Seattle Children's Provider News

Conferences

• 18th Annual Pediatric Bioethics Conference, July 20 to 22, hosted by the Treuman Katz Center for Pediatric Bioethics. Can criteria such as citizenship, cognitive disabilities, mental health or the absence of social support be used to decide who qualifies for a transplant? Should children be prioritized over adults for transplant? We’ll tackle these subjects and more at the 18th Annual Pediatric Bioethics Conference at the Bell Harbor International Conference Center in Seattle. Join us a day early on July 20th for our inaugural nursing bioethics conference “Pediatric Bioethics at the Point of Care: A Critical Examination of Ethical Issues in Pediatric Nursing” hosted by Seattle Children’s Center for Pediatric Nursing Research. Learn more and register at seattlechildrens.org/pbc.

CMEs

• Sports Cardiology and Sudden Cardiac Death Prevention. April 17, 2023, 6 to 7 p.m. (virtual). Category 2 CME. Learn more and register.

• Pediatric Mental Health Event hosted by the Partnership Access Line. April 22, 2023, in Bellingham, WA. Learn more.

• Is It Just Growing Pains? A Multidisciplinary Approach to Bone and Joint Pain. April 29, 2023 (virtual). This highly practical course will provide a framework to primary care providers and specialists who encounter patients with bone and joint pain. Learn more. Register.

• Team-Based Approach to Caring for Children With Complex Airway and Esophageal Conditions. May 2, 2023, 6 to 7 p.m. (virtual). Category 2 CME. Learn more and register.

• Updates on Primary Immunodeficiency Diseases for the General Practitioner. May 6, 2023, 8 a.m. to 12:15 p.m. (virtual). Learn more. Register.
• Epilepsy Surgery in Children. May 18, 2023, 6 to 7 p.m. (virtual). Category 2 CME. Learn more and register.

• Caring for Gender Diverse Youth, Series I – A Project Echo. Monthly virtual sessions from April through September 2023. Each session includes a didactic presentation and a case discussion. Curriculum: affirming clinical environment, supporting families in schools, mental health, social transition, eating disorders and neurodiversity. Category I CME credits and Quality Improvement MOC (Part 4) credits are available. Registration is free. Learn more and register by March 31, 2023.

Nursing Events

• Spring 2023 Continuing Nursing Education Spring Series. See the flyer. Register online.
  • April 5, 2 to 3 p.m.: Foundations of Orthopedic Surgeries, Pediatric Rheumatologic Conditions
  • April 26, 2 to 3 p.m.: Bowel Management Treatment Program, Pediatric Seizures
  • May 24, 2 to 3 p.m.: Eating Disorders – Management and Care Coordination, second topic TBD
• Nursing Research Symposium: May 11, 2023. In-person and virtual options available. Flyer.

Grand Rounds

Provider Grand Rounds

Year-round on Thursdays from 8 to 9 a.m. Learn more.

• April 6, 2023: Tic Talk: Trauma Informed Care That’s Possible, Practical and Productive (Virtual). Holt Webster Child Abuse Lecture. Heather Forkey, MD, Professor, Department of Pediatrics, University of Massachusetts Medical School; Attending Physician, Child Protection Program, UMass Memorial Children’s Medical Center, Worcester, MA.
• April 13, 2023: Are Black Girls Undergoing Puberty at Younger Ages? Examining Implications of Race-Based Teaching About Puberty (Virtual). Lisa Swarts Tobor, MD. Associate Professor of Pediatrics, Brown University; Director of Pediatric Endocrinology, Hasbro Children’s Hospital.
• April 20, 2023: Is That Malaria on Your Breath? Malaria Clinical and Diagnostic Update for a “Post-COVID” World. Resident/Fellow Research Day. Audrey John, MD, PhD. Chief, Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia; Stanley Plotkin Endowed Chair, Pediatric Infectious Diseases.
• April 27, 2023: Fetal Care: An Early Start on the Journey to Best Outcomes in Children. Tapper Surgery Lecture. Oluyinka Olutoye, MD, PhD. Professor & E. Thomas Boles, Jr., Chair of Pediatric Surgery, OSU College of Medicine Surgeon-in-Chief, Nationwide Children’s Hospital.
• May 4, 2023: Prevention of Preterm Birth and Neurodevelopmental Delay Using Chewing Gum. Greg Valentine, MD, Med, FAAP. Assistant Professor, Pediatrics, Division of Neonatology, Adjunct Assist. Professor, Oral Health Sciences & Mechanical Engineering, UW & Seattle Children’s.

