Children’s Hospital & Medical Center

2.2011

Contents

4 Health Lesson

8 Intensive Caring

14 Enhancing Critical Care

15 Investing in Our Community

16 Reaching Out

20 A World of Difference

24 Growing a Partnership

Spira

Spira is the biannual magazine of

Children’s Hospital & Medical Center,

8200 Dodge St., Omaha, NE 68114.

Spira@ChildrensOmaha.org

SpiraMagazine.org

Magnet® recognition is the gold standard for nursing excellence and is taken into consideration when the public evaluates health care organizations. For example, U.S. News & World Report’s annual showcase of “America’s Best Hospitals” and “America’s Best Children’s Hospitals” includes Magnet® recognition in its ranking criteria for quality of inpatient care.

Children’s was initially designated a Magnet® hospital in December 2006. Currently, only 386 of the nearly 6,000 U.S. health care organizations have achieved Magnet® recognition. Hospitals must reapply every four years.

In its report, ANCC noted the importance Children’s nurses place on the achievement of national certifi cation, their extensive involvement in the community and their concerted effort to promote

a culture of patient safety. In all, the nursing staff at Children’s received seven “Exemplars,” a special designation recognizing achievements that exceed Magnet® standards.

Regarding patient safety, The Joint Commission report rated Children’s as 100 percent compliant with all National Patient Safety Goals, which range from improving effective communication among caregivers to reducing the risk of infections.

An independent, not-for-profi t organization, The Joint Commission accredits and certifi es more than 19,000 health care organizations and programs throughout the nation. The commission’s accreditation and certifi cation is accepted as a symbol of quality that refl ects an organization’s commitment to meeting specifi c performance standards.

Rising Above Rising Above & Beyond& BeyondRising Above Rising Above & BeyondRising Above Rising Above

Children’s Hospital & Medical Center has once again been recognized for excellence in nursing by the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®, and also for achieving the highest compliance with patient safety goals established by The Joint Commission.

Health Lesson

Debra Tomek, M.D., understands the situation. Children don’t learn if they aren’t in school. Sick children don’t go to school. Get them healthy, keep them well, and they’ll miss fewer school days. That’s the reasoning behind the fi rst-ever School-Based Health Centers to serve the Omaha Public Schools.

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For Dr. Tomek, the faces of the children and the smiles of the parents she sees when she visits the centers put it all in perspective.

“I love witnessing the impact these centers are having on children’s lives,” says Dr. Tomek, an Emergency Department pediatrician at Children’s Hospital & Medical Center who also serves as medical advisor to Building Bright Futures, the educational and philanthropic group that initiated the School-Based Health Centers (SBHC).

“I know one father who feels the SBHC nurse practitioner ‘cured’ his child of asthma,” Dr. Tomek says. “Prior to visiting the School-Based Health Center, the child went to the school nurse every day to use an inhaler. The nurse practitioner did an assessment; it was determined that a different form of medication would be best to treat her persistent asthma. With the child on the correct medicine, she isn’t making daily trips to the school office anymore. She’s in the classroom, learning.

“We also determined that the family was qualified for Medicaid, which was a big help to them financially. This family was affected in a marvelous, positive way through a relatively minor encounter in one of our centers.”

As part of its continued outreach to the children of the community, Children’s Hospital & Medical Center, along with the

University of Nebraska Medical Center and Creighton University Medical Center, helped plan and currently supports the health centers.

Opened in August 2010, the six Omaha Public Schools (OPS) centers are funded in part by Building Bright Futures, which contracts with two area health care providers: OneWorld Community Health Centers and Charles Drew Health Center to operate the clinics.

Each is staffed by a nurse practitioner and a medical assistant. The clinics include a pediatric exam room and a separate waiting room to ensure privacy.

“It’s a lean model, both on personnel and space,” says Dr. Tomek.

In its first year, the program totaled 2,245 visits by 1,558 children from 63 area schools — numbers that met officials’ expectations. Due in part to OPS’s open enrollment policy, the children came from nearly every zip code in the city.

The availability of health care at area schools has been so well received that Building Bright Futures is expanding the service, in number of locations, services and hours of operation, says Executive Director John Cavanaugh.

Formerly a half-day service, it is now available from 7:30 a.m. until 4:30 p.m. on school days. It is also open to any OPS student and their siblings under age 18.

Additional licensed mental health professionals will be hired for the centers that do not yet offer those services. And, in early 2012, the first center will open at an OPS high school, Northwest.

“Omaha has the highest quality pediatric health care available in the nation” Cavanaugh says. “What we haven’t had is equal access for low income, underinsured or uninsured children.

