pediatrics - Cardinal Glennon

SSM Cardinal Glennon Children’s Medical Center
A closer look at some of the specialties
that make SSM Cardinal Glennon
Children’s Medical Center the very
best in pediatric patient care
PEDIATRICS
FOCUS ON
TM
2013
cardinalglennon.com
Medical news from SSM Cardinal Glennon Children’s Medical Center and
the physicians of Saint Louis University School of Medicine
Our hospital is constantly evolving. New physicians join our team
monthly so we can see more patients in a timely manner. Every year we
acquire new technology and enhance our facilities so we can continue
to provide exceptional care. Communication with you, our physician
partners, remains at the forefront of our priorities. As we continue to
grow and improve, we want to make sure you are part of that process.
For this reason, we continue to bring you new issues of our Focus on
Pediatrics magazine. Beginning in 2013, the magazine will transition to
an annual publication that focuses on quality and provides a broader
look at the many specialties that help make SSM Cardinal Glennon the
very best in pediatric care.
Please take a few minutes to review the 2013 Focus on Pediatrics issue.
We think you’ll find at least a few new opportunities for you and your
patients. If you have questions about anything you read or suggestions
about how we can better serve you, please feel free to contact us. As our
physician partners, your feedback is valued.
Sincerely,
Sherlyn Hailstone, President
Sherlyn_Hailstone@ssmhc.com
Robert Wilmott, MD, Chief of Pediatrics
wilmottr@slu.edu
Dennis Vane, MD, Surgeon-in-Chief
dvane@slu.edu
Robert Wilmott, MD,
Chief of Pediatrics
1
Sherlyn Hailstone,
President
Dennis Vane, MD,
Surgeon-in-Chief
PEDIATRICS
FOCUS ON
TM
Since 1956, SSM Cardinal Glennon Children’s Medical
Center has offered the highest level of care as the country’s
only free-standing, non-profit Catholic children’s hospital.
Located in St. Louis, Mo., SSM Cardinal Glennon is a
pediatric medical care destination. Every year, the medical
center provides hope to thousands of children with complex
medical conditions from Missouri, Illinois and beyond.
SSM Cardinal Glennon is a 190-bed teaching hospital
affiliated with the Saint Louis University School of
Medicine. In every way, SSM Cardinal Glennon lives out
the SSM Health Care mission: “Through our exceptional
health care services, we reveal the healing presence of God.”
SSM Cardinal Glennon is home to:
2013
cardinalglennon.com
Medical news from SSM Cardinal Glennon Children’s Medical Center and
the physicians of Saint Louis University School of Medicine
Table of Contents
Message from Leadership.......................................................... ..............1
Hospital Overview.......................................................................................2
Medical Education and Access Center................................................3
Diagnostic Imaging.....................................................................................4
>> Physician experts in more than 60 medical specialties
>> Missouri’s first Level 1 Pediatric Trauma Center, at the
Dan Dierdorf Pediatric Emergency and Trauma Center.
SSM Cardinal Glennon’s Level 1 status is granted in
both Missouri and Illinois.
Cardiology and Cardiothoracic Surgery.........................................5–6
Critical Care Medicine (PICU)............................................................7–8
>> The Dana Brown Neonatal Intensive Care Unit, a Level
IV NICU (the highest level of designation) with a
dedicated transport team, private rooms for every family
and staffed 24/7 by attending neonatologists
Emergency Medicine..........................................................................9–10
>> The Dorothy and Larry Dallas Heart Center, home to
St. Louis’ only pediatric hybrid catheterization suite and
the most experienced pediatric cardiothoracic surgery
team in the region
Gastroenterology / Hepatology.....................................................13–14
>> The Bob Costas Cancer Center, including a 16-bed
inpatient unit, day hospital and stem cell transplant unit
Endocrinology........................................................................................11–12
Hematology /Oncology ....................................................................15–16
Neonatology..........................................................................................17–18
>> Pediatric Intensive Care Unit, staffed 24 hours a day by
in-house, critical care attending physicians
Neurosurgery.......................................................................................19–20
>> The St. Louis Fetal Care Institute, the most
comprehensive program in middle America to provide
diagnosis and treatment of fetal developmental issues
including open and fetoscopic surgery
Pulmonology.......................................................................................21–22
>> The Knights of Columbus Development Center,
providing evaluation and care for children with autism
and other developmental disabilities
The St. Louis Fetal Care Institute..................................................25–26
>> The Missouri Poison Center, which responds to more
than 190,000 child and adult poison exposure calls each
year
>> The St. Louis Cord Blood Bank, one of the world’s
largest public banks of life-saving and non-controversial
cord blood cells (derived from the umbilical cord and
placenta)
Surgery..................................................................................................23–24
Transport and Trauma......................................................................27–28
Additional Pediatric Specialties..................................................29–30
Modern, Kid-Friendly Facilities....................................................31–34
For comments and suggestions, please email
FocusOnPeds@ssmhc.com.
2
Pediatric CME
Earn free CME credit online, on your own time with Pediatrics On Demand.
New lectures are posted every month. It’s easy – watch a presentation from your
computer, take a quick, five-question quiz, complete an evaluation, and within 48
hours a CME certificate will be sent to your e-mail.
To view a presentation:
Log on to www.pediatricsondemand.com
Username: ds\r010-online
Password: webcme
To earn 1 CME credit from
Saint Louis University School of Medicine:
For more information on
education opportunities through
SSM Cardinal Glennon and
Saint Louis University School of
Medicine, scan the QR code.
Choose the link icon above the presenter’s window. Click TEST LINK. Register (if you haven’t already), take the
quiz and finish the evaluation. CME certificates are sent to your e-mail address within 48 hours.
For additional CME/CEU opportunities, see Education Connections at cardinalglennon.com, For Physicians,
Education, Education Connections.
Direct Access
for Physicians
to Expert Care
>> 24/7 attending physician
consultations
>> Emergent transfers
>> Urgent appointments
>> Direct admissions
All calls answered 24/7 by
pediatric transport nurses
3
Diagnostic Imaging
Lowest dose, most advanced technology in
diagnostic imaging is at SSM Cardinal Glennon
Kid-Friendly Space
Interactive suites include personalized lighting, music and image displays that help reduce the need for sedation.
Technology
1.5T and 3.0T MRI: Detailed image quality, feet-first imaging and wide bore access for larger and critically ill patients.
Two 128-Slice CT Scanners: Lowest dose technology (up to five times less than standard pediatric doses),
quicker scan times and spectral imaging.
To make an appointment, please call: 314-577-5652, opt. 1
To obtain results, please call: 314-577-5652, opt. 2
Fax orders to: 314-268-6472
Scan the QR code with
your phone to see
FOX2News coverage of the
Imaging Center open house.
4
Cardiology and Cardiothoracic Surgery
Cardiac services continue to grow
the most experienced team
in the region
CGCMC Echocardiograms
8000
>> 10 pediatric cardiologists,
7000
6000
one of the fastest growing
cardiology programs in
middle America
5000
4000
2010
7,343
2009
6,581
99%
6,134
7000
2000
6000
1000
50000
5,996
4000
8000
3000
2011
2012
7,343
6,581
2000
5000
1000
survival rate for
patients who received
treatment for congenital
heart defects at
SSM Cardinal Glennon
in 2011 and 2012.
6,134
3000
5,996
CGCMC
Outpatient
Clinic 2012
Visits
2009
2010
2011
0
4000
5000
3000
4000
2000
4,366
0
2009
2010
2011
2012
2009
2010
2011
2012
4,366
1000
4,242
2000
0
4,242
No deaths following
Norwood procedure for
the past three years.
3,852
3000
1000
3,852
>> 2 cardiothoracic surgeons,
Ten pediatric cardiologists. Two pediatric cardiothoracic surgeons. The only
pediatric hybrid cardiac catheterization suite in the St. Louis region. The fastest
growing pediatric cardiology program in middle America. These are just a handful
of many benefits available to your pediatric heart patients at the Dorothy and
Larry Dallas Heart Center at SSM Cardinal Glennon Children’s Medical Center.