Nursing Grand Rounds

First Thursday of every month from 1 to 2 p.m. Learn more.

• April 6, 2023: Tracheostomy Safety and Education for Caregivers – Safe Care at Home. Leslie Elder, MSN, RN, CCM. See the flyer (PDF).

Psychiatry Grand Rounds

First Friday of every month October through June from 8 to 9:20 a.m. Learn more.

• April 7, 2023: LGBTQ-Affirmative Mental Health Care: From Theory to Trials to Community Implementation and Global Dissemination. John Pachankis, PhD, Susan Dwight Bliss Professor Department of Social and Behavioral Sciences, Yale School of Public Health.

Medical Staff

Agnes Chao, MD, Neonatology

Violeta Gomez, MD, Community Pediatrics

Siegfried Hirczy, MD, Neurology

Allied Health Professionals

Maria Brnjic, ARNP, Pain Medicine

Emily Kesheimer, CRNA, General Anesthesia

Jumie Lee, ARNP, Emergency

Tamara Morgan, ARNP, General Anesthesia

Jennifer Nathans, ARNP, Otolaryngology

Atylana Singh, LMHC, Psychology

Gurleen Kaur Singh, BCBA, Psychology

Sarah Stein, ARNP, Community Pediatrics

Hospital capacity

Seattle Children’s is beginning to experience some relief from the extremely high capacity constraints of recent months. We do, however, continue to see high winter volumes.

• Overall hospital census remains high, and the Emergency Department (ED) is still seeing extremely high patient volumes.
• The wave of patients experiencing mental and behavioral health crises is not slowing down.
• Seattle Children’s remains in active Code Yellow status, although at a lower level of response; we continue to monitor the situation and enact solutions to address the challenges we are facing.

Other important updates from Seattle Children’s

• Synagis season has ended: Due to exponential declines in RSV rates and related admissions, Seattle Children’s is no longer administering Synagis prophylaxis as of Tuesday, February 28. For more information, please consult state-specific recommendations for patients outside of our local area and review WA state and other data from the CDC.
• We have a scheduling backlog; please encourage families to proactively call us to schedule. We are hiring additional scheduling staff to keep pace with high demand but our pace of calling out to families to schedule is slower than we’d like. In some cases, patients may get an appointment several weeks sooner if they proactively call us to schedule instead of waiting for one of our schedulers to call them.
• GI has high referral volumes and long wait times; please manage constipation in primary care whenever possible.
  • Non-urgent general GI referrals without red flags, including constipation, are currently scheduling 3 to 5 months out.
  • GI has approximately 3,000 referrals in their scheduling queue with limited slots immediately available.
  • GI is still accepting constipation referrals but encourages PCPs to see these patients in primary care whenever possible to ensure timely care. This will also help Seattle Children’s maintain good access for patients who most need specialty care.
  • Our GI Refer a Patient webpage offers many PCP resources including:
    • Functional Constipation Clinical Protocol (PDF), developed by Seattle Children’s specialists in collaboration with community providers, can help you determine whether your patient should be referred to a specialist or treated in primary care.
    • Algorithm for Functional Constipation (p. 12 in document above)
    • Guideline for families, including education materials to help understand and manage their child’s constipation
    • Polyethylene Glycol (MiraLAX) Dosage Table
    • Severe or Chronic Constipation: Polyethylene Glycol (MiraLAX) Dosage Table
    • Chronic Constipation Treatment 3-Day Cleanout and Maintenance Dosing Tables
    • Bowel Cleanout and Maintenance Program at a Glance

Eating Disorders

The Adolescent Medicine team, in partnership with the Department of Psychiatry, at Seattle Children’s has created an eating disorders algorithm to help PCPs know when and how to refer patients with disordered eating to Adolescent Medicine, Psychiatry and Behavioral Medicine (Psychiatry) or, in some cases, both.