“With the School-Based Health Centers, we believe we are on a path to being a community where there are no unserved youth in terms of health care,” he says. “We’re going to remove that obstacle to academic success.”

The idea of school-based clinics was not new nationally, says Steven Burnham, president of Children’s Physicians. “Building Bright Futures wanted to bring that idea to Omaha, and Gary Perkins (president and CEO of Children’s Hospital & Medical Center) volunteered to take the lead,” Burnham says.

Perkins asked Burnham to serve as chairman of the SBHC formation committee, which included representatives of health care providers across the city.

“The program’s purpose is to keep kids well so that they don’t miss school,” Burnham says. “Our committee’s purpose was to make certain the program would be sustainable.”

“The program’s purpose is to keep kids well so that they don’t miss school. Our committee’s purpose was to make certain the program would be sustainable.”Steven Burnham

2.20116

Burnham now serves as chairman of the SBHC advisory group. “Our goal is to see that the program is on solid fi nancial ground and that it is meeting its goals,” he says. “This is not some fl ash-in-the-pan idea. It’s here today and it will be here tomorrow.”

The centers’ services are not free. Insurance is accepted, and a sliding fee scale is in place for uninsured children and families. Flat fees are available for some services like school sports physicals.

“We are doing all we can to keep it affordable for everyone,” says Dr. Tomek.

The centers are not intended to replace a student’s own physician, she says. “If there’s an issue requiring follow-up and they have a physician, we will contact that physician and refer the student to their care,” she says.

Cavanaugh says the process is underway to gather data from the health centers and the schools and correlate it with other data regarding the children who are seen at the centers.

“We have fl agged every student enrolled in the SBHCs in the OPS data system,” he says. “We will track their visits and see what impact these visits have on their school attendance and academic performance.”

Cavanaugh calls the SBHC program “an incredible example of community-wide

collaboration,” adding that “it could not have happened without the leadership and involvement of Gary Perkins, Steve Burnham and Children’s Hospital & Medical Center.

“Everyone at Building Bright Futures is very pleased with the program’s success,” he says.

For Dr. Tomek, seeing the children who visit the clinics reveals the depth of that success.

“There is one young man who had warts that were so severe he didn’t want to be in school,” she recalls. “He felt ostracized and the subject of ridicule. After all, children can be very self conscious, especially about their looks. He wanted to be anywhere but school.”

A visit to his School-Based Health Center connected him with the medicine he needed to clear up the warts — and his absenteeism.

“For him, it was both a health issue and a school issue,” Dr. Tomek says. “We might never have been able to help him overcome his situation without the collaborative effort of the School-Based Health Centers.”

Building Bright Futures began in 2006, when a group of business, civic and political leaders came together to assess the status of young people in Douglas and Sarpy Counties and see whether they were receiving the support and services they needed to succeed.

Today, the organization continues its mission to improve academic performance, raise graduation rates, increase civic and community responsibility and ensure all students are prepared for post-secondary education by developing partnerships with existing providers and creating new evidence-based programs that yield a comprehensive, community-based network of services.

Building Bright Futures’ Executive Board members are Chairman Richard Holland, President Michael Yanney, Susie Buffett, Executive Director John Cavanaugh, Mike Fahey, Dianne Seeman Lozier, Wallace Weitz, Barbara Weitz and Board Secretary Katie Weitz White.

Community Effort

Cavanaugh calls the SBHC program “an incredible example of community-wide

7

2.20118

The baby is resting quietly as the pediatric care team begins its rounds of the Newborn Intensive Care Unit at Children’s Hospital & Medical Center.

The tiny child is one of three infants receiving care after undergoing complex heart surgery at Children’s. The boy had suffered cardiac arrest immediately after being delivered at another local hospital and has been diagnosed with Total Anomalous Pulmonary Venous Return (TAPVR), a rare congenital malformation in which the four pulmonary veins that should connect to the left atrium of the heart instead drain into the right atrium via an abnormal, or anomalous, connection.

The baby received care for seven days at the other hospital before being brought to Children’s by the Critical Care Transport Team, an exclusive unit of medical

professionals trained in neonatal and pediatric critical care who respond by Children’s own ambulance, by LifeNet helicopter or airplane. Once at Children’s, the baby was taken immediately to the operating room for surgery.

As the rising sun peeks through the window into his room, the tiny baby is on a ventilator to help keep him breathing. His kidneys are not working properly, and fluids are building within his abdomen. His condition is constantly monitored by a group of critical care experts that includes cardiac surgeons, neonatologists, subspecialists and neonatal nurses and nurse practitioners, many of whom hold the highest national certifications.

The baby boy is very ill — and he’s in the only NICU in the region that can give him the care he needs to survive.