3,459
catheterization suite in the
St. Louis region
3,459
>> Only pediatric hybrid cardiac
300
250
Heart conditions have
200 no age limit. The cardiology/cardiothoracic surgery team
of 12 physicians, physician
assistant and three pediatric nurse practitioners treat
150
300
congenital heart patients from birth through adulthood.
285
220
50
200
207
227
100
250
1500
Interventional cardiology
procedures in 2011 and 2012 with 100 percent
2009
2010
2011
2012
survival rate
include,
but are not limited to, the following:
100
50
Cardiothoracic Surgeons
Dr. Charles Huddleston and
Dr. Andrew Fiore
0
ASD
device
closure
50
175
285
2011
2012
173
100
100
100
100
100
100
100
100
152
300
Coarctation
PDA closures: Aortic and
pulmonary angioplasty
device
and stent
valvuloplasty
and coil
placement
2011 survival rate
5
300
173
2010
100
150
250
VSD
100
device
closure
200
100
100
100
100
25
2009
152
200
100
From left to right:
175
220
250
0
207
50
75
227
100
Hybrid Electrophysiology
procedure
study with
cryoablation and
radiofrequency
ablation
2012 survival rate
2011 and 2012 cardiothoracic surgery procedures and survival rates
2011
2012
100
100
100
100
100
100
100
100
100
100
100
100
100
100
25
Ranked
among the country’s top pediatric heart programs
0
Coarctation
PDA closures: Aortic and
VSD
ASD
Hybrid Electrophysiology
procedure Best
study with
in U.S.
& World
Report’s
2013-2014
Children’s Hospitals
pulmonary angioplasty
device
device
deviceNews
cryoablation and
closure
closure
valvuloplasty
and coil
and stent
placement
radiofrequency
ablation
2012 survival rate
2011 survival rate
2011 and 2012 cardiothoracic surgery procedures and survival rates
2012
2011
ASD
VSD
AVC
TOF
Norwood
Arterial Switch
SubArotic Stenosis
TAPVR
Coronary Anomalies
Glenn shunt
Fontan
RV-PA conduit, Pulmonary Valve Replacement (PVR)
Aorta
Aortic Valve Replacement (AVR)
Other- Pump Cases
B-T Shunt
Hybrid
Pacemaker Procedures
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
89%
80%
100%
100%
100%
100%
100%
Kenneth Schowengerdt, MD
Director
Wieck-Sullivan Professor
of Pediatrics at
Saint Louis University
School of Medicine
100%
100%
100%
100%
100%
100%
100%
Saadeh Al-Jureidini, MD
100%
100%
100%
Saar Danon, MD
100%
100%
Andrew Fiore, MD
Director of Cardiothoracic
Surgery
89%
100%
100%
100
75
Total
50
25
0
98%
100
75
50
25
0
Total
ASD
VSD
AVC
TOF
Norwood
Switch
SubAS
MVR
TAPVR
Coronary
Glenn
Fontan
RV-PA, PVR
Aorta
AVR
Glenn/DKS
B-T Shunt
Hybrid
Pacemakers
Cardiology and
Cardiothoracic
Surgery Faculty
99%
Comprehensive care includes:
>> Fetal echocardiography testing
>> Interventional cardiology, including hybrid procedures
>> Cardiothoracic surgery
>> Heart transplantation
>> Mechanical circulatory support
>> Comprehensive arrhythmia management and ablation procedures
>> Collaboration with obstetrics, maternal-fetal medicine and neonatology
to deliver babies with congenital heart defects in need of immediate
intervention at SSM Cardinal Glennon
Jason Garnreiter, MD
Susan Haynes, MD
Charles Huddleston, MD
Cardiothoracic Surgery
Wilson King, MD
Renuka Peterson, MD
M. Babak Rahimi, MD
Jamie Sutherell, MD
Angela Sharkey, MD
Appointments: 314-577-5674
Service Locations:
Having the only pediatric
hybrid cardiac catheterization
suite in the region allows
our cardiologists and
cardiothoracic surgeons to
work together to provide
the best options for patients.
This state-of-the-art suite
allows our heart experts to
diagnose and fix complex
heart problems, in the same
room and in one procedure,
for safer care and a faster
recovery for our patients.
SSM Cardinal Glennon
St. Louis, Mo.
Southeast Missouri Hospital
Cape Girardeau, Mo.
St. Luke’s Hospital
Chesterfield, Mo.
The Center for Maternal Fetal Care
Columbia, Mo.
SSM St. Mary’s Pediatrics
Jefferson City, Mo.
SSM St. Joseph Hospital West
Lake St. Louis, Mo.
Anderson Hospital, Maryville, Ill.
Good Samaritan Regional Health
Center, Mount Vernon, Ill.
6
Critical Care Medicine and
the Pediatric Intensive Care Unit
>> PICU attending in-house
24/7
>> Experts in extra corporeal
membrane oxygenation
(ECMO)
>> Zero central line infections
during an eight month
period (2012-2013)
>> In 2011 and 2012,
unadjusted mortality
was 2.5 percent and
3.2 percent respectively
and risk-adjusted mortality
tracked consistently lower
than predicted
The bulletin board in the Pediatric Intensive Care Unit (PICU) staff lounge is
full of pictures and thank you notes from patients and families grateful for the
care they received. If asked, most would tell you that they neither wanted to
come to the PICU, nor were they unhappy to leave, but they were very happy
it was there when they needed it the most. Without the PICU facility or its
critical care experts, successful outcomes for the most extreme cases admitted by
pediatricians, surgeons and subspecialists would not be possible.
In the past year, more than 1,000 of the most critically ill and injured pediatric
patients received care delivered and coordinated 24/7 by seven board-certified
pediatric intensivists, four acute care-certified nurse practitioners, 80 registered
nurses, pediatric trained respiratory therapists, occupational and physical
therapists, social workers, pastoral care staff and other professionals.
3.2%
The PICU Patient (2011 - 2012)
Age Range
Length of Stay
30
6
29%
21%
15
21%
20%
3
4.3 days
1.7 days
0
5%
Under
1 - 23
1 Month Months
5%
2-5
Years
6-12
Years
13-18 Over 18
Years Years
0
Average length
of stay
Median length
of stay
Patients with stays longer than 1 week represent
20 percent of admissions and the most complex
diseases that require unique critical care needs
Reasons for admissions:
>> 30 percent of PICU patients underwent surgery for congenital heart disease
>> 15 percent of PICU patients required intervention by surgeons and
neurosurgeons for traumatic injuries or tumor resections (our pediatric
intensivists help provide the best care to injured organs without damaging
other less injured organs)
>> More than 50 percent of PICU admissions are non-surgical due to acute
illness or existing conditions such as respiratory failure, septic shock,
diabetic ketoacidosis or status epilepticus
56 percent of all patients receive some form of mechanical ventilation support
(more than just supplemental oxygen). Our clinicians are experts in extra
corporeal membrane oxygenation (ECMO) for children requiring heart and lung
bypass assistance.
7
PICU Quality Program
The PICU Quality Program focuses on infection rates, unintended extubations,
adverse drug events, readmission rate within 24 hours and 100 percent review
of all deaths, resuscitations and the ongoing patient care plans for those patients
requiring longer than seven days of ICU care.
0 CLIs
Following the initiation of the PICU quality program,
zero central line infections were detected for eight
consecutive months (2012-2013).
Critical Care Medicine
and the Pediatric
Intensive Care Unit
Faculty
Lia Lowrie, MD, Director
Professor of Pediatrics at
Saint Louis University
School of Medicine
Robert Ream, MD,
Medical Director
Teresa Andreone, MD, PhD
Nandini Calamur, MD
New look to match exceptional level of care
This year, the PICU will undergo a complete renovation that will include 18
private beds. While the exceptional level of patient care will be enhanced with
a new layout and equipment, the facility will also provide a more welcoming,
cheerful atmosphere for patients and their families.
Gordon Gale, MD
Procedural sedation
Jeremy Garrett, MD
Christina Mannix, MD
Procedural sedation
Jason Werner, MD
Michael Zahra, MD
Critical Care Medicine Division Director Dr. Lia Lowrie
proudly pins a picture from a child on the bulletin board
in the PICU.