Dr. Yolanda Evans, Adolescent Medicine, Eating Disorders Recovery Program

“We have a very high number of kids coming to our program for care, and our referral processes have changed over the last year as we’ve made care more accessible,” says Dr. Yolanda Evans. “We hope this new algorithm will clarify the referral process and help kids get their care started as quickly as possible.”

Patients referred to Psychiatry will meet with a clinical psychologist initially. If medication evaluation is needed, a separate appointment will be made with a prescribing provider (either an ARNP or psychiatrist).

“If the referring provider knows at the outset that their patient will need medication evaluation, they can submit 2 separate referrals initially to Psychiatry to speed up the process – one for the behavioral health evaluation with the psychologist and a second referral for medication evaluation with our psychiatrist or ARNP,” says Dr. Evans.

For those referring providers who request management of physiologic complications from malnutrition, all patients referred to Adolescent Medicine will receive a one-time telehealth consultation with a medical provider after which families will be offered support and resources to continue the patient’s care, either at Seattle Children’s if appropriate and care is available, or in the community. The Eating Disorders team will share the after-visit information with the referring provider to help guide continuing care of their patient.

The eating disorders algorithm is available along with 65+ other condition-specific resources for PCPs at seattlechildrens.org/algorithms.

As a reminder, when referring a patient for eating disorders, please include their growth charts and exam notes. You do not need to send labs or an ECG; we removed this requirement last year to reduce work for PCPs and help patients be seen sooner.

For more details about referral requirements and additional resources for PCPs, please visit our Eating Disorders – Refer a Patient page. You may also like to read “Treatment for Eating Disorders: A Q&A and Case Study by Robyn Evans, ARNP” from our March 2022 issue of Provider News.

Head Shape

Seattle Children’s Craniofacial team has created a head shape algorithm to help PCPs evaluate and refer their patient to either Craniofacial or Physical Therapy depending on their presentation.

For infants under 4 months who have positional plagiocephaly or positional brachycephaly but don’t have limited range of motion or neck tilt, the algorithm recommends repositioning strategies with reassessment at 4 months. However, these babies are welcome to be referred directly to Craniofacial if the provider feels they need to be evaluated before 4 months. Repositioning resources are available on the Seattle Children’s website, with links provided in the algorithm.

Febrile seizure pathway

Seattle Children’s has updated its clinical standard work pathway for febrile seizure; find it here. Key changes include updated admit criteria and risk of intracranial infection guidance. Additional clinical standard work pathways for dozens of other conditions are available on our website.

Written by Casey Egan and Empress Rivera-Ruiz, On the Pulse, February 16, 2023.

New findings from Seattle Children’s Research Institute’s Center for Clinical and Translational Research reveal that a three-dose primary series of Pfizer’s COVID-19 vaccine was safe and effective in children 6 months to 4 years of age, even when a new variant (Omicron) was circulating.

The findings were released on Feb. 16 in the New England Journal of Medicine by an international team conducting the study, including Seattle Children’s lead study investigator, Dr. Janet Englund.

“No data on a three-dose series of Pfizer mRNA vaccine has been previously published in young children,” said Dr. Englund.

Dr. Englund also noted that the findings demonstrate that three doses of the Pfizer vaccine offer better protection than two doses against the Omicron variant in this age group.

Studies of bivalent booster doses of the Pfizer mRNA vaccine are now ongoing at Seattle Children’s. This research continues under Seattle Children’s Pediatric Infectious Disease Research Group, directed by Dr. Englund.