IntensIve

it’s a few minutes past 6 a.m.

Caring

t he Children’s NICU — the largest in Nebraska — is a designated Level IIIC unit, providing the highest level

of intensive care available for newborns. The designation recognizes the hospital’s ability to perform advanced neonatal interventions, including extracorporeal membrane oxygenation (ECMO), the use of a machine to put oxygen into the blood; and newborn cardiac surgery.

The NICU’s furnishings, equipment and technology are designed specifically for newborns and their families, including low lighting and a reduced-noise environment — features pioneered locally by Children’s.

While the unit attracts patients and families from more than two dozen states, the majority of the 30 babies being cared

for on this particular day have been brought to Children’s after first receiving treatment at other area hospitals.

“At least 80 percent of our NICU patients come from other NICUs because they require pediatric subspecialty care not available anywhere else but here,” says neonatologist Lynne Willett, M.D., Clinical Service Chief of the Children’s NICU.

After first visiting the most seriously ill infants, Dr. Willett joins the other medical professionals as they begin their rounds of the other NICU babies, who range in age from a few hours old to almost one year.

Some are new to the unit but others have been at the NICU for weeks. Because their medical conditions are complex, many suffer from not one but a variety of issues. That’s where the interdisciplinary team of

Children’s Specialty Physicians becomes integral to the infants’ care and recovery. From board certified pediatric surgeons to experienced gastroenterologists, nationally recognized experts are a few steps away from the NICU.

Two teams begin rounds. Each team has a neonatologist and three to five nurse practitioners as well as the bedside nurse and other support personnel. They review X-rays, surgical reports and the latest information available about each baby, consulting and collaborating on a plan for that child for the next 24 hours. Then they communicate that plan to the parents.

The rounds are interrupted when a request for transport comes from an Omaha hospital. A baby born 15 weeks early has been undergoing treatment for 10 days for an intestinal blockage but is

Lynne Willett, M.D., with Angie Madsen, RN, and Melissa Kerr, RN

2.201110

not improving. The infant weighs only 600 grams — about 1.3 pounds.

One of the team’s nurse practitioners, and a registered nurse, rush downstairs to the awaiting Children’s ambulance and make the seven-minute trip to the other hospital.

The ambulance has not yet returned when another request for transport comes in, this time from a hospital in Norfolk, 110 miles away. A 12-hour-old infant is having diffi culty breathing and the attending physician is concerned about a possible infection. Another nurse practitioner gathers necessary medical items and boards the LifeNet helicopter as it idles on the hospital’s helipad. Children’s is the only hospital in the region that has registered nurses and neonatal nurse practitioners as part of the transport team.

As the helicopter lifts off, another baby arrives from a hospital in Lincoln. The full-term infant has been on a respirator for three weeks. She appears to be having seizures that stem from a complex genetic neurologic syndrome with anomalies, and requires care by specialists at Children’s skilled in pediatric neurology and surgery.

This will be the third hospital that has treated the infant. Her parents, who live in rural Nebraska, are anxious and upset.

“The information they’ve received up to this point was not what they wanted to hear,” says Dr. Willett. “They’re frustrated and they’re hoping we can give them a better prognosis. It’s up to us to give them a full account of how we plan to accomplish things over the next few hours, days and weeks, if necessary.”

it’s nOw aBOut 2 p.m. The regular NICU patients have been examined and their immediate needs have been met but parents have yet to be visited by the doctors whose rounds have been twice postponed. Most of the parents wait patiently, especially those who understand that emergency cases take precedence. But some do not, and the neonatologists and nurses are as profi cient at defusing tempers as they are at alleviating fears.

“The majority of parents are appropriately concerned and involved, but we do deal with all kinds of situations,” says Dr. Willett. “It ranges from 12-year-old fathers and 12-year-old mothers who are still babies themselves, to 44-year-old moms who became pregnant by accident, to situations where the husband is not the baby’s father.

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“We deal with all cultures and all sorts of language barriers, too. We have a number of people who bring their children for care but are frightened about deportation or being arrested — things that just don’t happen here. But we have to be able to communicate that to them. We have Spanish interpreters here and on call, but we’re running into new and more obscure languages.

“We had a pregnant young woman, for example, who came from the jungle in Burma and was brought to Omaha by a local church group. She had lived miles from running water and any form of health care. She had to be taught how to use a toilet.”

The woman’s baby required open heart surgery shortly after being delivered at a different hospital. “And now her son is recovering at Children’s, in one of the most sophisticated pediatric hospitals in the world.”

Dr. Willett recalls asking an interpreter to determine the baby’s name. “Apparently, a group of elders picks the baby’s name based on someone they admire in

America, so the child will have a better chance to succeed if they stay here.”