Critical Care Medicine
Academic Office:
314-577-5395
8
Emergency Medicine
>> 90.2 percent patient
Our top priorities while providing exceptional patient care to more than 49,000
children every year: quick, easy access to the emergency department (ED) and
satisfaction for you and your patients.
>> 83 percent of patients
Innovations
Input/Access – Call one number to speak with an attending physician 24/7, have
your patients seen quickly upon arrival and for emergent transfers.
satisfaction in 2012
seen by an emergency
medicine provider in less
than 30 minutes from
arrival in 2013 (YTD)
>> Average 18+ years
experience among team
of 12 pediatric emergency
medicine physicians
Throughput – Any Patient, Any Bed
In November 2011, “Any Patient, Any Bed” was initiated so that patients would
have a shorter stay within our ED. The result is exactly that. Patients are walked
from the waiting room to patient care rooms where triage assessments are
performed at the bedside. We “pull until full” 24 hours a day, 365 days a year.
Arrival to Room (Mean-Minutes)
20
15
5
0
2012
5000
11 min.
13 min.
12 min.
10
Jan. 2013
Feb. 2013
Door to Provider
4000 of patients seen by provider in less than 30 minutes):
(Percent
3000
100
2000
80
8000
9
7000
6000
5000
150
100
7000
6000
5000
4,984 pt. vol 75%
.
4,941 pt. vol 70%
.
ov
8000
D
ec
4,884 pt. vol 69%
N
.
O
ct
3,848 pt. vol 87%
4,366
4,388 pt. vol 78%
.
Se
p
4,242
ug
.
.
Ju
l
2012
2012
A
3,465 pt. vol 82%
3,852
3,648 pt. vol 74%
3,459
4,304 pt. vol 70.3%
2011
.
pr
.
Ju
n
200
A
250
2010
M
ay
4,942 pt. vol 52%
2009
300
.
.
0
4,945 pt. vol 46%
10
Ja
n
Emergency Department
Division Director Dr. Robert
Flood comforts 4-yearold Brandon who has a
high fever.
0
M
ar
4,119 pt. vol 75%
20
Fe
b.
40
4,555 pt. vol 61.4%
1000
60
60
60
40
40
CPB
0 Cases
3.2%
Non-CPB
Cases 2010
2011
131
2012
2010
75
40
80.3%
0
2009
2011
212
112
131
126
74.2%
42
49
40
80.3%
70.3%
112
49
2010
2011
CPB Cases
Non-CPB
Cases
2012
2011
20
2012
75
33%
100
212
60
42
100
20
0
2012
7,343
6,581
Robert Flood, MD, Director
Associate Professor of
Pediatrics at
Saint Louis University
School of Medicine
Hemina Bailey, MD
0
2010
2011
2010
2012
2011
Rachel Charney, MD
47.2%
100
44.3%
100
80
0 20
7,343
6,134
2009
2011Percent
2012
2010 of Patients
2011
2012
Patients
Admitted <4 hours
Admitted <4 hours
80
2009
ec
.
0
Emergency
Medicine Faculty
2009
2010 of
Percent
47.2%
300
1000
150
50
D
N
ov
ct
.
O
Se
D
epc
..
0
173
2000
80
126
74.2%
70.3%
1000
3000
150
50 40
010
5000
4000
2011 20002012
200
100
A
N
uog
v
JOu
clt.
.
09
2010
2009
2011
2012
2010
2011
2012
Percent
of175Patients
Percent
of
Patients
152
173
175
300
152
250
Discharged
<3 Discharged
hours250
<3 hours
200
5000
4000
3000
7,343
0
7,343
6,134
5,996
6,134
Output – Discharged/Admitted
1000
6000
33%
2010
2012
7000
6000
220
2009
2011
285
207
0
2010
220
6,581 227
3000
0
2009
2000
207
6,581 227
5,996
50
8000
7000
6,581
5,996
100
8000
44.3%
1006000
2012
6,134
150
5,996 285
2012
8000
150
7000
5000
50
4000
SJue
np.
.
200
M
Aa
ugy
JAup
lr. .
JMua
nr.
Fe
M
aby.
Ja
A
pnr.
.
ar
.
M
.
eb
200
Ann DiMaio, MD
2012
Faye Doerhoff, MD
Patient Satisfaction
Jim Gerard, MD
Patients Left Without
Being Seen
Press Ganey:
Out-Patient Likelihood to Recommend
100
75
3.0
83.1%
87.1%
88.6%
90.2%
25
Steve Laffey, MD
3.2%
2.0
Al Nakanishi, MD, MPH.
2%
John Peter, MD
1.0
<1%
0
<1%
0
2009
2010
2011
2012
John Gleeson, MD
2009
2010
2011
2012
Teresa Schiff, MD
Trevor Tredway, MD, PhD
Contact: 314-577-5666
SSM Cardinal Glennon
pediatricians are close
to home in the ER at:
SSM DePaul Health Center
Bridgeton, Mo.
SSM St. Clare Health Center
Fenton, Mo.
SSM St. Joseph Hospital West
Lake Saint Louis, Mo.
SSM St. Joseph Health Center
St. Charles, Mo.
The Dan Dierdorf Emergency and Trauma Center
Learn more about SSM Cardinal Glennon’s Level 1 trauma team
and multi-disciplinary transport team on page 27.
St. Anthony’s Medical Center
South St. Louis County
Anderson Hospital
Maryville, Ill.
10
Endocrinology
>> One of 15 sites participating
in the NIH-funded
multi-center type 2 diabetes
study
>> Created diabetes transition
program for teens
transitioning to adult care
Type 2 diabetes is an epidemic in the pediatric population, and SSM Cardinal
Glennon’s endocrinology team is at the forefront of prevention and treatment.
SSM Cardinal Glennon/Saint Louis University is one of 15 sites participating
in the multi-center “Treatment Options for Type 2 Diabetes in Adolescents
and Youth (TODAY)” study, funded by the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health. In
response to the growing epidemic of type 2 diabetes in childhood, the research
protocol was designed to evaluate the efficacy of three treatment regimens
(metformin alone, metformin plus rosiglitazone, and metformin plus intensive
lifestyle intervention) on time to treatment failure based on glycemic control.
Nationwide, 1,211 subjects were screened, 927 subjects proceeded to run-in, and
699 subjects were randomized into one of the treatment regimens and were treated
for at least two years, as shown in Figure 1.
Baseline
2-6 months
7,000
7,000 clinic visits in 2012
at SSM Cardinal Glennon
and four regional
outreach clinics
Screening
N = 1211
2-6 years
Primary outcome
Failure to maintain A1C < 8% x 6 months or
inability to wean from temporary insulin
Run-in
N = 927
Randomization
N = 699
At SSM Cardinal Glennon/Saint Louis University, 54 subjects were screened, 48
subjects proceeded to run-in and 39 subjects were randomized. Figure 2 compares
the performance of the SSM Cardinal Glennon and Saint Louis University site
with the entire TODAY Study group. The percentages of screened participants
entering run-in, participants successfully completing run-in and randomized, and
randomized participants that have been retained were higher at the SSM Cardinal
Glennon and Saint Louis University site.
Study Group
SLU
100
80
60
40
0
Screened
participants
entering run-in
11
Participants
successfully
completing run-in
and randomized
Randomized
participants
retained
94.9
80.4
81.2
75.4
88.9
10
76.5
20
Overall, 72.2 percent of screened participants were randomized at Saint
Louis University (compared to 57.7 percent study-wide) and 94.9 percent
of randomized participants have been retained (compared to 80.4 percent
study-wide).
The primary outcome of the TODAY Study was published in the New England
Journal of Medicine in June 2012. Of the 699 randomly assigned participants
(mean duration of diagnosed type 2 diabetes, 7.8 months), 319 (45.6 percent)
reached the primary outcome over an average follow-up of 3.86 years. Metformin
plus rosiglitazone was superior to metformin alone (P = 0.006); metformin
plus lifestyle intervention was intermediate but not significantly different from
metformin alone or metformin plus rosiglitazone.
