Seattle Children's Provider News

PCPs Play a Critical Role in Pandemic Response

Seattle Children’s anticipates a massive response will be required by healthcare providers on all fronts to respond to COVID-19. Hospitals, ERs and urgent cares will be strained to capacity to treat the sickest patients; their ability to keep up and save lives will depend in large part on primary care providers having capacity and resources to treat less acute patients throughout our communities.

What you can do:

• Prepare your clinics immediately to see low acuity respiratory patients.
  • Divide your flow so that patients with and without respiratory symptoms are seen in separate spaces.
  • Consider a front door v. back door check in process.
  • Consider seeing symptomatic kids in their cars and/or asking them to remain in cars until a room is ready for them.
  • Be creative in this crisis situation to minimize in-person patient visits for suspected COVID; use phones, video apps, etc. to see patients and help limit the spread of the virus.
  • Do not automatically redirect patients with respiratory symptoms to urgent care or emergency departments. Manage as much patient care as possible without sending patients to urgent care or the ED.
• If you experience an increased demand for respiratory visits, consider canceling planned non-urgent patient visits, such as well-child care. Limit well-child appointments to immunizations only, to free up appointments for respiratory patients.
• Isolate non-emergent respiratory patients with quarantine at home.
• Consider coordinating with other clinics to become a larger outpatient system for triaging and managing patients.
• Focus now on procuring the personal protective equipment (PPE) needed by your staff, including gloves, masks, eye shields or goggles (not eyeglasses), and gowns.
• Stay up-to-date on the CDCs guidance on evaluating and reporting Persons Under Investigation (PUI).

Read full post »

Constipation is incredibly common in the pediatric population. It affects up to 30% of children, accounts for 3-5% of general pediatric outpatient visits and up to a quarter of all pediatric gastroenterology visits. This represents significant cost to our healthcare system.

Peak prevalence of constipation occurs during preschool years. Painful stooling during this time can lead to withholding of stool. This can lead to harder, less frequent stools, which further reinforces the withholding cycle. Starting daycare or grade school often restricts access to the bathroom and it is common for our patients to avoid stooling in these environments. Other factors that can lead to constipation include diets without enough fruits, vegetables and fiber, inadequate water intake and a lack of physical exercise.

Constipation is a frustrating experience for both children and parents. It often takes a dedicated, long-term, multifactorial approach consisting of behavioral, lifestyle and medication management.

At Seattle Children’s, we use the Rome IV criteria to define constipation in children. There are separate definitions for children older and younger than 4 years old. Our detailed practical clinical protocol for constipation evaluation and treatment, which includes an algorithm, is found here. Read full post »

New referral guidelines are now available from Seattle Children’s Neurosciences Center, along with new resources to help manage patients with tic and headache in primary care.

The current wait time for new patients with non-urgent headache or tic is about 3 months. As Seattle Children’s continues its effort to improve access to specialty care for children who most need it, the headache and tic resources from Neurosciences are intended to help patients with these conditions find appropriate care with their primary physician and avoid the longer waits to see a specialist.

Please visit the Neurosciences “Refer a Patient” webpage.     Read full post »

As announced last week in a special Provider News bulletin, Seattle Children’s has re-opened the operating rooms (ORs) on the hospital campus that were previously closed for installation of a new air handling system and in-room HEPA filtration systems in each OR. We are taking a thoughtful approach to rescheduling surgeries that were postponed due to the closure, including reviewing surgeries on a daily basis to assess urgency and priority.

For surgery referrals, please follow our normal referral process. Read full post »

Ocean Pharmacy Now Open 24 Hours

On Feb. 24, the hours of our Ocean Pharmacy expanded to 24 hours a day, seven days a week. The goal of this expansion is to enhance the continuity of care patients receive at Seattle Children’s. Patient families can now avoid the hassle of finding a late-night pharmacy after being discharged from the Emergency Department. The expanded hours will also help improve daytime turnaround times for inpatient and surgery center discharges.

Ocean Pharmacy is not open to the general public. Read full post »

Seattle Children’s has updated the clinical standard work pathway for Urinary Tract Infection (UTI). For more information, please reference our Urinary Tract Infection CSW Pathway.