Learn more here: COVID-19 Vaccine Found Safe, Effective for Youngest Children (seattlechildrens.org)

Resources:

• Pediatric Infectious Disease Research Group’s COVID-19 Research (seattlechildrens.org)
• Infectious Diseases and Virology – Seattle Children’s (seattlechildrens.org)
• Seattle Children’s Research Division (seattlechildrens.org)

Seattle Children’s new hospital wing, Forest B, opened 20 new surgical inpatient rooms on the 8th floor, bringing the total number of surgical inpatient beds at Seattle Children’s to 94 — a 27% increase.

The new inpatient rooms are single-occupant and primarily serve patients who are recovering from general surgery and urology procedures. The inpatient unit includes a lounge and kitchen for family use.

Forest B was completed in summer 2022 and has been opening in waves, with eight new operating rooms and two catheterization labs opening last October followed by the opening in December of the new outpatient space for the Cancer and Blood Disorders Center. Forest B sits adjacent to the Emergency Department and serves as the hospital’s new “front door.” Learn more.

Odessa Brown Children’s Clinic (OBCC) Othello is now offering X-ray services. A provider referral is required.

Families can bring their child (age 0 to 18) in for an X-ray any time between the hours of 8 a.m. to 4:30 p.m., Monday through Friday, once they have a referral from their child’s provider. Appointments are not required.  To refer your patient, fax the Radiology Exam Request Form to 206-985-3128, send the original form with the patient or use EpicCare Link (the latter eliminates the risk of sending an order to the wrong fax number and avoids delays due to potential network errors).

Repairs are complete at OBCC Othello following water damage from a fire in December in the building where the clinic is located. The clinic is fully reopened. All clinic appointments are being held on-site as usual.

Seattle Children’s is pleased to announced Dr. Terri Laguna has accepted the position of division chief of Pulmonary and Sleep Medicine at Seattle Children’s.

She is coming to us from Ann & Robert H. Lurie Children’s Hospital of Chicago where she is division head of Pulmonary and Sleep Medicine in the Department of Pediatrics at Northwestern University Feinberg School of Medicine and director of the Primary Ciliary Dyskinesia Center of Excellence. Read full post »

Written by Elizabeth Dimarco, On the Pulse, February 28, 2023.

When patients and families with sickle cell disease (SCD) call Seattle Children’s to schedule appointments, they are greeted by the friendly voice of Enjoli Harris, who is a skilled member of the SCD patient scheduling team and a “sickle cell mom.”

Harris’ youngest child, Nehemiah, was diagnosed with SCD at birth almost 12 years ago and has been receiving care at Seattle Children’s, including at the Odessa Brown Children’s Clinic (OBCC), ever since. The frequent visits have helped Harris not only empathize with the concerns of families, but also better navigate their scheduling needs.

SCD is a group of blood conditions that affect hemoglobin, the part of red blood cells that delivers oxygen to cells in the body. In the United States, approximately 100,000 Americans are affected by SCD, most of whom are of African or Hispanic heritage, however the disease can affect anyone, especially people of southern European, Middle Eastern or Asian Indian heritage.

Children with SCD go to a lot of appointments. At any given time, Harris juggles the schedules of more than 140 SCD families who need to arrange care visits for transcranial doppler ultrasounds, blood draws, pulmonary function tests, ophthalmology exams, nutritional support, physical therapy, speech therapy, psychological visits, cognitive screenings or pain management. The SCD team’s goal is to coordinate multiple appointments into one visit, so families don’t have to make numerous trips or take extra time off work. Read full post »

As Seattle Children’s referral volumes continue to grow, we are hiring additional scheduling staff to keep pace with demand. But until we are fully staffed later this Spring, our pace of calling out to families to schedule their appointments will continue to be slower than we’d like.

In some cases, patients may get an appointment several weeks sooner if they proactively call to schedule instead of waiting for one of our schedulers to call them. 

When referring a patient to Seattle Children’s, please advise the family to call us to make their appointment (1-2 days after the referral is submitted).

We regret this inconvenience to families but believe this will help them receive better service in the short term.