Endocrinology
Faculty
Sherida Tollefsen, MD
Director
Professor of Pediatrics at
Saint Louis University
School of Medicine
David Dempsher, MD, PhD
Mark Eddy, MD
Susan Myers, MD
Diabetes Transition Program
The endocrinology team recently initiated a Diabetes Transition Program in
an effort to improve clinical outcomes for high school seniors with diabetes
transitioning to adult care. High school seniors attend several education sessions
with a diabetes nurse educator, dietitian and social worker if needed. Important
topics such as preparing for college life, handling sick days, safe driving and
refilling prescriptions are reviewed. Participants also receive a binder with relevant
handouts and resources. A research study comparing outcomes of program
graduates to those of teens leaving our practice prior to the program is underway.
Appointments:
314-268-4010
Service Locations:
SSM Cardinal Glennon
St. Louis, Mo.
St. Luke’s Hospital
Chesterfield, Mo.
Clayton Oliver has been a patient of Division Director
Dr. Sherida Tollefsen since he was 2 years old. Now 16 years old,
Clayton celebrates his good glucose numbers with Dr. Tollefsen
at his recent visit. But that’s not all Clayton has to celebrate. Just
hours before his appointment at SSM Cardinal Glennon, Clayton
passed his driver’s license test.
St. Anthony’s Medical
Center, South St. Louis
Southeast Missouri Hospital
Cape Girardeau, Mo.
Anderson Hospital
Maryville, Ill.
12
Gastroenterology and Hepatology
>> One of seven pediatric
hospitals taking part
in the Non-alcoholic
Steatohepatitis Clinical
Research Network to
find treatments for
obesity-related liver
disease
>> Multidisciplinary team
includes two dedicated
GI PNPs, adolescent
psychologists and
feeding and weight
management
specialists
No matter the condition, the goal is the same – “Identify the problem early,
start treatment and minimize impact on the patient and family,” says Dr. Jeffrey
Teckman, Division Director of Gastroenterology and Hepatology.
The gastroenterology and hepatology team at SSM Cardinal Glennon is specially
trained to treat a variety of conditions involving the intestines, liver, growth and
nutrition. The team consists of five physicians, two nurse practitioners and three
registered nurses.
Endoscopy Lab
Built in 2009, the endoscopy lab at SSM Cardinal Glennon is a state-of-theart suite equipped with full pediatric anesthesia coverage. More than 1,500
endoscopies are performed here yearly.
>> Active celiac disease
1200
900
1,590
2006
1,398
2005
1,199
300
1,033
600
882
Between 1/1/09-6/30/11
1500
766
1 year graft survival and patient
survival rate of liver transplant
patients has been 100%
1600
680
100%
Endoscopic Procedures
530
program and focused
clinical care and
research in eosinophilic
esophagitis
0
2007
2008
2009
2010
2011
2012
Special areas of interest and research conducted by the gastroenterology
and hepatology team include:
Inflammatory Bowel Disease (IBD) – Crohn’s Disease and Ulcerative Colitis
The gastroenterology and hepatology team includes a dedicated IBD coordinator
and follows more than 150 patients with IBD. With all pediatric gastroenterology
cases, an in-depth evaluation is performed when diagnosing IBD when one or
more signs are present.
GI Division Director
Dr. Jeffrey Teckman visits
with his patient Gabe Heller
who is receiving a Remicade
infusion for Inflammatory
Bowel Disease.
13
Alpha-1-Antritrypsin Deficiency
Alpha-1-antitrypsin deficiency, a genetic condition that can result in serious
liver and/or lung disease, is often misdiagnosed due to the unfamiliarity with the
condition and because liver problems can masquerade as other diseases. Because
of this, the GI team tests for Alpha 1 during all liver problem evaluations and
sometimes even when evaluating failure to thrive or poor growth.
For nearly 20 years, Dr. Teckman has been leading Alpha-1 research efforts and
studying basic liver chemistry. SSM Cardinal Glennon and Saint Louis University
are part of a leading network of pediatric hospitals across North America
sponsored by the National Institutes of Health to study and develop treatments
and cures for a range of cholestatic liver diseases including Alpha-1.
For questions or to learn more about the studies, please contact Dr. Teckman at
314-577-5647.
Fatty Liver Disease
With funds from the National Institutes of Health, SSM Cardinal Glennon and
Saint Louis University are one of seven pediatric hospitals taking part in the
nationwide Non-alcoholic Steatohepatitis Clinical Research Network to find
treatments and diagnostic modalities for pediatric non-alcoholic steatohepatitis
(NASH) and non-alcoholic fatty liver disease (NAFLD).
Gastroenterology and
Hepatology Faculty
Jeffrey Teckman, MD, Director
Professor of Pediatrics,
Biochemistry and Molecular
Biology and Associate Chair
for Pediatric Research at
Saint Louis University
School of Medicine
Tom Foy, MD
Ajay Jain, MD
Nisha Mangalat, MD
Jerry Rosenblum, MD
For questions or to learn more about the study, please contact Dr. Ajay Jain
at 314-577-5647.
Liver Transplant
For more than 20 years, pediatric liver transplant outcomes have been consistent
with or above national transplant benchmarks. This successful program is staffed
by physicians board-certified in transplant medicine and specialized nurse
coordinators with national accreditation, all of whom are members of the MidAmerica Transplant Association and affiliated with the United Network for
Organ Sharing (UNOS).
Hepatitis B
“While there are treatments for Hepatitis B, the best options for children at
different stages of the disease are not clearly known,” says Dr. Jeffrey Teckman.
In an effort to better diagnose and treat pediatric patients with Hepatitis B,
SSM Cardinal Glennon and Saint Louis University joined the national Hepatitis
B Research Network (HBRN), which consists of seven leading pediatric hospitals
and is funded by the National Institutes of Health.
For questions or to learn more about the study, please contact Rosemary
Nagy, RD, at 314-268-2700 (ext. 6144) or rnagy@slu.edu or Dr. Teckman at
314-577-5647.
Short Bowel Syndrome
SSM Cardinal Glennon has a multi-disciplinary team of GI physicians, surgeons
and therapists. The team provides intestinal rehabilitation, bowel lengthening and
nutritional management as well as home nutritional technology and appliance
placement.
For questions or to learn more about the program, please contact
Dr. Thomas Foy at 314-577-5647.
10,000
Greater than 10,000
patient contacts annually
at SSM Cardinal Glennon
and three regional
outreach clinics
Appointments:
314-678-2178
Service Locations:
SSM Cardinal Glennon
St. Louis, Mo.
St. Luke’s Hospital
Chesterfield, Mo.
SSM St. Joseph Hospital West
Lake Saint Louis, Mo.
St. Anthony’s Medical Center
South St. Louis County
14
Hematology/Oncology
>> First federally designated
pediatric Comprehensive
Hemophilia Treatment
Center in the St. Louis area
>> 89 percent survival rate
for blood and marrow
transplant procedures
>> 80-90 percent overall
average rate of PCP
communication generated
by ambulatory encounters
(4th quarter 2010-2012)
Our hematology-oncology team treats
children and adolescents who have a
variety of malignant tumors. We also
have a large sickle cell program and
the first federally-designated pediatric
comprehensive Hemophilia Treatment
Center in the St. Louis area. The
distribution of malignancies reflects the
overall incidence of childhood cancer
cases, with leukemias and lymphomas
being most common, followed closely
by central nervous system tumors
(see Table 1). Multidisciplinary teams
provide specialized care for children
with brain tumors and bone/soft tissue
sarcomas and are part of a robust
long-term follow-up clinic.
Blood and Marrow Transplant Program
Our Blood and Marrow Transplant
Program has a special interest in
advancing use of umbilical cord blood
as a stem cell donor source (see Table
2). According to the latest data from
the Center for International Blood
and Marrow Transplant Research, our
program has a one-year survival of 89
percent, which is well above the network
mean of 65 percent and the second-best
survival among comparable transplant
programs. SSM Cardinal Glennon is
home to the St. Louis Cord Blood Bank,
one of the largest public cord blood
banks in the world.
Hematology/Oncology
Division Director Dr. William
Ferguson jokes with Lauren
Lee during a checkup and
chemotherapy treatment.
Lauren, who was diagnosed
with Hodgkin’s Lymphoma
in Dec. 2010, says she didn’t
like doctors until she met
Dr. Ferguson.
