Caring for babies: Regional hospitals differ in approaches, with some outsourcing pediatric services

Many hospitals in the Boulder Valley and Northern Colorado have reevaluated their inpatient pediatric services in the past couple of years to determine if it is something they want to continue offering or if it makes more sense to outsource those services.

Boulder Community Health and Avista Adventist Hospital in Louisville have both formed a care alliance with Children’s Hospital Colorado to provide Boulder County children and their families with coordinated pediatric care across their respective organizations.

For BCH, the alliance officially started May 1, 2017. As part of the alliance, BCH and Children’s Colorado review and collaborate on best-practice treatment protocols for pediatric patients in the Foothills Hospital Emergency Department; expand educational opportunities for the BCH caregivers treating pediatric patients; and streamline the referral process for Boulder families needing inpatient care at a Children’s Colorado facility.

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The majority of local pediatric care will still be provided by Boulder pediatricians, family practitioners, emergency physicians, nurses from the BCH Family Birth Center and therapists from BCH Pediatric Rehabilitation. Through the alliance with Children’s, local physicians get additional support from Children’s Colorado, including a streamlined process for consulting with Children’s nationally recognized specialists.

“This is truly a win-win situation for local physicians and Boulder families,” said Dr. Stephen Fries, a Boulder Medical Center pediatrician for 37 years and a member of the BCH Board of Directors. “Boulder pediatricians and family practitioners will continue to care for Boulder kids. Families will continue to bring their ill and injured children to our Emergency Department. Newborns will continue to be treated in the Foothills Hospital Intensive Care Nursery. But local families needing inpatient care for their children will have expanded access to one of the best children’s hospitals in the country.”

Longmont United Hospital just solidified its role as a provider of inpatient pediatric care.

“Longmont is far enough away from metro Denver and other facilities that offer inpatient services it would be a real inconvenience for our families admitted and transferred to a facility far away from home,” said John Tynes, chief medical officer at LUH and St. Anthony North Health Campus. “We feel like having some sort of inpatient pediatric presence is important to us.”

As part of Centura Health, LUH also belongs to the care alliance with Children’s Colorado.

“For many years we have had neonatal nurse practitioners in our intensive care nursery. They have been affiliated with Children’s for many years,” Dr. Tynes said. More recently, LUH has partnered with a pediatric hospitalist service for Longmont. The hospital has pediatricians available to come and see kids in the hospital 24/7. They support the hospital’s neonatal nurse practitioners, see healthy newborns and pediatric patients who are admitted to the hospital’s pediatric unit.

The hospital will send children who need a higher level of care to Children’s Hospital in Aurora, but it will continue to serve children who are sick enough to be admitted to the hospital but who need only a few days of care before they are ready to go home. Many of those patients are admitted with respiratory problems such as RSV or pneumonia.

LUH has one wing of the hospital that is equipped to serve inpatient pediatric patients. It has 16 to 18 beds that can be used for that purpose.

“At the moment, we are currently, as far as I know, the only hospital in Boulder County that admits pediatric patients to the hospital,” Tynes said. “Some other hospitals in the county, over the last year or two, have gotten out of the business, frankly because you have to have critical volume to stay good at this and have nursing staff trained and able to take care of kids.”

Boulder Community Health said it made the decision to partner with Children’s because it had been experiencing a persistent decline in the number of pediatric inpatients treated at Foothills Hospital as local pediatricians and families have steadily increased their use of Children’s Colorado’s resources for inpatient care.

All three Banner Health facilities in Northern Colorado offer general medical surgical inpatient and observation services for pediatrics, said Debra Clark, RN manager for pediatrics at North Colorado Medical Center in Greeley. NCMC hired a pediatric hospitalist, someone who specializes in pediatrics for hospitalized patients, for its dedicated 15-bed pediatric unit. McKee Medical Center in Loveland is also working to increase its pediatric services by acquiring a pediatric hospitalist. Banner Fort Collins Medical Center is increasing its pediatric service line by acquiring more pediatricians who would come into the hospital as needed.

“We’ve seen an increase in census, and we understand that many of the people in our communities don’t have the ability to commute to Denver for pediatric care,” Clark said. “We want to provide this service to this community. I think Banner understands the strain when you separate families, when you have a sick child in another facility in another town. Dividing that family unit is also a hardship.”

NCMC has worked hard to educate its nurses in the care for pediatric patients.

“Pediatric care is much different than adult care. You’re not only taking care of the patient, the child, but you also have to care for the family unit as a whole and educate the family as well, which can include their siblings,” Clark said.

Higher-acuity patients might require more intensive care and those patients could be sent to Denver facilities, she adds.

NCMC is expanding its pediatric burn unit and is implementing cardiac monitoring capabilities for various diagnoses. It also offers a hospitality house to families who want to stay close to their children during treatment. The house is offered to them for much less than the cost of a hotel room, Clark said. NCMC just opened its pediatric playroom in August, which is in the middle of the center’s pediatric unit. It offers toys and games to keep the hospital’s littlest patients entertained.

“It is a little getaway for the patients so they can feel like a kid,” Clark said.

Dr. Mark Schane, a pediatrician and chief medical officer at UCHealth Longs Peak Hospital in Longmont, which is opening its doors in the next couple of weeks, said the hospital will take care of inpatient pediatric patients.

“We really want to keep this service close to home, for us to take care of our community where we live. It is really important to our group,” he said. “We didn’t want to have our patients forced to leave the community if they needed to be admitted to the hospital for kind of the less severe pediatric illnesses we can manage at a community facility.”

The hospital set up a pediatric hospitalist program where one pediatrician is dedicated to the hospital for a week rotation so that pediatric inpatients have a consistent pediatrician presence during their stay.

The hospital looked at the most common reasons children are hospitalized and “we reviewed evidence-based guidelines and best practices to make certain we are all on the same page and provide consistent care for common diagnoses,” Schane said.

If patients need to see a specialist, they will be transferred to Children’s Hospital, but the hospital does have dedicated beds for pediatric patients, right next to the nurse’s station.

Suzanne Ketchem, senior director for the women and children’s service line at Poudre Valley Hospital in Fort Collins and Medical Center of the Rockies in Loveland, said one of UCHealth’s goals is to provide care for children in the community where they live.

Medical Center of the Rockies has a six-bed pediatric unit that is located beside the surgical intensive care unit. It cares for low-risk pediatric patients who are there for things like tonsillectomies, appendectomies, jaundice or respiratory infections.

Poudre Valley Hospital has a 17-bed pediatric unit and a two-bed pediatric intensive care unit. It handles the same types of pediatric cases as MCR but also admits children who aren’t thriving for a variety of reasons and children with behavioral problems who need observation. It also offers outpatient infusions for children who need blood infusions, chemotherapy or need to be fed intravenously.

“Our staff at PVH and MCR are experienced pediatric nurses,” Ketchem said. Newer nurses have experienced nurses to learn from and both hospitals have a pediatric hospitalist at their disposal as well.

Good Samaritan Medical Center in Lafayette is a level 2 trauma center. It treats patients of all ages in the emergency room and, depending on age and the condition of the patient, may transfer them to another hospital that is able to work with pediatric patients who require acute care, said Rachel Hamasaki, communications manager for the hospital.

The hospital no longer has a pediatric unit, but it will care for patients that don’t require acute care.

“I don’t think we had a high census in that unit so maybe it made more sense to have capabilities to stabilize and transfer as needed,” she said.