Seattle Children's Provider News

Emergency Department volumes

A new space opened in the hospital in July to help care for Emergency Department (ED) patients with mental health concerns. The ED still has capacity constraints, especially in the evenings secondary to patient surges and patients who remain in the ED awaiting final disposition. Effective July 18, Seattle Children’s deactivated the code yellow for the surge in youth mental health patients and the Emergency Department (ED). Seattle Children’s continues to update our policies and improve workflows to support mental health patients experiencing extended lengths of stay due to barriers to discharge.

Please continue to call the Mission Control team at 206-987-8899 when sending a patient to the Seattle Children’s ED.

Chemotherapy drug shortages

A nationwide shortage of certain chemotherapy drugs is impacting many hospitals, including Seattle Children’s. It is not yet known when supply will improve. Some of our patients may require changes to their treatment; our care teams are working hard to limit negative impacts. We are working with multiple distributors to secure as much medication as possible. Read full post »

Dr. Jennifer Bauer is chief of spine surgery at Seattle Children’s.  She is a committee member of leading international and national pediatric spine societies and study groups and an editor and reviewer for scientific journals. 

Q: When should a child with scoliosis see a specialist?

Dr. Bauer: Kids with a thoracic or lumbar rib hump on an Adams forward bend who have a scoliometer reading of 3 to 5 degrees should be rechecked in six months by their PCP. For a scoliometer reading over 5 degrees, we recommend ordering a two-view standing PA/LAT spine radiograph. If it shows a Cobb angle over 20 degrees for any age child or over 10 degrees in a child under 10 years old, we recommend referral to Seattle Children’s. If they don’t meet those thresholds, we advise a follow-up X-ray in 6 months and referring to Orthopedics if any increase in curvature is seen.

We recently developed an algorithm for scoliosis that offers guidance on how to assess the pediatric spine and when to refer to orthopedics.

Read full post »

Evaluation and management of a child with suspected seizure 

Epilepsy is the most common neurological disorder in children, but a child’s first contact with the medical system after a suspected seizure is almost always through the emergency room or their primary care provider, not directly with a pediatric neurologist. Therefore non-neurologists are the first line of evaluation, care and often long-term management in areas without immediate access to a neurologist. Thoughtful evaluation of a suspected seizure patient, whether they are presenting with a first suspected seizure or are a known epilepsy patient who is new to a primary care practice, allows these children to receive the correct level of care and helps worried families to know what to expect next.

• See our new Epilepsy/seizure algorithm.

History

Just as with any other medical condition, the history and physical examination are the first step.

Common suspected seizure types include “convulsions” and “staring spells.” The terms “grand mal” and “petit mal” are old-fashioned and only indicate whether the onlooker saw a convulsive or nonconvulsive event; they do not indicate whether the event was epileptic, or even what type of seizure was witnessed if it was in fact an epileptic seizure. Read full post »

In response to the national pediatric mental health crisis, Seattle Children’s is creating the Telemedicine Extension for Adolescent and Child Mental Health Boarders (TEAM B) program to address the growing needs of youth who present to emergency departments in mental health crisis.

This program will provide clinical consultation and resource assistance to our colleagues at outside facilities in need of support for their mental health boarders. Our team consists of psychiatric providers, mental health and community resource specialists and behavioral support providers. We will offer this program to assist with potential diversion efforts through psychiatric consultation and the provision of community-based resources. We will also provide behavior support consultation to your care teams for boarding youth with behavioral challenges. Read full post »

Seattle Children’s South Clinic in Federal Way

Seattle Children’s rheumatologists Dr. Esi Morgan (division chief), Dr. Erin Balay-Dustrude, and Dr. Stephen Wong will begin seeing patients at Seattle Children’s South Clinic in Federal Way 6 days each month effective September 1, bringing care closer to home for families in the South Sound region.

