Seattle Children's Provider News

Preventing Youth Suicide

More than 500 children have screened positive for suicide risk in Seattle Children’s Emergency Department and inpatient settings over the past six months who presented for concerns unrelated to their mental health. A new clinical pathway known as Seattle Children’s Zero Suicide Initiative (ZSI) is a universal screening method introduced in March 2019 to help identify and treat youth at risk of suicide. The pathway incorporates the National Institute of Mental Health’s (NIMH) Ask Suicide-Screening Questions (ASQ) — a brief, five-question screening by intake nurses that assesses if patients ages 10 and up are currently having or have recently had suicidal thoughts.

On average, every week in 2017, nearly four Washington youths died by suicide and two youths were hospitalized because of intentional self-injuries or suicide attempts. One of the most common misconceptions about youth suicide is the idea that talking about suicide will “plant the seed” of suicidal thoughts that weren’t already there — especially in younger children. While there’s no data to support this misleading theory, NIMH research shows that the suicide rate for children ages 10 to 12 has substantially risen over the past 10 years. Read full post »

Register Now for the Pediatric Nursing Update Conference, Jan. 31

Seattle Children’s Outreach Education Department invites you to register for the 2020 Pediatric Nursing Update all-day conference scheduled for Jan. 31, 2020, in Wright Auditorium from 7:50 a.m. to 4:45 p.m. Topics include the latest on school and child care immunization requirements, pediatric psychiatry and behavioral medicine, up-to-date trends in pediatric conditions and more. This year we are excited to offer breakout sessions as part of the conference. View the brochure for more details.

WONDER Study Recruiting Participants Ages Birth to 6 Months

Seattle Children’s is recruiting infants for a new study at Seattle Children’s. The WONDER research study uses technology and behavioral assessments to monitor and map social brain development. The study consists of five in-person study visits during the first three years of life at our research lab in Seattle. During visits, researchers record brain activity and eye movements while showing the child pictures and videos. They engage the child in play-based activities to assess different aspects of development, such as language and motor skills.

We are recruiting English-speaking families with infants under the age of 6 months to be part of one of three groups:

  1. Infants with an older sibling (whole or half) with a diagnosis of autism spectrum disorder.
  2. Infants born with low birth weight – 3lbs., 15 oz. or less (1800 g).
  3. Infants born weighing more than 5 lbs., 5oz. (2500 g) with no known serious medical conditions and no first- or second-degree relatives with autism.

Read full post »

Families Raise Awareness of Rare, Underdiagnosed Lung Disease

Isabelle Zoerb, 13, and Elliot Fox, 5, both have primary ciliary dyskinesia (PCD), a rare genetic condition that prevents bacteria from clearing the lungs, sinuses, nose and ears. They are patients at Seattle Children’s, which is the only Pacific Northwest PCD referral center. Dr. Margaret Rosenfeld, an attending physician and researcher at Seattle Children’s, says parents often go through a “diagnostic odyssey” before their child is diagnosed. Most people with PCD have unexplained neonatal respiratory distress, requiring oxygen or breathing support. They generally develop chronic nasal drainage and chronic wet cough within the first six months of life. And it’s a progressive disorder, worsening with time.

“We hope to increase awareness of PCD, which is highly underdiagnosed, so doctors across different fields can identify children with PCD and help them,” said Dr. BreAnna Kinghorn, a researcher at Seattle Children’s.

Rosenfeld researches PCD as the Seattle Children’s site investigator for the Genetic Disorders of Mucociliary Clearance Consortium, which recently received a $7.5 million grant from the National Heart, Lung and Blood Institute. “We are hoping to make diagnosing PCD more streamlined so that we can hold clinical trials to develop new therapies for people with the condition,” Rosenfeld said. “We are hopeful that more effective therapies for PCD will exist in the future.”

Read the article: Families Raise Awareness of Rare, Underdiagnosed Lung Disease – On the Pulse

Seattle Children’s Has Lead Role in Tuberculosis Research

Kevin Urdahl

Dr. Kevin Urdahl, a Seattle Children’s researcher in the Center for Global Infectious Disease Research, recently received a seven-year, $83 million grant from the NIH to study how protection against tuberculosis (TB) works in order to develop a more effective TB vaccine. It is the NIH’s largest-ever investment in TB. Seattle Children’s is the largest of the four centers awarded funding and will lead a consortium made up of the University of Washington, Fred Hutch, Oregon Health & Science University, Beth Israel Deaconess Medical Center of Harvard and three sites in Africa. Read full post »

Updated FAQs about Air Quality in Operating Rooms

Dear Providers,

We are deeply sorry for the impact the air quality issues in our operating rooms (ORs) continue to have on our patients and families. We are grateful for your partnership and support during this period. Seattle Children’s remains committed to doing what’s right to keep our patients safe.