15
Table 1
Frequency by Diagnosis, 2010-2012
Central Nervous System
Astrocytoma
Glioma
Medulloblastoma
Glioblastoma muliforme
Ependymoma
Atypical Teratoid Rhabdoid Tumor
PNET
Benign/Other
45
19
9
4
3
2
1
1
6
Leukemia
ALL
AML
CML
JMML
42
34
6
1
1
Lymphoma
Hodkin's
Non-Hodgkin's
16
8
8
Neuroblastoma
Wilms Tumor
Rhabdomyosarcoma
Osteosarcoma
Ewings Sarcoma
Malignant Germ Cell Tumor
10
11
4
6
3
5
30
Other
Teratoma
12
Ganglioneuroma
5
Nasopharyngeal carcinoma
2
Desmoplastic Small Round Cell Tumor
2
Hepatoblastoma
1
Hepatocellular Carcinoma
1
Melanoma
1
Malignant Peripheral Nerve Sheath
1
Epithelioid Sarcoma
1
1
Synovial Sarcoma
1
Pancreatic neuroendocrine carcinoma
1
Inflammatory myeloblstic tumor
Soild pseudopapillary tumor of pancreas 1
TOTAL
172
Table 2
Blood and Marrow Transplant Procedures, 2010-2012
Marrow Source
Autologous
Allogeneic
related bone marrow
unrelated umbilical cord blood
Diagnosis
Leukemia/MDS
Lymphoma
Immunodeficiency
Neuroblastoma
CNS malignancy
Aplastic Anemia
Relapsed Ewings
11
10
4
6
5
3
4
4
3
1
1
21
Communication
Communication failure is increasingly
recognized as a central cause for
avoidable medical errors. Starting in
TOTAL
2010, our team focused on improving
communication with primary care physicians following outpatient visits and
providing accurate discharge instructions for patients admitted to the hospital.
As shown in the chart, the percentage of ambulatory encounters that generate
communication with the PCP has increased from 26 percent to a consistent
overall rate averaging between 80 and 90 percent; additional analysis shows that
almost all of the remaining outpatient visits will have had a letter sent within 30
days. This ensures that patient encounters will result in a recent communication
with the primary care provider.
In terms of discharge instructions, we have focused on providing accurate
information on how to contact the Hematology-Oncology service following
discharge; and ensuring accurate instructions for discharge medications,
specifically looking for PRN medications without indications and for
medications lists with conflicting information. The frequency of correct contact
information has increased from zero to over 90 percent; similarly, the number of
medication lists that are free of conflicting instructions increased from a baseline
of 40 percent to over 90 percent.
Q4 2010
Q2 2011
Q1-2 2012
William Ferguson, MD
Director
Professor of Pediatrics at
Saint Louis University
School of Medicine
Deepika Bhatla, MD
Communication Initiatives
100
Hematology/
Oncology Faculty
Q3-4 2012
90
Christopher Hugge, MD
John Puetz, MD
80
70
Shermini Saini, MD
60
50
40
30
20
10
0
PCP communication
(outpatient visits)
Contact information
correct at discharge
No discharge
medication conflicts
Complete indications
for PRN medication
We strive to provide
a friendly, comforting
environment where
patients and families
are not only treated
as individuals, but as
partners in working
toward a cure.
- Dr. William Ferguson
Division Director
The centerpiece of the Bob Costas Cancer Center
is our day hospital, which provides a comfortable setting for
children to receive prolonged treatments without having to
be admitted to the hospital. The Center also has facilities for
performing minor procedures under sedation, thus avoiding pain
or discomfort. It is conveniently located near the hospital entrance
and other important hospital services. Family members and friends
can accompany patients during their treatments in quiet, private
accommodations.
Appointments:
314-268-4000
16
Neonatology
>> Recognized as a Neonatal
Recognized as a Neonatal Center of Excellence by the American Accreditation
Healthcare Commission, the Dana Brown Neonatal Intensive Care Unit at
SSM Cardinal Glennon Children’s Medical Center provides tertiary/quaternary
levels of care for the most acute pediatric patients.
>> Extra Corporeal Membrane
In 2013, the NICU at SSM Cardinal Glennon will grow from 60 private rooms
to 65 private rooms to better welcome more patients and their families who need
the help of the 18 board-certified neonatologists. In addition to neonatologists,
our multidisciplinary teams of pediatric specialists are available 24/7 to provide
the highest level of care for the most complex diagnoses.
Center of Excellence by the
American Accreditation
Healthcare Commission
Oxygenation (ECMO) and
mobile ECMO capabilities
available 24/7
>> Infant mortality rate at
SSM Cardinal Glennon for
babies less than 1000 gm
is 20 percent (National
average is 26 percent as
reported by the Vermont
Oxford Network)
>> Attending neonatologists
in-house 24/7
A low ratio of patients to nurses ensures each patient receives continuous
personalized care from dedicated, specially trained neonatology nurses.
Our 24-hour pain management team members keep patients comfortable
throughout their stay.
Ongoing support is also available for families through parental support
groups and patient support groups for NICU graduates. The parental advisory
committee gives parents an opportunity to provide feedback and helps to
improve our parental support services.
Admissions ≤ 1000g
2009
105
2008
106
103
100
111
Admission rates for
babies less than
1000 gm each year
124
150
50
0
2010
2011
2012
Mortality in babies ≤ 1000gm
2008
2009
CG
2010
2011
26%
20%
26%
19%
26%
21%
22%
26%
0
28%
15
25%
Infant mortality rate for
babies less than 1000 gm
is 20 percent (national
average is 26 percent as
reported by the Vermont
Oxford Network)
30
2012
VON
Extra Corporeal Membrane Oxygenation (ECMO)
Neonatologists and a skilled multidisciplinary ECMO team allow for 24-hour
access to ECMO for neonates who require it. Mobile ECMO capabilities are also
available 24 hours a day.
Neonatology Division Director
Dr. Farouk Sadiq and Division
NICU Noon Conferences on Demand
Director of Cardiothoracic
Every month an SSM Cardinal Glennon and Saint Louis University School of
Surgery Dr. Andrew Fiore
Medicine neonatologist presents a case conference on a topic that addresses the
visit with Baby Cosmo who is
CLABSI in roles
the NICU
2008-2011
recovering from pacemaker
of pediatricians,
OB/GYNs and nurses. These presentations are available
placement surgery.
online and free of charge10,000
for CME credit at www.pediatricsondemand.com.
30
17
See page 3 for details.
7,500
Ranked among the country’s top neonatology programs
in U.S. News & World Report’s 2013-2014 Best Children’s Hospitals
Continuous Quality
Improvement efforts
shown by reduction in
Central Line-Associated
Bloodstream Infection
(CLABSI) events from
2008-2011
CLABSI in the NICU 2008-2011
30
Neonatology Faculty
10,000
7,500
5,000
15
0
2008
2009
Infections
2010
Farouk Sadiq, MD, Director
Associate Professor of
Pediatrics
at Saint Louis University
School of Medicine
2,500
Mohamad Al-Hosni, MD
0
Ayoob Ali, MD
2011
Line Days
Dedicated Neonatal Transport Team
The specially trained neonatal transport team stabilizes and transports critically
ill newborns from around the region to the Level IV NICU at SSM Cardinal
Glennon 24/7. For each transport, the team includes a registered nurse and
respiratory therapist, both with extensive training in the stabilization, treatment
and transport of neonates. Physicians also accompany the transport team when
appropriate or requested.
Each member of the team has completed advanced training, such as:
Connie Anderson, MD
Thomas Bender, MD
Greg Booth, MD
Robert Brooker, MD
Laura Cerny, MD
Cathy Cibulskis, MD
Robert Fleming, MD
Heather Hall, MD
Tom Havranek, MD
Noah Hillman, MD
>> Two years of critical care pediatric nursing in the Neonatal Intensive Care
Unit, Pediatric Intensive Care Unit or Emergency Department
William Keenan, MD
>> Classroom training and eight to ten weeks of mentor/preceptor training with
an SSM Cardinal Glennon transport nurse
Akihiko Noguchi, MD
>> PACTS (Pediatric Advanced Life Cardiorespiratory and Trauma Support) for
Life and PALS (Pediatric Advanced Life Support) courses
Marya Strand, MD
>> A minimum of eight hours of continuing education in trauma nursing per year
>> One pediatric intubation per quarter
>> Neonatal resuscitation
Joyce Koenig, MD
Kimberly Spence, MD
Contact: 314-577-5663
Neonatology services
available throughout the
St. Louis metro area at:
The neonatal transport team also has access to a dedicated ambulance and a
helicopter, “Cardinal Glennon Air.” These critical care vehicles are mobile ICUs
used to stabilize and care for neonates in transit. Having sole access to these
vehicles allows the most critical patients to travel with the care they need, as
quickly as possible.
