Certain patients undergoing craniosynostosis
skull reconstruction are eligible for a limited incision endoscopic technique
that reduces operation time, blood loss, and hospital stay. For face and jaw
surgery, advanced orthodontic splinting systems can eliminate the need for
incisions on the face. Off-the-shelf manufactured tissue grafts are used in certain
reconstructions that can eliminate the need to take tissue from elsewhere in the
body. For patients with complex anatomy, we have been creating sterilized 3D
surgical models from patients’ own CT scans to use in the operating room to
improve safety and results. While these technologies are appropriate only for
specific situations, the team strives to use minimal surgery to achieve the best
reconstructions.
Urology
Children are diagnosed with vastly different urologic conditions than adults,
and they respond differently to anesthesia and surgical procedures. For these
and many other reasons, they deserve to be cared for by pediatric specialists. The
urology team at SSM Cardinal Glennon specializes exclusively in the urologic
care of children while providing the most innovative care in a child-friendly
setting. Our surgeons are experienced in laparoscopic and endoscopic surgery,
using miniature instruments and cameras inserted through tiny openings. These
techniques, used to repair obstructed kidneys and undescended testicles, allow
faster, less painful recovery from surgeries with virtually invisible scars. Using
advanced endourology, many problems can be treated by passing telescopes into
the bladder and kidney, avoiding the need to even make an incision.
31
In addition to surgical problems, urinary incontinence is common, but seldomdiscussed problem in children. While not a dangerous condition, wetting can
be terribly damaging to a child’s self-esteem and social standing. Our nurse
practitioners, in association with Dr. Barry Duel, lead the continence program
with treatments that include behavior modification, medications and St. Louis’
first dedicated urologic biofeedback program. The first step in treating these
problems is understanding the underlying causes, and we are able to achieve
dryness in just about every child we see.
Some of our patients are even diagnosed with urologic problems long before
they’re even born. In these cases, the urology team works closely with the St.
Louis Fetal Care Institute. Dr. Barry Duel, as part of the Fetal Care Institute, is
able to meet with parents before the child is born, answer their questions and
outline a treatment plan. In some cases, our specialists even intervene prenatally,
as in children with urinary bladder obstruction.
Orthopedic Surgery
The Pediatric Orthopedic Surgery Service at SSM
Cardinal Glennon provides comprehensive care to
children with the full spectrum of musculoskeletal
disorders. Whether the child has a simple fracture or a
complex congenital deformity, our surgeons and their
teams are dedicated to providing the highest quality
of care to successfully manage the condition. Our four
pediatric orthopedic surgeons care for children with
spinal deformity, traumatic injuries, neuromuscular
diseases, congenital deformities, bone dysplasia’s, limb
deficiencies and infection. We have additional surgeons
who provide specialization in orthopedic oncology,
pediatric hand disorders and sports-related injuries.
Our orthopedic surgeons see over 15,000 outpatients,
perform 800 surgeries and about 200 sedated
procedures per year. They follow the American
Academy of Orthopedic Surgeons Clinical Guidelines
for the treatment of pediatric femur and supracondylar
humerus fractures.
The orthopedic service participates in multidisciplinary
clinics for patients with neurofibromatosis, cerebral
palsy and myelomeningocoele. These clinics are staffed
by physicians from multiple subspecialties and provide
coordinated care for these complex patients. Rather
than having separate appointments for each doctor, the
patient sees all of their doctors during one visit, in the
same office.
SLUCare Physician and Orthopedic
Surgeon, Dr. Margaret Grisell meets
with a patient after her surgery.
32
The St. Louis Fetal Care Institute
One of the only
comprehensive fetal care
centers in the country
One of the fastest growing
fetal myelomeningocele
repair programs in the
United States
The area’s leading center
for the screening and
monitoring of highrisk twin and multiple
pregnancies.
More than 1,000 families
served since 2009
The St. Louis Fetal Care Institute (FCI) at SSM Cardinal Glennon Children’s
Medical Center is one of the leading comprehensive fetal care programs in
the country. Since 2009, SLUCare high-risk obstetrical specialists at SSM
St. Mary’s Health Center and pediatric subspecialists at SSM Cardinal Glennon
have worked together to provide the most well-rounded, compassionate and
innovative care to mothers whose unborn babies have congenital, structural and
genetic anomalies.