Dr. Mark Del Beccaro, SVP and Chief Medical Officer

Mady Murrey, SVP and Chief Clinical Officer

Dr. Jeff Ojemann, SVP and Surgeon-in-Chief

 

Read Our Additional FAQs

How should we refer patients with possible surgical needs?

Please continue to refer patients by calling our ED Communications Center at 206-987-8899. We will review potential surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. We still expect to have capacity for emergency cases. We will continue to divert some cases to other local hospitals and perform additional surgeries at our Bellevue Clinic and Surgery Center.

How does this affect patients currently scheduled for surgery at Seattle Children’s?

Over the coming days and weeks, our surgery coordinators will be contacting families to help them reschedule their procedures. We will review surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. If a family contacts you with a question about their child’s scheduled surgery, please ask them to call their surgery clinic at Seattle Children’s for assistance.

We are also telling families in clinics to anticipate longer than normal wait times when trying to schedule their surgeries, and that they are welcome to speak to their PCP if they would rather schedule somewhere else instead of waiting.  

We understand the impact that postponing surgeries has on our patients and families, and are deeply sorry for the inconvenience. We are grateful for our families’ understanding and your partnership and support during this period.

Will my patient’s surgery get cancelled?

This will depend on the type of surgery or procedure. Coordinators from the Surgery Center will call patients and families to give updates about rescheduled or postponed surgeries.

How many surgeries have been canceled or rescheduled due to the closure of the main campus operating rooms?

To date, we have postponed 255 surgeries, and our surgery coordinators are in close contact with patients and families whose scheduled surgeries are impacted. We are deeply sorry for the impact this closure will have on our patients and families.

During this temporary closure of most of our operating rooms, Seattle Children’s will perform surgeries at partner hospitals, including Harborview, Swedish, UW Medical Center and Mary Bridge Children’s Hospital.  We will continue to perform surgeries in our remaining operating rooms and at our Bellevue Clinic and Surgery Center.

What types of surgeries are being sent to other hospitals?

We will continue to conduct surgeries in three of our ORs that already have HEPA filtration, and prioritize those surgeries that are most emergent. Additionally, one non-HEPA filtered OR will remain open for procedures that carry very low or no risk of infection. We will cancel, postpone or divert some surgical cases to other area hospitals including Mary Bridge Children’s Hospital, UW Medical Center, Harborview and Swedish, and move others to our Bellevue campus.

In addition to installing HEPA filters what else is Children’s doing to make improvements?

In addition to addressing the air-quality issues in our operating rooms, we will conduct a rigorous, thorough review of the factors that led to this situation. Among other issues, we will examine our culture, our leadership, and how our teams communicate problems and escalate concerns.

Where should I direct families who have questions?

If your patient or family has a concern, please ask them to visit our website for the most up-to-date information or call 206-987-2550. If they need an interpreter, they may call 866-583-1527 and ask to be connected to this number: 7-2550.

What if I have more questions?

If you would like to speak with Seattle Children’s leadership team directly, please contact Dr. Jeff Ojemann, Seattle Children’s Surgeon-in-Chief (206-987-2544  or Jeffrey.Ojemann@seattlechildrens.org).

If you have an urgent clinical concern, please call the Provider-to-Provider Line at 206-987-7777 and ask to speak to the specific surgical service on call.

Plan for Installing HEPA and Re-Opening ORs

Dear Providers,

We are deeply sorry for the impact the air quality issues in our operating rooms (ORs) continue to have on our patients and families. Seattle Children’s remains committed to doing what’s right to keep our patients safe.

Dr. Mark Del Beccaro, SVP and Chief Medical Officer

Mady Murrey, SVP and Chief Clinical Officer

Dr. Jeff Ojemann, SVP and Surgeon-in-Chief

Plan for Installing HEPA and Re-Opening ORs

On Wednesday, Nov. 13, we closed our main operating rooms (ORs) at the hospital to inspect our air handling system and determine the appropriate corrective actions.

After careful consideration and in consultation with outside experts, we have decided to proceed with the immediate installation of custom in-room HEPA filtration in 10 ORs and two equipment storage rooms, and to continue with the planned installation of the new air handling system. We had previously planned to build in-room filtration systems room-by-room in order to minimize disruption to our patients, and have already completed this work in three rooms. The room-by-room installation was previously scheduled to be completed by July 2020.