SSM Cardinal Glennon
St. Louis, Mo.
The Dana Brown NICU features privacy, comfort and access to resources
for families, including:
SSM St. Joseph Hospital West
Lake Saint Louis, Mo.
>> Unlimited visiting hours for parents, siblings and family
>> Private in-suite nursing areas, breast pumps, lactation consultants and
personal refrigerators for milk in each suite for nursing moms
SSM St. Joseph Health Center
St. Charles, Mo.
>> In-hospital Ronald McDonald room and nearby Ronald McDonald house for
families and guests
>> Dedicated social workers, pastoral services and mental health services
available for families
SSM DePaul Health Center
Bridgeton, Mo.
SSM St. Clare Health Center
Fenton, Mo.
SSM St. Mary’s Health Center
Clayton, Mo.
St. Anthony’s Medical Center
South St. Louis County
Memorial Hospital
Belleville, Ill.
18
Neurosurgery
>> One of the fastest growing
fetal myelomeningocele
repair programs in the
United States
Brain Tumors
In 2011, under the new
leadership of Division Director
Dr. Samer Elbabaa, the total
number of brain tumors removed
at SSM Cardinal Glennon more
than doubled from that of 2010.
In 2012, brain tumor volume
increased again.
Brain Tumors
30
25
invasive neurosurgery
22
>> Experts in minimally
15
9
rate in 2012 and only 4.44
percent infection rate over
four years (2009-2012)
Excellent outcomes are dependent on surgical planning, coordination and
collaboration. The neurosurgery team at SSM Cardinal Glennon Children’s
Medical Center works tirelessly, collaborating with multiple pediatric
subspecialties in preparation for surgery to achieve the best outcomes for
patients and their families.
21
>> 1.4 percent shunt infection
0
2009
2010
2011
2012
Pediatric Brain Tumor Clinic
This multidisciplinary clinic meets bi-monthly to continue care of patients who
have had brain tumors removed. Following diagnosis and surgery, patients are
typically seen once every three months for a year, depending on the patient.
Specialists from a variety of fields are available to help care for our patients with
brain tumors, including:
>> Neurosurgery
>> Neurology >> Neuro-Oncology
>> Neuro-Psychology >> Radiation-Oncology
>> Endocrinology
>> Audiology
>> Social Services
Shunts vs. Infections
In comparison to the number of shunt procedures performed since 2009, the
infection rate is extremely low – 4.44 percent over four years. In 2012, the
infection rate was just 1.40 percent with 71 shunt procedures performed.
Shunts
Infections
80
71
70
51
7
60
54
49
40
20
Neurosurgery Division
Director Dr. Samer Elbabaa
removes a posterior fossa
cerebellar tumor from a
16-year-old boy.
19
10
4
2
3
1
0
2009
7.84%
2010
4.08%
2011
5.55%
2012
1.40%
Minimally invasive neurosurgery
In the last 10-15 years, the practice of minimally invasive neurosurgery
has grown and become standard of care for the management of certain
conditions at institutions with proper surgical expertise and technology.
In contrast to an open neurosurgical procedure, minimally invasive
neurosurgery requires just a few small incisions, shortens recovery time and
reduces pain, blood loss and scarring. The surgery, which typically lasts only
30-60 minutes, requires a tiny endoscope, small pump, video camera and a
special light source. Dr. Elbabaa’s clinical and research specialties involve the
practice of minimally invasive neurosurgery.
Neurosurgery
Faculty
Samer Elbabaa, MD, FAANS, FACS
Director
Associate Professor of
Neurosurgery at
Saint Louis University
School of Medicine
Saleem Abdulrauf, MD
Endoscopic applications performed by the team include:
Richard Bucholz, MD
>> Endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus
Ann Marie Flannery, MD
>> Endoscopic tumor biopsy and removal for intraventricular tumors
>> Endoscopic fenestration of arachnoid cysts
>> Endoscopic resection of colloid cysts
>> Endoscopic simplification of multi-loculated hydrocephalus
>> Endoscopic placement of ventricular catheters in shunts
>> Endoscopic trans-sphenoidal surgery for sellar and supra-sellar tumors
>> Endoscope-assisted microsurgery
>> Endoscopic strip craniectomy for craniosynostosis
>> Endoscopic choroid plexectomy
>> Endoscopic aqueductoplasty
>> Endoscopic spinal surgery
Fetal Myelomeningocele Repair
In partnership with the St. Louis Fetal Care Institute at SSM Cardinal
Glennon, Dr. Elbabaa performs open fetal operations on babies with the
most severe form of spina bifida. Prenatal treatment helps reduce, or even
eliminate, the major complications of Myelomeningocele, which include
hydrocephalus, Chiari malformation and lack of movement in the lower
extremities. The St. Louis Fetal Care Institute has one of the fastest growing
fetal myelomeningocele repair programs in the country. See page 25 for
more information.
Our skills and
specialized training
allows our pediatric
neurosurgery team
to successfully
perform complex
surgeries others
won’t attempt.
-Dr. Samer Elbabaa
Division Director
Contact:
314-577-5306
20
Pulmonology
75
50
1.0
25
75
50
1.0%
100
0.82%
pediatric-focused sleep
lab in Missouri
Asthma Readmission Rate
Inpatient Asthma Core Measures
0.96%
>> Only accredited
3.2%
Asthma
Strict adherence to asthma protocols and admission order set ensures quality care
for pediatric patients.
99.6%
and accredited care
center by the Cystic
Fibrosis Center
99.48%
>> Nationally recognized
At SSM Cardinal Glennon our experienced pulmonology specialists provide
expert treatment for all pulmonary disorders from asthma to cystic fibrosis. No
matter the severity, our specialists take the time to connect with each patient at
their routine checkups, making for lifelong bonds between patient and caregiver.
97.66%
above 99 percent in
2011-2012
97.33%
>> Asthma core measures
25
0
0
2009
2010
2011
2012
2010
2011
2012
Asthma Pathway
In July 2012, an asthma pathway project was implemented to standardize care
and provide efficient weaning of beta-agonists. Based on standard analysis
utilizing control charts, the pathway significantly decreased the length of stay
and decreased the variation in care for asthma patients. With this decrease in the
length of stay, the asthma patient readmission rate has remained essentially zero
and the assessment score has improved communications between physicians and
respiratory therapists.
40.2
hours
Mean length of
stay before
pathway
implementation
34.9
hours
Mean length of
stay after
pathway
implementation
Cystic Fibrosis
The pulmonology team is accredited by the Cystic Fibrosis Foundation and
recognized for “Outstanding QI Processes and Accomplishments”.
Pulmonology Division
Director Dr. Blakeslee Noyes
checks in on Jordyn after an
inpatient hospital treatment.
Dr. Noyes has been treating
Jordyn for Cystic Fibrosis
for 5 years.
21
Quarterly visits are
recommended as part of the
CF national care guidelines.
Our goal is to establish
consistent quarterly clinic
visits for our CF patients.