The FCI clinical suite at SSM Cardinal Glennon offers patient-centered care
with three nesting rooms, an ultrasound examination and treatment room, and a
large conference/consultation room to allow the family to meet with a larger care
team. Deliveries at SSM Cardinal Glennon are available for patients who require
immediate specialized pediatric services that may only be accessible at our main
campus.
The FCI is proud to offer needle-based fetal interventions, fetoscopy and
open fetal surgery procedures including:
Fetoscopic laser photocoagulation of placental vessels for twin to twin transfusion syndrome (TTTS), selective intrauterine growth restriction
(sIUGR), and twin reversed arterial perfusion (TRAP) sequence
Open fetal repair for myelomeningocele
Minimally invasive laser ablation for fetal tumors
Prenatal surgery for bladder outlet obstruction
Fetoscopic amniotic band release
Open fetal resection for sacrococcygeal teratoma
EXIT (Ex Utero Intrapartum Treatment procedure)
deliveries
423 Fetal Interventions Performed since 2009
80
80
56
60
St. Louis Fetal Care
Institute Director
Dr. Mike Vlastos with
baby Caroline, congenital
cystic adenomatoid
malformation survivor
33
20
0
37
37
38
36
40
26
20
4 7 1
2009
8 3
2010
18 14
7 4
2011
Needle Based Intervention
Fetoscopic Surgery
4
2012
8 1
2013
13 1
2014
Open Fetal Surgery
EXIT/Deliveries at Glennon
12
An Advanced Fetal Heart Program
The Fetal Heart Program at the St. Louis Fetal Care Institute provides a gateway
to the two most experienced pediatric cardiothoracic surgeons in the region,
nationally recognized pediatric cardiology and neonatology departments and
a renowned fetal medicine program. Collaborating with referring physicians,
the Fetal Heart Program’s team coordinates care for babies amongst maternal
fetal medicine specialists, cardiologists, cardiothoracic surgeons, neonatologists,
genetic counselors, and social services to create a delivery and care plan for each
baby’s unique situation, which may or may not require surgery after birth.
Many mothers who visit with the Fetal Heart Program can continue care with
their selected obstetrician and pediatric cardiologist.
Referrals by Diagnosis
200
63
52
37
27
29
31
30
Amanda Denny, RN, BSN
Nurse Coordinator
38
19
18
14
6
6
U
Following the MOMS protocols,
exclusion and inclusion criteria and
ACOG recommended counseling
guidelines, the Fetal Care Institute
performs this open fetal surgery on
qualified patients between 19 and 26
weeks gestation.
l
na
I
er
G
es
e
m
at
ro
M
nd
Sy
Kate Koenen RN, BSN
Nurse Coordinator
ic
en
Experienced Fetal Myelomeningocele Repair Team
Within weeks of the release of the
nine-year-long Management of
Myelomeningocele (MOMS) Trial
results, the Fetal Care Institute’s team was
performing the fetal myelomeningocele
repair operation. Four years later, the
Fetal Care Institute is one of the fastestgrowing centers in the country.
Julie Vertodoulos RN, BSN
Nurse Coordinator
Suzanne Pyle RN, BSN
Nurse Coordinator
G
C
et
O
m
ph
al
oc
el
ns
e
io
at
rm
fo
N
S
M
al
ft
lip
/p
al
at
cs
s
di
pe
C
le
rt
ho
as
O
k
ec
N
se
M
as
M
Tu
s/
tr
as
se
s
or
m
C
os
ch
is
D
H
is
s
le
ds
tip
/M
ul
G
s
TT
TS
ot
ic
B
an
on
y
ni
m
A
Lu
ng
Le
si
og
le
ol
ce
gy
/N
ep
hr
di
ar
ro
lo
ye
lo
m
en
in
C
go
ac
0
M
Samer Elbabaa, MD, FAANS, FACS
Neurosurgeon
Katie Francis, RNC-NIC, MSN, CPNP
Program Coordinator
97
100
50
Dr. Suwan Mehra, MD, FACOG
Maternal Fetal Medicine Specialist
Rachael Bradshaw, MS, CGC
Genetic Counselor
136
129
Mike Vlastos, MD, FACOG
St. Louis Fetal Care Institute
Director
Cathy Cibulskis, MD
Neonatologist
166
150
The St. Louis Fetal
Care Institute SLUCare
Fetal Myelomeningocele repair
evaluations and surgeries at
the St. Louis Fetal Care Institute
70
Betty June, RNC-NIC, BSN
Database & Research Coordinator
Cindy Jansen, RDMS
Sonographer
Shatahr Levin, RDMS
Sonographer
Valerie Akerson, MSW
Social Worker
35
0
39
42
67
Number of
patients
who received
surgery
Number of
patients
offered
surgery
Number of patients
screened for fetal
myelomeningocele
repair surgery
through 10/31/14
Following a short stay in St. Louis, many of our mothers return home and deliver
via c-section at their local hospital with their original OB/GYN or MFM.