The baby’s name, they learned, is John. “But we still don’t know why,” Dr. Willett says.

The mother also wants to learn something from the interpreter.

How to say, “Thank you.”

it’s nearly 7 p.m. The NICU rounds have finally been completed. The emergency transport cases have arrived and the babies are receiving care, including the infant with the intestinal blockage who will require surgery. Thanks to antibiotics, the baby from Norfolk has stabilized. It’s time to update records, review laboratory tests and X-rays from later in the day.

But before she heads home for a dinner cooked by her son to mark her husband’s birthday, Dr. Willett has one last stop to make. There is a baby she hasn’t yet seen today, one who has been hospitalized in

the NICU for several weeks. Although improving, the infant requires care that can’t be given in a home environment.

“Some of the older babies and their parents, the ones who have been here a long time, become like family to us,” she says. “We like to stop in and see the babies when we aren’t on rounds. We sing or play a little bit, and they really seem to like it.

“It’s different than when we’re conducting a medical evaluation, because during an exam we’re busy probing and checking, touching places that might hurt. We want the babies to know that our voices aren’t always an indication of something uncomfortable or unpleasant. That’s why we make time to interact with them or play. We want them to know we care.”

Pausing briefly at the doorway to smile at the parents, Dr. Willett steps quietly to the bedside and stays only a minute, playing a quick game of peak-a-boo. Tiny toes curl and wiggle their approval.

More than just care. It’s intensive caring.

“some of the older babies and their parents, the ones who have been here a long time, become like family to us.”Lynne Willett, M.D.

2.201112

A unique new diagnostic and delivery service at Children’s Hospital & Medical Center will make it possible for parents and medical professionals to plan for babies whose serious health conditions are identifi ed prior to birth.

Scheduled to open in 2012, the Fetal Care Center will enable women to deliver their babies in a specialized area situated adjacent to Children’s Newborn Intensive Care Unit (NICU) when such a delivery is determined best for the health and safety of the baby.

“There is no other center like this in Omaha,” says Kathy English, executive vice president and chief operating offi cer at Children’s. “Today, there are mothers whose unborn babies’ medical conditions are so serious they could have to go out of the state to deliver. That will change with the opening of the Fetal Care Center at Children’s.”

Expectant mothers initially will be referred to the Fetal Care Center when their obstetricians detect a possible issue with the fetus. Through the new Diagnostic Center opening in 2012, Children’s multidisciplinary team of specialists will provide comprehensive evaluation and diagnostic testing. Generally, delivery at the center will be recommended when it is anticipated a baby will require advanced neonatal care offered at Children’s.

“The center will enable us to identify serious medical issues prior to birth and have a well-conceived plan of action to immediately care for that child upon delivery,” English says. “By having the necessary experts and resources right there, we’re being proactive rather than reactive.”

Diagnoses that would prompt delivery at Children’s include diaphragmatic hernia (when a hole in the diaphragm allows the abdominal organs to move into the chest cavity), and congenital heart defects, the leading cause of birth defect-related deaths.

Throughout the delivery planning process, the mother’s obstetrician will consult with perinatologists who specialize in high-risk pregnancies, neonatologists and a full team of subspecialists to develop a seamless care plan for both mother and baby.

The Fetal Care Center will include a state-of-the-art delivery room next to Children’s NICU. Four comfortable mothers’ recovery rooms will be located nearby, so both mother and baby can receive care in neighboring units.

“We will have the specialists, the equipment and the services necessary to care for mother and baby all in one place,” English says.

In addition to keeping a mother and baby in close proximity, studies indicate newborns who are critically ill or require surgery have better outcomes when delivery occurs where there is immediate access to a Level IIIC NICU facility. Children’s NICU is a Level IIIC unit, the only one in the state operating at

the highest level and with immediate, on-site access to complex open heart procedures.

Planning is underway for renovations to accommodate the new Fetal Care Center. The fi rst deliveries are expected to be scheduled in 2012, with between 50 and 70 births anticipated annually.

Children’s will not be duplicating delivery services that already exist, English says, “nor will this be the place for sick mothers to come prior to delivery. The center is designed to provide the very best care for the most critically ill newborns.

“Additionally, having the full support of Children’s specialists ready nearby makes all the difference,” she says. “Every minute spent planning, and the fewer minutes spent responding to a situation, will have a huge impact in the outcome for that baby.”

Fetal Care Center Because Minutes Count

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Enhancing critical carE

Whether it’s the result of a devastating accident or a sudden, life-threatening illness, children throughout the Omaha metropolitan area and beyond are benefiting from a shared vision of cooperation. Soon to begin its second year, a partnership agreement between Children’s Hospital & Medical Center and Creighton University Medical Center (CUMC) has enhanced the delivery of pediatric critical care.