Percent Quarterly CF Visits
100
75
50
25
0
2009
2010
2011
2012
80
2009
2010
National Average
60
2011
SSM Cardinal Glennon
Children’s Medical Center
2010
2011
National Average
SSM Cardinal Glennon
Children’s Medical Center
CF patients (6-17 years of age) with
nization for CF patients
CF patients (6-17 years of age) with
Influenza
Immunization
for CF 2patients
more than
4 visits, 1 culture,
PFTs
of age and older)
more
than
4 visits, 1 culture, 2 PFTs
(6patients
months
and
older)
CF
patients
patients
(6-17
(6-17
years
years
of
of
age)
age)
with
with
Influenza
Influenza
Immunization
Immunization
for
for
CFCF
patientsof age CF
Pulmonology Faculty
80and
more
than
visits,
1 culture,
2 PFTs
(6(6
months
ofof
age
and
older)
more
than
44
visits,
1 culture,
2 PFTs
months
age
older)
100
80
100
100
Mean BMI percentile for patients
2-19 years
8080
70
90
9090
2010
7070
60
80
2011
8080
2009
2009
SSM Cardinal Glennon
2010
2010
2010
2009
2010
6060
2011
2011
National Average
National
National
Average
Average
60
2011
2011
2010
2010
55
SSM Cardinal Glennon
National Average
Children’s Medical Center
SSM Cardinal
Glennon
Children’s
Medical
Center
Children’s Medical Center
National
National
Average
Average
SSM
SSM
Cardinal
Cardinal
Glennon
Glennon
Children’s
Children’s
Medical
Medical
Center
Center
Blakeslee Noyes, MD, Director
Professor of Pediatrics at
Saint Louis University
School of Medicine
70
60
2010
2011
Gary Albers, MD
2011
2011
National Average
SSM Cardinal Glennon
SSM
SSM
Cardinal
Cardinal
Glennon
Glennon
Children’s
Children’s
Medical
Medical
Center
Center
Kurt Sobush, MD
50
Mean BMI percentile for patients
2010
2011 for patients
Mean BMI percentile
2-19 years
Robert Wilmott, MD
Mean
Mean
BMI
BMI
percentile
percentile
for
for
patients
patients 2-19 years
ofGlennon
Pediatrics
National
Average
SSMChief
Cardinal
60
2-19
2-19
years
years
60
Children’s Medical Center
Jamie Wooldridge, MD
6060
55
55
5555
50
2010
5050
50
2011
2010
2010
2010
SSM Cardinal Glennon
Children’s Medical Center
National Average
National
Average
National
Average
2011
2011
National Average
SSM
Cardinal
Glennon
SSM
Cardinal
Glennon
Children’s
Medical
Center
Children’s
Medical
Center
2011
SSM Cardinal Glennon
Children’s Medical Center
Supplemental feedings (oral or via gastrostomy tube) for
children 2-19 years of age with BMI <50th percentile
73%
84.4%
National
SSM Cardinal Glennon
tal feedings (oral or via gastrostomy
Average tube) for
Children’s Medical Center
Supplemental feedings (oral or via gastrostomy tube) for
2-19 years of age with BMI <50th percentile
children
2-19
years of tube)
age
with
BMI <50th percentile
Supplemental
Supplemental
feedings
feedings
(oral
(oral
oror
via
via
gastrostomy
gastrostomy
tube)
for
for
children
children
2-19
2-19
years
years
ofof
age
age
with
with
BMI
BMI
<50th
<50th
percentile
percentile
2011
National
Average
Shalini
Paruthi,
Children’s
Medical MD
Center
Director of Sleep Medicine
84.4%
73%
73%
National
National
Average
Average
SSM Cardinal Glennon
Children’s MedicalNational
Center
Average
73%
2011
2011
2011
84.4%
84.4%
Appointments:
314-678-2173
84.4% SSM Cardinal Glennon
Service Locations:
Children’s Medical Center
SSM Cardinal Glennon
SSM Cardinal Glennon
is home to the only
2011
St. Louis, Mo.
pediatric-focused
sleep lab in Missouri
SSM St. Mary’s Pediatrics
Jefferson City, Mo.
accredited by The
American Academy of
SSM St. Joseph Hospital West
Sleep Medicine.
Lake Saint Louis, Mo.
SSM
SSM
Cardinal
Cardinal
Glennon
Glennon
Children’s
Children’s
Medical
Medical
Center
Center
And erson Hospital
Maryville, Ill.
22
Surgery
>> Skilled surgeons in
We know surgery can’t always wait. Patients in the womb through young
adulthood have immediate access to our team of pediatric surgeons who are
trained in a wide range of state-of-the-art procedures and perform surgery in
state-of-the-art operating suites.
>> Kid-friendly, state-of-the-
Designed with Kids in Mind
The 10 technologically integrated operating suites at SSM Cardinal Glennon
were remodeled and expanded in 2007 and are physician- and patient-friendly.
Each 700-square-foot OR allows for increased mobility with portable monitors
and improved traffic flow with equipment booms that are attached to the
ceiling keeping the floors clean and clear. The suites are equipped with the latest
surgical technology, specifically installed for minimally invasive procedures.
Large flat-panel televisions that double as monitors let patients fall asleep to
a DVD of their choosing and provide surgeons imaging to navigate through
3-mm incisions.
general, minimally
invasive and 16 pediatric
subspecialties
art operating rooms
Parents can be with their children until the very last minute before surgery.
During the surgery, families wait comfortably in the brand new waiting room
with access to a surgery concierge. Beepers are also provided, which allow
parents to be reached throughout the hospital.
Less Pain, Quicker Healing
Procedures that once required 6-inch incisions can now be completed with a
.5 inch incision thanks to minimally invasive surgical procedures like single-port
splenectomy and laparoscopic cholecystectomy and pyloromyotomy. Pediatric
patients who are candidates for this type of surgery have less pain, less blood loss,
less scarring and recover quicker. Many patients leave SSM Cardinal Glennon
the next day.
Surgical Subspecialties
Our surgical subspecialists utilize the most advanced intraoperative imaging
techniques and minimally invasive procedures to provide the most advanced
surgical care available in the region. Our surgeons manage issues of
reconstruction, injury and advanced diseases in ways that not only provide
surgical access to areas thought previously to be inaccessible, but also minimize
discomfort for our children.
Surgeon-in-Chief Dr. Dennis
Vane performs a laparoscopic
cholecystectomy to remove
two-year-old Corwin’s
gallbladder.
The two-hour procedure
required a few small incisions
and a short stay in the
hospital.
23
>> Cancer
>> Cardiac (see page 5)
>> Chest wall deformities
>> Cleft lip/palate and craniofacial
>> Ear, nose and throat
>> Fetal (see page 25)
>> Minimally invasive
>> Neonatal (see page 17)
>> Neurosurgery
>> Ophthalmology
>> Orthopaedic
>> Plastic
>> Solid organ transplant
>> Trauma (see page 28)
>> Urology
7,743
8,199
7,650
7,427
2,500
7,458
ENT
Our ENT specialists provide procedures and interventions not available
elsewhere in the region. Using the most advance STEALTH technology available,
our surgeons provide interventions dealing with some of the most complex
airway, sinus and hearing disorders. From advanced cochlear implants and
fetal interventions, to the placement
Surgical Case Volume
of simple decompressive tubes in
the ear, our ENT team provides
10,000
a complete array of services for
7,500
children.
5,000
Plastic Surgery
0
The plastic surgery team and the
2008
2009
2010
2011
2012
St. Louis Cleft-Craniofacial Center at
SSM Cardinal Glennon specialize in interventions designed to take the most
complex deformities and return the child to as normal a life as possible. The latest
technological advances are used to minimize surgery when the situation safely
allows. In patients with facial trauma, resorbable plates and screws that slowly
absorb in the body are used when possible, rather than using permanent titanium
plates and screws in a child who is still growing. Certain patients undergoing
craniosynostosis skull reconstruction are eligible for a limited incision endoscopic
technique that reduces operation time, blood loss and hospital stay. For face
and jaw surgery, advanced orthodontic splinting systems can eliminate the
need for incisions in the face. Off-the-shelf tissue matrices are used in certain
reconstructions as to eliminate the need to take tissue from elsewhere in the body.
While these technologies are not appropriate for every situation, the team strives
to use minimal surgery to achieve the best reconstructions.
Surgery Faculty
Dennis Vane, MD, MBA, FACS,
FAAP, Director
Professor of Surgery at
Saint Louis University
School of Medicine
Richard Bower, MD
Kaveer Chatoorgoon, MD
Colleen Fitzpatrick, MD
Y. Jose Greenspon, MD
Jill Powell, MD
Pediatric OB/GYN
Betsy Tuttle-Newhall, MD
Transplant
Fertility Preservation
Certain medical conditions can slowly damage a girl’s ovaries, leaving her infertile
before reaching adulthood. Likewise, the treatment of other medical conditions,
like cancer or rheumatoid arthritis, can also destroy ovaries and leave a young
woman infertile. In many conditions, there is a window of opportunity to
remove her normal ovaries and preserve them for later use.