Contact:
314-268-4037
or 877-776-3385
E-mail: [email protected]
www.stlouisfetalcare.com
34
Transport & Trauma
Dedicated ambulance
and helicopter
equipped for pediatric
and neonatal patients
Level I Pediatric
Trauma Center
designated by Missouri
and Illinois
Staff certifications
include PALS, NRP,
ACLS and BLS
Transport Services
Our neonatal and pediatric transport team of attending physicians, fellows,
registered nurses, respiratory therapists and paramedics have advanced training in
the stabilization, treatment and transport of small infants and children of all ages.
Our team has a regional footprint with crews stationed 24/7 in Hannibal and
Cape Girardeau, MO, in addition to the home base at SSM Cardinal Glennon in
St. Louis.
In the cases of very critical patients, time is of the essence. With our team of
experts dispersed to areas north and south of St. Louis, children all over the region
– including central and eastern Missouri, west central and southern Illinois as well
as western Kentucky and Tennessee – have faster access to the highest level of care.
1
st
Service Locations:
St. Louis, MO
SSM Cardinal Glennon’s Transport Team was the first to
staff a satellite base in Cape Girardeau, MO and Hannibal,
MO with a total of 460 transfers in the past three years.
Cape Girardeau, MO
Hannibal, MO
Trauma Services:
314-577-5629
Dan Dierdorf Emergency and Trauma Center
SSM Cardinal Glennon Children’s Medical Center is designated a
Level I Pediatric Trauma Center by Missouri and Illinois.
As a state-of-the-art pediatric medical center, we are prepared for the most
critical child health emergencies. We know that children are not just small
adults, but they require special physical, developmental, pharmacological and
psychological needs.
Call to arrange a transport:
Experienced transport nurses answer
the Access Center line 24/7!
35
Specialists in Pediatric Trauma
All members of our trauma team are board-certified specialists in pediatric care. This multidisciplinary team includes
surgeons, emergency medicine physicians, child protection physicians, emergency and critical care nurses, respiratory
therapists, pharmacists, radiologists, child life specialists, social services, laboratory technicians and pastoral care
representatives. Experts in the following subspecialties are also trained in trauma and available 24 hours a day:
neurosurgery, orthopedic surgery, plastic surgery, cardiothoracic surgery, genitourinary surgery, ophthalmology,
otolaryngology and anesthesia.
Our medical staff is certified in Pediatric Advanced Life Support (PALS) and Pediatric Advanced Cardiac & Trauma
Support (PACTS) for Life. Our anesthesiologists specialize in pediatric sedation for our young patients.
The GlennonKids Safety Program at SSM Cardinal Glennon is not only dedicated to caring for children with
traumatic injury, our mission is the prevention of childhood injuries. Since its inception over 20 years ago, the
GlennonKids Safety Program has contributed to a 45 percent national reduction in child fatalities resulting from
unintentional injuries, saving more than 38,000 lives. The GlennonKids Safety Program partners with KohlsCares
to provide free car seat inspections/installations by certified child passenger safety (CPS) technicians and the
distribution of properly fitted free bicycle helmets. We are also the lead agency for the SafeKids St. Louis coalition;
the many services we offer include infant and child CPR classes, home safety equipment and education to ensure
our children’s safety.