The partnership is specific to the care of trauma patients who require hospitalization in the pediatric intensive care unit (PICU).

“This collaboration helps to ensure that critically ill and injured children have

immediate access to some of the highest levels of care — an urgent and expert trauma response, coupled with rapid intervention and ongoing treatment from critical care specialists who have extensive experience caring for the sickest children in the region,” said Mohan Mysore, M.D., FCCM, Director of Pediatric Critical Care at Children’s Hospital & Medical Center.

As a designated Level 1 trauma center, CUMC receives pediatric trauma patients and provides immediate medical intervention. Once the child is stabilized and approved for transfer, the Children’s Critical Care Transport Team transfers him to the Children’s PICU for ongoing, specialized care.

“While our medical community always values collaboration, formalizing this process is a significant step that provides Children’s with an expanded role in the treatment of children with traumatic injuries and life-threatening illnesses,” said Dr. Mysore.

As the only pediatric specialty health care center in Nebraska, Children’s provides 24/7, in-house staffing by pediatric intensivists, doctors who specialize in intensive care. Children’s Hospital & Medical Center operates a 19-bed PICU that cares for patients from newborn through age 21.

it’s known as the “golden hour” ➜ 60 minutes that can make the difference between life and death. the greatest chance of survival is for those who receive definitive care within the first hour of a major traumatic injury.

Seeing a child smile, sharing a fi rst word, or providing comfort when there are tears; we’re honored to spend each and every day serving children and their families.

We witness milestones and inspirational recoveries; courageous battles and even the routine as we strive to make children, and our community, safer and healthier.

From an active injury prevention program to ongoing medical education and free classes for parents, Children’s Hospital & Medical Center is committed to addressing our community’s health care and educational needs. Guided by our community, we’re working to improve the lives and health of children across our region.

This time, we’re online!Find Children’s full 2010 Community Benefi t and Annual Report at www.ChildrensSnapshot.org

Financial Assistance Benefi tsUnpaid costs of Medicaid programs, uncompensated or discounted care for those unable to pay

Bad Debt ExpenseLack of insurance reimbursement, unpaid care

Community Benefi t ServicesOutreach programs and materials provided free of charge to patient families and community

Health Professions EducationThe cost of providing education to future physicians and health professionals

Subsidized Health ServicesClinical services provided despite a fi nancial loss to the organization

Sponsorships and In-Kind DonationsServices and support directly to the community, charity events and non-profi t organizations

ResearchHealth and research studies facilitated by the University of Nebraska Medical Center College of Medicine

Community-Building Activities and Assigned Staff CostsStaff involvement in external outreach

$24.3 million

$1.4 million

$1.4 million

$6.7 million

$18.2 million

$775,000

$5.2 million

$58.4 million

$61,000

2010 Total Community Benefi t ( 25% of Children’s Total Operating Expenses )

Investing in Our Community

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Every two weeks, a cardiologist and nurses from Children’s board an airplane and fly to Rapid City, S.D. They join specialists in endocrinology, neurology, orthopaedics, pulmonology, oncology and blood disorders who drive west on Interstate 80 each week to the Children’s Specialty Pediatric Clinic in Lincoln. Add routes on Interstate 29 and state highways for monthly trips to Sioux Falls, S.D., Sioux City, Iowa, and communities throughout greater Nebraska.

It’s the closest thing these families will ever come to a house call — and it’s all part of Children’s expanding effort to provide high-quality clinical care throughout the region.

Families are making the most of these unique outreach opportunities. In 2010, more than 5,000 patient visits were recorded at Children’s periodic specialty clinics in South Dakota, Iowa and Nebraska.

Justin R. Bradshaw, FACHE, is vice president of ambulatory services for Children’s. He says the outreach clinics help Children’s deliver care in a way that helps contain costs far beyond those of the care itself.

“For the families involved, considering the cost of travel and time taken off work, the financial burden can be immense,” he says. “By providing outreach specialty

ReachingOutSurgeons log hours in the operating room. Researchers track time in the lab. Specialists at Children’s Hospital & Medical Center count the miles they travel each year ensuring all children have improved access to the care they need.

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clinics, we’re caring for a greater number of children and at the same time doing our best to be good stewards managing health care costs for society.”

Cardiac specialty clinics are held throughout the region. Other specialties available in Lincoln include rheumatology, surgery and neurosurgery; pulmonology, endocrinology and neurology in Sioux City; and endocrinology in North Platte, Hastings and Norfolk.

Some of the clinics are recent additions, while others, such as Sioux City, have been in operation 10 years or more, says Children’s Director of Specialty Clinics Janelle K. Shepherd.