Learn more

• Rheumatology at Seattle Children’s
• Seattle Children’s South Clinic in Federal Way
• Rheumatology resources for PCPs:
  • Antinuclear antibodies (ANA): Algorithm
  • Back pain: Algorithm and Evaluation of back pain in children and adolescents (AAFP)
  • Chronic Recurrent Multifocal Osteomyelitis (CRMO): Algorithm
  • Growing pains: Algorithm
  • HSP: Algorithm
  • Hypermobility/benign hypermobility joint syndrome (BHJS)/Ehlers-Danlos syndrome: Algorithm
  • Urticaria: Algorithm
  • Pain syndromes (fibromyalgia, central sensitization, pain amplification, chronic regional pain, complex regional pain syndrome, reflex neurovascular dystrophy)
  • Postural orthostatic tachycardia syndrome (POTS): Information for PCPs.

From On the Pulse, July 11, 2023

At just 19 years old, Faye, an avid swimmer and college freshman at Northeastern University, found her life plans on hold when she began experiencing fevers and flu-like symptoms.

When her temperature reached 104 degrees, Faye called an Uber and headed to the nearest emergency department.

While at Boston Medical Center, providers discovered Faye had an abnormally low white blood cell count and kept her overnight.

“The minute they walked in, I knew something was deeply wrong,” recalled Faye.

The doctors explained to Faye and her mom, Molly, that her blood was filled with abnormal, immature white blood cells called blasts; they believed she had leukemia.

Words like “cancer” and “chemotherapy” filled the room, and Faye felt a burning sensation run down her spine while the rest of her body went numb. At the same time, her mom broke down.

“I’ll never forget the sound of her voice when she called my dad to tell him,” shared Faye. “She just lost it.” Read full post »

Conferences

• What’s New in Medicine 2023: Infectious Disease, Pediatrics and Internal Medicine. Friday, September 8 and Saturday, September 9, 2023. Option to register for ONLY the Saturday conference (Pediatrics), allowing for 8 Category 1 CME credits.  Or register for two days (Infectious Disease on Friday and either Pediatrics or Internal Medicine on Saturday) and view the other Saturday conference anytime via video (up to 1 year after the event) to attain all 24 Category 1 CME credits.  Participate virtually or in person (Kennewick, WA). Register by August 9 for a discount. For more information, please contact [email protected] or visit whatsnewinmedicine.org. Brochure.
• 2023 Peroxisome Scientific Meeting. September 10-13, 2023. Seattle Children’s Research Institute will host three days of exciting scientific discussions, a keynote address, short talks by invitees and social activities. Learn more: event website.
• 2023 Epilepsy Symposium, “Improving Pediatric Outcomes: Advances in Diagnosis, Management and Treatment.” Saturday, October 14, 2023. Hear from experts from Seattle Children’s Neurology, Epilepsy, Neurosurgery and Genetics Programs. Medical professionals and caregivers of children with epilepsy are welcome to attend. Registration is required. Learn more.

CMEs

• Category 2 CME: “Tried, True and New in Adolescent Idiopathic Scoliosis.” October 17, 2023, from 6 to 7 p.m. (virtual). Presenter: Jennifer Bauer, MD. More details to come.
• Category 2 CME: “Common Presentations of Childhood Cancer in Children, Adolescents and Young Adults.” September 20, 2023, from 6 to 7 p.m. (virtual). Mark Fluchel, MD, Medical Director of Outreach for Seattle Children’s Cancer and Blood Disorders Center, will discuss typical presenting symptoms of the most common pediatric and young adult cancers, identify common causes of delays in diagnosis and identify oncologic emergencies in newly diagnosed patients. Event flyer. Register.