Trauma team is at the bedside 100 percent of the time when patient arrives
(within five minutes with no prior notification.)
Full gamut of specialists ready/available 24/7
Level I Pediatric Trauma Center in Missouri and Illinois
36
Additional Pediatric Specialties
is a teaching hospital affiliated with Saint Louis
University School of Medicine. Our team of
experienced experts from SLUCare Physician Group
provides exceptional care for patients and their
families in a kid-friendly environment.
Adolescent Medicine
Victoria Cornelius, MD
Marianne Dunstan, MD
Allergy/Immunology
Alan Knutsen, MD, Director
Bradley Becker, MD
Manoj Warrier, MD
Anesthesiology
Brenda McClain, MD, Director
Naila Ahmad, MD
Farid Azzam, MD
Vipin Bansal, MD
James DeBoard, MD
Tatyana Demidovich, MD
Orlando Perez-Franco, MD
Marion Svendrowski, MD
Child Protection
Timothy Kutz, MD, Director
Linda Shaw, MD, MSSW
Dermatology
Elaine Siegfried, MD, Director
Developmental Pediatrics
Rolanda Maxim Gott, MD, Director
Shula Portnoy, MD
Petra Swidler, MD
Cristiana Teodorescu, MD
Kimberly Twyman, MD
Barbara Braddock, PhD
Michael Bunis, PhD
Sarah Grafeman, PhD
Debra Zand, PhD
37
General Academic Pediatrics
M. Susan Heaney, MD, MPH, Division Director
Shahnaz Ahmad, MD
Josh Arthur, MD
Matthew Broom, MD
Mark Eddy, MD
Kenneth Haller, MD
Donna Halloran, MD, MSPH
Tim Kutz, MD
Gene LaBarge, MD
Jennifer Ladage, MD
Shahida Naseer, MD
Jay Noffsinger, MD
Elisa Pincus, MD
Tim Rice, MD
Heidi Sallee, MD
Michelle Sineff, MD
Marianne Dunstan, MD
Victoria Cornelius, MD
Chris Sallee, MD
David Wathen, DO
Marta King, MD
Aline Tanios, MD
Aaron Miller, MD
Genetics
Stephen Braddock, MD, Director
Amelia Kirby, MD
Jacqueline Batanian, PhD
James Shoemaker, MD, PhD
Gynecology
Jill Powell, MD, Director
Hospital Medicine
Chris Sallee, MD, Section Chief
Marta King, MD
Aaron Miller, MD
Aline Tanios, MD
David Wathen, DO
Infectious Disease
Stephen Barenkamp, MD, Director
Ed Anderson, MD
Aaron Miller, MD
Dennis O’Connor, MD
Missouri Poison Center
Rebecca Tominack, MD, Medical Director
Neurology
Sean Goretzke, MD, Director
Deepa Arun, MD
Thomas Geller, MD
Vincent Gibbons, MD
Shubhangi Peche, MD
Mary Rickard, MD
Ophthalmology
Bradley Davitt, MD, Director
Oscar Cruz, MD
Gabriela Espinoza, MD
Rafif Ghadban, MD
Michelle Beck, OD
Orthopedics
Elizabeth Engel, MD, Director
John Boudreau, MD
David Greenberg, MD
Meg Grisell, MD
Scott Kaar, MD
Jasmin McGinty, MD
Joao Panattoni, MD
Howard Place, MD
Aki Puryear, MD
Otolaryngology/ENT
Dary Costa, MD, Director
Jennifer Brinkmeier, MD
John Eisenbeis, MD
Josh Hentzelman, MD
Anthony Mikulec, MD
Thomas Sanford, MD
John Stith, MD
Scott G. Walen, MD
Alan Wild, MD
Pathology
Carole Vogler, MD – Interim Director
Ashima Agarwal, MD
David S. Brink, MD
Susan Crawford, DO
Judy Grishaber, DO
Miguel Guzman, MD
T. Scott Isbell, PhD
Karen Moser, MD
Cirilo Sotelo-Avila, MD
Jacqueline Batanian, PhD
Katherine Robbins, MD
Ella Swierkosz, PhD
Plastic Surgery
Alexander Lin, MD, Director
Christina Plikaitis, MD
Psychiatry
Zafar Rehmani, MD, Medical Director
Donna Gfeller, PhD, Director
Annmarie Loth, MD
Psychology
Donna Gfeller, PhD, Director
Barbara Barnes, PhD
Sarah Hanly, PhD
Michael Kenney, PhD
Joel Nadler, PhD
Jaimi Ramsey, PhD
Karen Snyder, MS
Mary Weatherford, PhD
Stacey Woodrome, PhD
Radiology
Karen Caudill, MD
Shannon Farmakis, MD
Stephen Huebner, MD
Martin Reis, MD
Vilaas Shetty, MD
Ting Tao, MD
Joan Zawin, MD
Yihua Zhou, MD
Rheumatology
Terry Moore, MD, Director
Peri Hickman Pepmueller, MD
Reema Syed, MD
Sleep Medicine