Most specialty clinics are conducted monthly. The full-time clinic in Lincoln, which opened in 2008, is a direct response to families and pediatricians there, Shepherd says.

“We found there are many people who live south of Lincoln who have no problem driving there but are very apprehensive about driving to Omaha,” she says. “We saw this as a need and worked very hard to fill it.”

Coupled with the Children’s Specialty Pediatric Center in Omaha, Bradshaw says, “the outreach clinics are significantly increasing our ability to deliver high quality care to the region.”

Without the clinics, he says, some families would not see a specialist, or would choose to see an adult specialist for their children, “which is far from an ideal situation.”

In Rapid City, for example, the only local pediatric cardiologist retired last year, says Susan Walsh, director of the cardiac service line at Children’s.

“Through the years we built a very good relationship with him,” Walsh says. “Many

times he would send children to us for interventions and surgeries. Children’s became his provider of choice.”

When he retired in April 2010, she says, “We saw this as an opportunity to continue providing convenient care for his patients.”

Cardiologists and nurses travel to Rapid City twice a month to conduct two-day clinics and see an average of 20 patients each day. The 32 clinics in 2010 recorded a total of 463 visits — the highest number of all the cardiology outreach clinics.

“Few families can travel great distances for a clinic visit,” says pediatric cardiologist Christopher C. Erickson, M.D., interim clinical service chief of cardiology, Children’s Specialty Physicians. “Providing clinical specialty care and subspecialty care in a convenient location is one of the most useful things we do.”

“The outreach clinics are significantly increasing our ability to deliver high quality care to the region.”Justin R. Bradshaw, FACHE

2.201118

“From the families’ perspective, quality is a primary concern,” Walsh says. “When they see us they see the whole team is there to care for their child. That builds trust in our abilities.”

Beyond the convenience and familiarity the visiting specialists provide families, the clinics also create a rapport with referring physicians and pediatricians throughout the region.

“Many of these referring physicians might otherwise never meet our specialists,” Bradshaw says. “Their ability to put a face with a name is a valuable tool, and it allows the referring physicians to pass on reassurance to their patients’ families.”

Communication is key to strengthening these relationships, Walsh says, and Children’s cardiologists strive to keep referring physicians informed as recommendations are made.

“Our specialists really have a strong customer service focus for our referring physicians,” she says. “If a referring physician gets a call from the family, we make sure they have information from us that they can pass along with confidence. We emphasize that we’re all part of a team taking care of that family.”

Outreach building relationships and saving lives.

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woRLD of DIffeReNce

A

the RoAD LeADING oNe DoctoR to

omAhA

2.201120

As a child growing up in Haiti, a nation of extreme contrasts between wealth and poverty,

Shirley Delair, M.D., learned there are three careers considered by

parents to be most “acceptable” for their children to pursue: medicine,

engineering and law.

She choSe two of them.

21

the fIRSt wAS eNGINeeRING. After earning a Bachelor of Arts at Dartmouth College and a Bachelor of Engineering from its prestigious Thayer School of Engineering, she went to work for an East Coast engineering consulting fi rm. But as careers go, hers was very brief.

“I quickly realized I would be working more with machines than people, and I’m a people person,” she recalls. “After a year, I looked at someone who had been there fi ve years and decided that was not how I wanted to be.”

Medicine had been on her mind since she was very young.

“I remember when my brother was born I was fascinated by how they were paging people over the loudspeaker at the hospital,” she recalls. “I asked my dad how you get your name announced like that, and he said, ‘You have to be a doctor.’”

Experienced as a clinic volunteer in high school in Haiti, and later shadowing physicians in the Dominican Republic, she compared what she had been doing

in engineering and what she might do in medicine. “I liked the atmosphere of healing. I felt comfortable in that environment.”

So she moved to Medellin in Colombia, South America, to study medicine at the Universidad CES.

“My dad never understood why I went back to school, but I believe it was the level of human interaction associated with medicine,” says Dr. Delair. “I felt I could do more for, and with, more people.”

Today Dr. Delair is a pediatric infectious disease specialist. Her expertise is shared with patients at Children’s Hospital & Medical Center and at the University of Nebraska Medical Center (UNMC), where she is an Assistant Professor in the College of Medicine’s Department of Pediatrics.

Dr. Delair was born in Boston, Mass., while her late father, Jean Fenelon Delair, and her mother, Philocia, resided in the United States.

“We lived in Boston three or four years, but Mom couldn’t deal with the cold,” she says, smiling. “I was about a year old when I moved to Haiti to live with my grandmother, and kept going back and forth until my parents moved back.”