Read full post »

Medical Staff

Lauren Nicole Carlozzi, MD, Cardiology

Mustafa Chopan, MD, Plastic Surgery

Erin Chung, MD, Infectious Disease

Isabella Helene Dahlgren, MD, Pediatrics

Natalie Ann Derise, MD, Otolaryngology

Kelsey Bishop Eitel, MD, Endocrinology

Alexander David Gauger, MD, Radiology

Julia Hadley, MD, Hospital Medicine

Matthew Hastings, MD, Neurology

Rachel Hollingsworth Jonas, MD, Otolaryngology

Yamini Satish Kapileshwarkar, MD, Neurology

Kristine Karvonen, MD, Hematology-Oncology

Camille Keenan, MD, Hematology-Oncology

Danielle Crawford Kirkey, MD, Hematology-Oncology

George Edward Koch, MD, Urology

Andrew Daniel Linkugel, MD, Plastic Surgery

Alison Lowen, MD, Community Pediatrics

Brandon Mauset, MD, Infectious Disease

Chinenyenwa Mpamaugo, MD, Community Pediatrics

David Hamilton Noyd, MD, Hematology-Oncology

Murat Alp Oztek, MD, Radiology

Sruti Pisharody, MD, Pediatrics

William Scott Porter, MD, Pediatrics

Todd Raleigh, MD, Neurology

Jeannette Yu Stallworth, MD, Ophthalmology

Kathryn Virk, MD, Cardiology

William Walker, Jr. MD, Developmental Medicine

Allied Health Professionals

Christine Elizabeth Batten, PA-C, Gastroenterology and Hepatology

Marybelle Camacho, LICSW, Psychology

Terrance Chambers, LMHC, Psychology

Amanda Dorr, ARNP

Jason Christopher Field, BCBA, Psychology

Kendra Mae Graham, PA-C, Community Pediatrics

Eileen Venable Magill, ARNP, Community Pediatrics

Jessica Mooney, ARNP, Cardiology

Sandra Linda Rodgin, PsyD, Psychology

Wendy Skarra, LMFT, Community Pediatrics

Romario Solano, LMHC

Sara Elizabeth Taylor, PhD, Psychology

Trista Pauline Trumbo, LMHC, Psychology

Xiahan Zhang, BCBA, Psychology

Since our last update in early June, the Emergency Department (ED) is still over 100% capacity many evenings but has seen some decrease in wait times.  We continue to see many patients presenting for mental health assessment and are still requiring a significant number of those patients to wait more than 24 hours for the next step in care, which may be an inpatient bed in our Psychiatry and Behavioral Medicine Unit (PBMU), a transfer to an outside facility or a safe discharge plan.  As always, please do not hesitate to send patients to the ED when you have emergent concerns.

Overall inpatient census has improved.

We continue to monitor the situation and employ our internal Emergency Operations Center to ensure systemwide coordination to address capacity constraints.

How you can help:

• Please continue to identify and manage lower-acuity complaints in outpatient settings to help maintain our limited capacity in the ED for higher-acuity concerns.
• Before sending your patient to the ED, contact our Mission Control team with as much notice as possible at 206-987-8899. Your early call allows the necessary time to plan for your patient’s arrival, and, in appropriate instances, we may be able to directly admit your patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit.

As a reminder: Patients experiencing an emergency should come to the ED (or go to their local ED) without hesitation.

Resources that may help you manage patients in primary or urgent care instead of sending to the ED: Read full post »

Samuel Browd, MD, PhD, is a neurosurgeon and surgical director of the Tone Management Program at Seattle Children’s. He is a world leader in training surgeons in selective dorsal rhizotomy (SDR) procedures. Roughly 1 in 4 surgeons in the United States who offer SDR trained under Dr. Browd, in addition to many doctors from around the world.

Q: Who is SDR for?

Dr. Browd: Any child with high tone (spasticity) in their lower extremities is a possible candidate for SDR [selective dorsal rhizotomy] surgery.  This includes many children with cerebral palsy. Providers and parents often think of surgery as a last resort, but in the case of kids with high tone, we encourage them to think of it as an early option instead. Even if their spasticity is being reasonably well-managed by medication and/or therapies, SDR can help them reduce or even get off their medication. With better physical functioning and mobility, we see kids do better with their social, family and school life too — because they’re putting less physical and mental energy into controlling their body and more time into doing things that are fun for them. Longer-term, kids are less likely to require more surgeries or experience some of the serious health consequences of having high tone.

Ages 3 to 5 is when we like to see kids get evaluated for SDR because their neuroplasticity is so high at that age, but we also consider the surgery for older children.

Read full post »