Our patients’ safety is our top priority and we remain committed to doing what’s right to keep them safe.  HEPA is an extremely effective filtration system that removes more than 99% of particles from the air passing through the filter. Installing in-room HEPA filtration requires custom-building a system for each OR – an extraordinary measure – but one that we know is the right thing to do for our patients and families.

To allow for the installation of the new filtration systems, 10 ORs will remain closed until the end of January. We will continue to perform surgeries in the four remaining ORs, three of which already have HEPA filtration. Cases that must be done at Seattle Children’s will be performed in the ORs with HEPA filtration. Only those surgeries that pose little or no risk of infection will be performed in the OR that does not yet have HEPA filtration. After February, the one remaining OR will receive its in-room HEPA filtration system.

We know this closure will result in the postponement of many surgeries, and we are sorry for the impact this will have on our patients and families. We are confident this is the safest option for our patients.

How does this affect patients who are referred with possible surgical needs?

Please continue to refer patients by calling our ED Communications Center at 206-987-8899. We will review potential surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. We will continue to divert some cases to other local hospitals and perform additional surgeries at our Bellevue Clinic and Surgery Center.

How does this affect patients currently scheduled for surgery at Seattle Children’s?

Our surgery coordinators will be contacting families to help them reschedule their procedures. We will review surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. If a family contacts you with a question about their child’s scheduled surgery, please ask them to call their surgery clinic at Seattle Children’s for assistance.

We understand the impact that postponing surgeries has on our patients and families, and are deeply sorry for the inconvenience. We are grateful for our families’ understanding and your partnership and support during this period.

Is my patient at risk if he/she had surgery at Seattle Children’s recently?

We have been actively monitoring all high-risk patients since re-opening our ORs in July and have contacted those families.

Where should I direct families who have questions?

If your patient or family has a concern, please ask them to visit our website for the most up-to-date information or call 206-987-2550. If they need an interpreter, they may call 866-583-1527 and ask to be connected to this number: 7-2550.

What if I have more questions?

If you would like to speak with Seattle Children’s leadership team directly, please contact Dr. Jeff Ojemann, Seattle Children’s Surgeon-in-Chief (206-987-2544 or Jeffrey.Ojemann@seattlechildrens.org).

If you have an urgent clinical concern, please call the Provider-to-Provider Line at 206-987-7777 and ask to speak to the specific surgical service on call.

Air Quality in Operating Rooms – November 2019

Dear Providers,

We are deeply sorry for the impact the air quality issues in our operating rooms (ORs) continue to have on our patients and families. Aspergillus is again present in some of our ORs. Out of an abundance of caution, we have closed all main ORs at our main campus in order to investigate the air handling system and take corrective actions. Seattle Children’s remains committed to doing what’s right to keep our patients safe.

The duration of the OR closures is still being determined.

We have provided a Q&A below to help answer your questions. We will update you again when we have new information to share.

Dr. Mark Del Beccaro, SVP and Chief Medical Officer

Mady Murrey, SVP and Chief Clinical Officer

Dr. Jeff Ojemann, SVP and Surgeon-in-Chief

 

What is happening?

On November 10, routine air tests detected Aspergillus in three operating rooms and two procedural areas. Aspergillus is a common mold often present in the air we breathe. However, in some instances it can cause complications for surgical patients.

What are we doing in response?

We have closed all main ORs at our main campus. The duration of the operating room closures is still being determined.

Some surgical cases may be postponed, diverted to other local hospitals temporarily, or performed at one of our community-partner sites by Seattle Children’s surgeons who have privileges at that site. We will perform some procedures at our Bellevue Surgery Center or at other sites on our main campus that are not in the main ORs.

We have also self-reported the issue to the Washington State Department of Health and Public Health – Seattle & King County.

Have patients been affected?

We recently confirmed one new Aspergillus surgical site infection, and continue to investigate one other potential infection.

How does this affect patients who are referred to the ER with possible surgical needs?

Please continue to refer patients by calling our ED Communications Center at 206-987-8899. We will review potential surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief.

How does this affect patients currently scheduled for surgery at Seattle Children’s?

Our surgery coordinators will be contacting families to help them reschedule their procedures. We will review surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. If a family contacts you with a question about their child’s scheduled surgery, please ask them to call their surgery clinic at Seattle Children’s for assistance.

We understand the impact that postponing surgeries has on our patients and families, and are deeply sorry for the inconvenience. We are grateful for our families’ understanding and your partnership and support during this period.

What should PCPs be monitoring for?

Signs of Aspergillus infection may include:

  • Redness
  • Swelling or drainage from the surgical site or fever
  • Neurosurgery patients might experience headache or a stiff neck.