When he returned to Haiti, Dr. Delair’s father served the government in the Ministry of Foreign Affairs and Cults, which regulates the recognition and operation of religious groups for the 8.4 million residents, and later with the Haitian Secretary of State’s Offi ce of National Literacy. Her mother owned a bakery.

“Because both my parents worked, I was fortunate,” she says. “I recall the happy atmosphere in our family home, and yet I also saw the discrepancies in wealth. You can not be isolated from poverty in Haiti. There are nice houses right next door to poor houses.”

Her interest in infectious diseases developed as a medical student in South America and through her experiences in the Dominican Republic and Haiti. “There are so many different infections present there,” she says. “The people have no access to vaccines or antibiotics, basic things we take for granted.

“The infectious disease specialty is a very broad fi eld because many organs can get infected. I am able to work with subspecialists in achieving patient well-being on an individual level, and through vaccine and public health intervention programs on a wider population level,” she says. “I chose pediatrics because children are the most vulnerable segment of our population.”

After receiving her medical degree, Dr. Delair completed her pediatric residency at St. Joseph’s Children’s Hospital in Patterson, N.J., and a fellowship in pediatric infectious diseases at Mattel Children’s Hospital, UCLA School of Medicine in Los Angeles, Calif.

She came to Omaha because Children’s and UNMC afford a unique opportunity to work with pediatric HIV patients.

“In the U.S., we have been able to reduce the maternal fetal transmission of HIV to less than 2 percent, making pediatric HIV fortunately less common, but therefore not many academic centers here have

Shirley Delair, M.D.

2.201122

dedicated pediatric HIV programs,” she says. “Also, I wanted to continue to work in pediatric HIV because I would like to be more involved in the reduction of transmission in the Caribbean region as well. That’s one of the reasons I am pursuing a public health degree.”

At Children’s, Dr. Delair works with Kari Simonsen, M.D., a fellow specialist whose interests also include pediatric HIV. They are on the staff of the Children’s Infectious Disease Clinic along with Drs. Jessica Snowden, Archana Chatterjee and Meera Varman.

She praises the facilities and support staff at Children’s. “With HIV there are a lot of medical and social issues. It’s more than just treating a disease, you’re treating the whole patient. There are great social workers, clinical psychologists and nutritionists who help do the things I can’t do by myself. Not a lot of facilities offer the completeness of care that Children’s does.”

Although she wasn’t exactly sure what to expect when she came to Omaha in the summer of 2010, she has been pleasantly surprised.

“One of my fears was that the community would have a very homogeneous

population. As I discovered, there is actually quite an interesting mix of people.”

A certifi ed interpreter who has worked translating Haitian Creole, French and Spanish into English (she’s also fl uent in Portuguese), Dr. Delair is delighted to fi nd many cultures sprinkled across the city.

“There is a growing Hispanic population, as well as East and West African population. I use more Spanish and French now than I did in Los Angeles. Our HIV clinic is like the United Nations.”

Dr. Delair makes her home in the Old Market and spends some of her free time walking along the riverfront. “Omaha has a big-city feeling without being overwhelming.”

Fond of “smooth jazz and Brazilian music,” Dr. Delair also likes to read novels, political non-fi ction and economic journals, and foreign newspapers in their original languages — when she isn’t exploring the Web. “My browser usually has about 10 tabs open at a time. I don’t know what my life would be like without the Internet.”

She returned to Haiti twice in 2009 as a guest speaker at AIDS Healthcare Foundation conferences. She has received

a Certifi cate in Travel Health, sees patients in a family centered pre- and post-international travel health clinic in west Omaha with UNMC Physicians, and hopes to one day combine that interest with an international adoption service. “I’d like to focus on children with chronic infections such as Hepatitis B and HIV and show prospective parents interested in adopting that they can consider these children, too.”

While her father never understood why she went back to school to study medicine, Dr. Delair does.

“I feel that I can personally participate in improving health care, and family-centered care, for chronically infected patients, making it more holistic and comprehensive,” she says. “I think I could have made a difference in engineering, but medicine is a better fi t for my personality.”

If she ever changes her mind, as her mother might remind her, she still hasn’t tried law.

“I chose pediatrics because children

are the most vulnerable segment of our population.”

Shirley Delair, M.D.

23

Growing a Partnership

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There’s more to planting a tree than just digging a hole. It requires knowledge and foresight. The sapling you select has to be the right tree for the right spot. Imagine its growth and shape as it matures. Will it have the support it needs in the form of water, nutrients from the soil and sunshine? Is it sustainable, and does it have adequate opportunity to realize its full potential, whether the goal is to bear fruit, provide shade or simply add beauty?

Plan well and in time you will see it fl ourish.