The pathway first went live in December 2011 and completed its last periodic review in April 2015. After a review of synthesized medical literature and consensus on the recommendations, the pathway team updated the care algorithm. This was an extensive revision that included the following changes:

• Shortened IV antibiotic duration for infants 0-1 month of age with E. coli UTI
• Shortened IV antibiotic duration for bacteremic E. coli UTI
• Shortened total antibiotic duration for children 2 months of age and older
• Criteria for obtaining a renal bladder ultrasound (RBUS)
• Criteria for obtaining a voiding cystourethrogram (VCUG)

Read full post »

1. There IS a Washington Mental Health Referral Service for Children and Teens!

Washington’s Mental Health Referral Service for Children and Teens connects families to licensed providers in their local area with current availability who fit a child’s mental health needs and insurance coverage. Washington Healthcare Authority funds the referral service and Seattle Children’s operates it.

The service launched in Spring 2019, but many health care providers still don’t know about it. If you have been a subscriber to Provider News for the last year, you may have seen our April 2019 launch announcement and our update in August about the service growing.

2. It connects families to mental health providers who actually have availability and take the child’s insurance.

One of the unique features of the Washington Mental Health Referral Service is that families get connected with mental health providers who actually have availability to see their child. When a family receives a referral, it includes providers who take their child’s insurance.

There are more than 1700 pediatric mental health providers currently identified by the service. Read full post »

To help contain the spread of COVID-19 in our community, Seattle Children’s is canceling large group gatherings taking place at our facilities, including those with attendees from the community (e.g. CMEs, classes, conferences, PALS courses, etc.). Some Grand Rounds may be moved to WebEx rather than cancelled. Please check with event organizers if you have questions or need additional information. If you are registered for an event and it is moved to WebEx only, event organizers will notify you. Read full post »

To help keep our staff, patients and their families safe as the situation with COVID-19 rapidly changes, CMEs and other large-group events are temporarily being cancelled, rescheduled or moved to WebEx. Organizers will let registrants know of any changes.

WebEx:

March 21: Olympia PAL Program CME

8 a.m. to 12:30 p.m. 

The PAL Program is hosting a free child mental health educational conference for primary care providers.

• • Location: WebEx
  • Read more information about upcoming conferences
  • Register

A patient who visited Seattle Children’s North Clinic on Monday, February 24 has been tested for COVID-19. Initial test results have come back positive for COVID-19. The Center for Disease Control (CDC) is currently performing additional testing; the patient is presumed positive.

Following CDC and Public Health guidance for patients with symptoms of a respiratory infection, the patient put on a mask shortly after arriving and was put in appropriate isolation.

Visit the Washington State Department of Health site for more information.

We are reaching out to workforce members and patient families who may have been exposed with information and guidance.

Since the beginning of January, leaders at Children’s have been preparing for the possibility of a COVID-19 pandemic and planning how to care for patients who test positive.

How will you be notifying families who were potentially exposed and their PCPs?

Both Seattle Children’s and King County Public health will be contacting any families or staff who may have exposed. We will be reaching out to the PCPs of any patients who were potentially exposed.

How should PCPs refer patients with suspected COVID-19?

PCPs who are caring for a patient with suspected COVID-19 should first contact Public Health-Seattle & King County. If, after discussing with Public Health, the decision is made to send the patient to Children’s, the PCP should first notify the ED Communications Center at 206-987-8899.

The viral respiratory panel used at Seattle Children’s does not detect this virus. If the panel detects coronavirus it is due to a different strain.

Coronaviruses are a large family of viruses. They usually cause mild respiratory illnesses such as the common cold. COVID-19 is a new coronavirus that was not seen in humans prior to December 2019. For more information, please review the coronavirus information sheet.

What should families do if they think they were exposed to COVID-19?

If a family thinks they were exposed to COVID-19, they should contact their primary care provider and Public Health – Seattle & King County by calling 1-800-525-0127 and pressing #. Unless it is an emergency, families should not go to their nearest emergency room without calling ahead so Public Health can take steps to provide them with the right treatment and protect others from a possible exposure. Please direct families to the Public Health-Seattle & King County website for more information.

For the most accurate and up-to-date information about COVID-19 visit;

• Centers for Disease Control and Prevention
• Washington State Department of Health
• Public Health — Seattle & King County