Shalini Paruthi, MD, Director
Raman Malhotra, MD, Co-Director
Sports Medicine
Scott Kaar, MD
Toxicology
Anthony Scalzo, MD, Director
Urology
Barry Duel, MD, Director
38
Modern, Kid-Friendly Facilities
The Dorothy
and Larry Dallas
Heart Center is a
comprehensive care
center with advanced
technology including
electrocardiogram,
echocardiogram,
cardiac MRI, oximetry
and stress testing. The
center makes cardiac
care more convenient
and accessible for the
more than 23,000
patients treated
annually.
has the region’s only
pediatric hybrid
cardiac catheterization
suite, a unique space
that allows a pediatric
cardiologist to work
alongside the region’s
top pediatric cardiac
surgeons to find
and fix a patient’s
congenital heart defect
in the same space.
Having the ability to
diagnose and treat
problems at the same
time means safer
care, faster healing
and a better recovery
process for our young
patients.
39
The Level IV Dana
Brown Neonatal
Intensive Care Unit
offers 65 private
rooms, in-suite
nursing areas, breast
pumps, personal
refrigerators and
unlimited visiting
hours for families.
The St. Louis Fetal
Care Institute clinical
suite offers patientcentered care with
three nesting rooms,
an ultrasound
examination and
treatment room and
a large conference/
consultation room for
families to meet with
a larger care team.
40
Modern, Kid-Friendly Facilities
Our Imaging Center
combines the most
advanced pediatric
diagnostic imaging in the
region with a focus on
comfort for children. The
kid-friendly CT and MRI
suites allows patients select
a color theme for their
room and a movie to view
during their exam.
The ten technologically integrated,
700 square foot operating suites
allow for increased mobility with
portable monitors and improved
traffic flow with equipment booms
that are attached to the ceiling,
keeping the floors clean and clear.
The suites are equipped with
the latest surgical technology,
specifically installed for minimally
invasive procedures. Large flat
panel televisions that double as
monitors let patients fall asleep
to a DVD of their choosing and
provide surgeons imaging to
navigate through 3-mm incisions.
Our specially-trained
pediatric anesthesiologists
maintain a safe and relaxed
state for children during
surgery. Following the
procedure, children wake
up next to their family in
the newly remodeled post
anesthesia care unit.
41
The Costas Center
provides a comfortable
setting for children
to receive prolonged
treatment in quiet, private
accommodations welcome
to family and friends.
The Knights of Columbus
Developmental Center moved
to a brand new space next to
SSM Cardinal Glennon in 2013.
The comprehensive center’s new
observation rooms are equipped
with two-way mirrors for parents
to observe their children during
treatment and advanced video
equipment that allows for
recording of behavioral changes
in patients, valuable for training
and research.
The Ronald McDonald
Room offers a comforting
environment with some
of the amenities of home,
including a full kitchen,
dining area, computers,
internet access, shower,
laundry facility, cozy
couches and television.
42
Non Profit Org
Marketing and Public Relations Department
1465 South Grand Blvd.
Saint Louis, Missouri 63104-1095
24/7 attending physician consultations
Emergent transfers
Urgent appointments
Direct admissions
All calls answered 24/7 by pediatric transport nurses
U.S. Postage
PAID
St. Louis, MO
Permit No. 2412

2015 - Cardinal Glennon

Transcription

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