In 2007, Children’s Hospital & Medical Center entered into a landmark institutional affi liation agreement with the University of Nebraska Medical Center (UNMC) College of Medicine. Four years later, this unique partnership continues to unite and build upon the respective strengths of both institutions.

The idea of working with the physicians at UNMC was not new. Children’s and the College of Medicine had long benefi tted from an informal relationship. But there was nothing binding the two institutions to a formal partnership. No ink on paper.

That is why, as we began to discuss a formal agreement, the leadership at Children’s and UNMC, including Chancellor Harold M. Maurer, M.D., and then College of Medicine Dean John Gollan, M.D., Ph.D., looked to the future and established several “guiding principles” that would be the foundation of our affi liation.

We wanted to be certain it would:

❱ be in the best interest of all children in the city, state and the region;

❱ advance the respective pediatric missions of both institutions, and

❱ ensure access to cost-effective, state-of-the-art, high-quality pediatric specialty care and further promote medical education and research.

Lasting partnerships don’t form overnight. And while we continue the process of developing specifi c aspects of our affi liation, the accomplishments we’ve made to date are truly impressive.

Under the agreement, the more than 125 members of Children’s Specialty Physicians are also faculty members at UNMC, an element key to advancing the education mission of both entities. It also allows us to integrate physicians in their respective subspecialties into one unifi ed service.

Because of the affi liation agreement, we have identifi ed several signifi cant medical opportunities and expanded our scientifi c collaborations. Thanks to our joint Pediatric Research Offi ce (PRO) and Institutional Review Board (IRB), we are working to eliminate unnecessary administrative burdens for physicians conducting these research projects. The PRO helps investigators defi ne and develop protocols and ensure they are written well enough to meet the approval of the IRB. This IRB combines what once were two

review boards into a single entity, greatly streamlining the application process.

Rather than acting as separate entities, as partners we have been much more effective recruiting highly-skilled subspecialists needed to treat the most complex conditions. In fact, since 2008, we have jointly recruited 40 pediatric specialists representing some of the most competitive pediatric specialties in the country including rheumatology, radiology, gastroenterology, neurology, cardiology, and sleep medicine.

The affi liation is a win-win for Children’s and UNMC. It positions Children’s to develop the most advanced programs, treatments, techniques and services to meet the needs of an expanding pediatric population. And it broadens the educational opportunities for UNMC’s medical students, residents and researchers.

In the years to come, this agreement will continue to strengthen the delivery of pediatric care and the development of research as we strive to produce a total continuum of pediatric care.

Growing a tree requires careful thought and foresight. So does growing a strong partnership. For Children’s and UNMC, what we’ve learned as we move forward, and the wisdom still awaiting discovery, directly benefi ts the children in Omaha and throughout the region.

It’s the power of knowledge, times two.

Commentary by Gary A. Perkins, FACHECommentary by Gary A. Perkins, FACHEPresident and CEOPresident and CEOChildren’s Hospital & Medical CenterChildren’s Hospital & Medical Center

Enhancing medical marvels by utilizing the latest in business technology has again placed Children’s Hospital & Medical Center on the InformationWeek 500 listing of the top technology innovators in the nation.

2011 marks Children’s third consecutive year to be included among the list’s top 250 companies, and for the fi rst time among the top 200, breaking into that elite group at No. 191.

The InformationWeek 500 list is particularly signifi cant for Children’s because it examines all companies and industries, not just health care, says George Reynolds, M.D., chief information offi cer and chief medical informatics offi cer at Children’s.

“Our ability to continue the momentum from year to year is signifi cant, especially given the fact that Children’s is one of the smallest companies involved in this survey,” Dr. Reynolds says. “We have a talented team of professionals who can think outside of the box and create solutions that ultimately benefi t our patients.”

Children’s transitioned to electronic medical records and computerized provider order entry systems before most other hospitals in the region and continues to raise the technology bar. For example, the Children’s Physicians pediatrics group began in early 2010 offering “Children’s Connect,” a secure, online portal that allows parents convenient access to their children’s growth chart, immunization record, medical test results and more.

For 23 years, InformationWeek magazine has identifi ed and honored the nation’s most innovative users of information technology with its annual 500 listing. The rankings are unique among corporate lists as they spotlight the power of innovation in information technology, rather than simply identifying the biggest IT spenders.

T O P T E C H I N N O V A T O RT O P T E C H I N N O V A T O R

“We have a talented team of “We have a talented team of professionals who can think professionals who can think outside of the box and create outside of the box and create solutions that ultimately solutions that ultimately benefit our patients.”benefit our patients.”

George Reynolds, M.D.George Reynolds, M.D.

ChildrensOmaha.org