If you have a clinical concern, you may call the Provider-to-Provider Line at 206-987-7777 and ask to speak to Infectious Disease.

What is causing Aspergillus to be present in the operating rooms?

At this time, the source of Aspergillus in the operating rooms is unknown and we are actively investigating.

What did Seattle Children’s do previously to address its air quality issues?

During the summer of 2019, we implemented multiple improvements recommended by outside industrial hygiene experts. These included:

  • Removing our previous air handling and purification system and switching to a newer air handler, which has been upgraded, cleaned, sanitized and tested to verify proper performance.
  • Installing and testing a new humidification system.
  • Sealing potential sources of air leaks in all of the operating rooms.
  • Extensively and repeatedly deep cleaning all of our operating rooms and core rooms.
  • Adding a new device to our operating room cleaning protocol that emits ultraviolet light to disinfect surfaces.
  • Continuing to monitor and test our air handling system in an effort to maintain a safe environment for our patients.

To validate that our operating rooms were safe for patient care, this summer we invited the Centers for Disease Control and Prevention (CDC), the Washington Department of Health and Public Health – Seattle & King County to tour our facilities, assess our safety protocols and share in our learnings. They confirmed we have taken appropriate actions to reduce the risk of future Aspergillus infections.

Where should I direct families who have questions?

If your patient or family has a concern, please ask them to visit our website for the most up-to-date information or call 206-987-2550. If they need an interpreter, they may call 866-583-1527 and ask to be connected to this number: 7-2550.

What if I have more questions?

If you would like to speak with Seattle Children’s leadership team directly, please contact Dr. Jeff Ojemann, Seattle Children’s Surgeon-in-Chief (206-987-2544 or Jeffrey.Ojemann@seattlechildrens.org).

If you have an urgent clinical concern, please call the Provider-to-Provider Line at 206-987-7777 and ask to speak to the specific surgical service on call.

New Endocrinology Algorithms

Seattle Children’s Endocrinology program has posted new algorithms for goiter, hypothyroid, obesity, short stature and vitamin D deficiency on its Refer a Patient page webpage, along with related resources for these conditions. The tools help PCPs know how and when to manage their patients’ endocrinology care in the primary care setting.

Seattle Children’s recently announced updated referral requirements for several specialties, including Endocrinology and Diabetes, Genetics and Gastroenterology, as well as a major change in the Diabetes intake and patient education protocol. Otherwise, healthy diabetes patients ages five and up will now be referred to a two-day outpatient education program rather than the previously prescribed two- to three-day inpatient hospital stay, as long as they meet the eligibility requirements. Details are available on our Endocrinology and Diabetes Refer a Patient page under “Patients newly diagnosed with diabetes.” Read full post »

Diagnosing and Treating Thyroid Cancer: A Q&A With Drs. Scott Manning and John Dahl, with Case Study

Headshot of Scott Manning

Scott Manning

Headshot of John Dahl

John Dahl

Is thyroid cancer on the rise?

Scott Manning, MD, program director, Otolarnygology Education, and John Dahl, MD, PhD, MBA, pediatric otolaryngologist, Seattle Children’s: Yes, the reported incidence of thyroid nodules across all age groups is increasing in the United States, with thyroid cancer now the fastest-growing cancer diagnosis for adult women. We believe environmental factors are contributing to this rise. For children, a thyroid nodule has an even higher chance of being malignant than for adults; in some centers, as many as 20% of pediatric thyroid nodules turn out to be cancer, versus 5 % in adults. That said, it’s important to keep in mind that the majority of thyroid nodules in children and adults turn out to be benign. About 350 pediatric thyroid cancers are reported each year in the United States.

What is the best way to diagnose a thyroid nodule?

Ultrasound is the best way to initially evaluate a nodule and will determine whether a particular nodule additionally needs a fine needle aspiration (FNA) biopsy in order to make the definitive diagnosis. Ultrasound does not require anesthesia/sedation or radiation and is cost-effective. It can also be used to evaluate for the presence of cervical metastases in children with thyroid cancer.

At Seattle Children’s, we are able to do FNA biopsies in clinic with our kids awake under local anesthetic, which makes the process that much safer and easier on the family and child. About 85% of our FNA biopsies are done this way, which is unique in the United States; most FNA biopsies elsewhere are done under general anesthesia.

It’s important to have a patient’s ultrasound read by a pediatric radiologist rather than an adult radiologist, because of their specialized knowledge and training in working with children and imaging.

For a variety of treatment-related reasons, we don’t recommend diagnosing a nodule by starting with a CT with contrast. Read full post »