SSM Cardinal Glennon offers ovarian transplant to pediatric patients, allowing
many young adult patients to freeze their ovaries and conceive a child after
defeating their condition. Young patients who are eligible for the fertility
preservation treatment will have an ovary removed in a safe procedure by
specially trained pediatric surgeons at SSM Cardinal Glennon. This procedure
will occur prior to beginning treatment for their medical condition. The ovary
tissue will be stored until the patient reaches adulthood, at which point the
transplanted ovary can be placed back into the body.
Contact the Surgery Department at 314-577-5629 for more information.
Appointments:
314-678-2180
Service Locations:
SSM Cardinal Glennon
St. Louis, Mo.
St. Luke’s Hospital
Chesterfield, Mo.
St. Anthony’s Med ical Center
South St. Louis County
Anderson Hospital
Maryville, Ill.
24
The St. Louis Fetal Care Institute
>> One of the only
comprehensive fetal care
centers in middle America
>> One of the fastest growing
myelomeningocele repair
programs in the United
States
The St. Louis Fetal Care Institute (FCI) at SSM Cardinal Glennon Children’s
Medical Center is one of the only comprehensive fetal care centers in middle
America. Since 2009, SLUCare high-risk obstetrical specialists at SSM St. Mary’s
Health Center and pediatric subspecialists at SSM Cardinal Glennon have worked
together to provide the most well-rounded, compassionate and innovative care to
mothers whose unborn babies have congenital, structural and genetic anomalies.
The new FCI clinical suite at SSM Cardinal Glennon offers patient-centered care
with two nesting rooms, an ultrasound examination and treatment room and a
large conference/consultation room to allow the family to meet with a larger care
team. Deliveries at SSM Cardinal Glennon are available for patients who require
immediate specialized pediatric services that may only be accessible at our main
campus.
The FCI is proud to offer needle-based fetal interventions, fetoscopy and
open fetal procedures including:
>> EXIT (Ex Utero Intrapartum Treatment procedure) deliveries
>> Fetoscopic amniotic band release
>> Fetoscopic laser photocoagulation of placental vessels
>> Open fetal repair for myelomeningocele
>> Prenatal surgery for bladder outlet obstruction
>> Radiofrequency ablation
>> Open fetal resection for sacrococcygeal teratoma
>> Tissue laser ablation for tumors
529 mothers evaluated since 2009
120
25
47
40
44
St. Louis Fetal Care
Institute Director
Dr. Mike Vlastos with
baby Caroline, congenital
cystic adenomatoid
malformation survivor
68
60
69
87
80
89
103
100
20
0
JulyDec ‘09
JanJune ‘10
JulyDec ‘10
JanJune ‘11
JulyDec ‘11
JanJune ‘12
JulyDec ‘12
12
The St. Louis Fetal
Care Institute
Comprehensive Team
190 Fetal Interventions Performed since 2009
21
20
15
13
10
15
13
11
4
4
JulyDec ‘09
JanJune ‘10
JulyDec ‘10
2
2
JanJune ‘11
Needle Based Intervention
Fetoscopic Surgery
6
4
3
2
1
8
7
4
1
0
11
9
7
5
20
18
2
JulyDec ‘11
2
JanJune ‘12
JulyDec ‘12
Mike Vlastos, MD, FACOG
St. Louis Fetal Care Institute
Director
Kim Martin, MD, FACOG, FABMG
Interventional Geneticist/ObGyn
Samer Elbabaa, MD, FAANS, FACS
Neurosurgeon
Open Fetal Surgery
EXIT/Deliveries at Glennon
Referrals by Diagnosis
Rachael Bradshaw, MS, CGC
Genetic Counselor
91
100
Katie Francis, RNC-NIC, MSN, CPNP
Nurse Coordinator
71
75
61
Amanda Jones, RN, BSN
Clinical Nurse
42
51
50
20
18
17
16
15
13
5
Jenny Kaiser, RNC-NIC, BSN
Staff Nurse
37
33
26
25
Suzanne Pyle, RN
Staff Nurse
Experienced Myelomeningocele
Repair Team
Within weeks of the release of the
nine-year-long Management of
Myelomeningocele (MOMS) Trial
results, the Fetal Care Institute’s team was
performing the fetal myelomeningocele
repair operation. Nearly two years later,
the Fetal Care Institute is one of the
fastest-growing centers in the country.
Following the MOMS protocols, exclusion
and inclusion criteria and ACOG
recommended counseling guidelines, the
Fetal Care Institute performs this open
fetal surgery on qualified patients between
19 and 26 weeks gestation.
y
og
Betty June, RNC-NIC, BSN
Database & Research Nurse
ep
hr
di
ar
C
ol
ac
s
le
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tip
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/M
U
C
ro
lo
gy
TT
/N
TS
fo
rm
at
io
is
is
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ch
os
tr
al
as
N
S
M
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en
in
go
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es
m
m
lo
ye
M
G
en
et
ic
Lu
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nd
Le
ro
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D
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s
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on
G
si
cs
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rt
ho
pe
di
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ds
se
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Tu
m
an
as
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A
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ni
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ic
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/p
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ft
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ph
al
oc
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at
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e
0
Fetal Myelomeningocele repair
evaluations and surgeries at
the St. Louis Fetal Care Institute
Cindy Jansen, RDMS
Ultrasound Technician
Valerie Akerson, MSW
Social Worker
40
35
30
25
20
15
10
5
0
21
Number of
patients
who received
surgery
24
Number of
patients
offered
surgery
39
Number of patients
screened for fetal
myelomeningocele
repair surgery
from 4/1/11–5/10/13
Following a short stay in St. Louis, many of our mothers return home and deliver
via c-section at their local hospital with their original OB/GYN or MFM.
Contact:
314-268-4037
or 877-776-3385
E-mail: fetalcare@ssmhc.com
www.stlouisfetalcare.com
26
Transport & Trauma
>> Dedicated ambulance and
helicopter equipped for
pediatric and neonatal
patients
>> Level 1 Pediatric Trauma
Center designated by
Missouri and Illinois
>> Staff certifications include
ECMO, PALS and ATLS
Transport Services
Our neonatal and pediatric transport team of attending physicians, registered
nurses and respiratory therapists have advanced training in the stabilization,
treatment and transport of small infants and children of all ages. We provide
the highest level of care fast with our dedicated ambulance and helicopter
“Cardinal Glennon Air” equipped with life-saving equipment to help the
most critical patients.
1st
SSM Cardinal Glennon’s Transport Team was the first:
>> Pediatric transport team in the St. Louis area to provide mobile Extra
Corporeal Membrane Oxygenation (ECMO)
>> To staff a satellite base in Cape Girardeau, Mo. In 2011 and 2012 neonatal
transfers from Southern Missouri and Illinois increased by 44 percent and
pediatric transfers increased by 110 percent.
Two locations:
SSM Cardinal Glennon
St. Louis, Mo.
Cape Girardeau, Mo.
Transport office:
314-242-5988
Trauma services:
314-577-5629
Dan Dierdorf Emergency and Trauma Center
SSM Cardinal Glennon Children’s Medical Center is designated
a Level 1 Pediatric Trauma Center by Missouri and Illinois
As a state-of-the-art, high-tech pediatric medical center, we are prepared for the
most critical child health emergencies. We know that children are not just small
adults, but they require special physical, developmental, pharmacological and
psychological needs.
Call to arrange a transport:
Experienced transport nurses answer
the Access Center line 24/7!
27
Specialists in Pediatric Trauma
All members of our trauma team are board-certified specialists in pediatric care. This multidisciplinary team includes
surgeons, emergency medicine physicians, child protection physicians, emergency and critical care nurses, respiratory
therapists, pharmacists, radiologists, child life specialists, social services, laboratory technicians and pastoral care
representatives. Experts in the following subspecialties are also trained in trauma and available 24 hours a day:
neurosurgery, orthopaedic surgery, plastic surgery, cardiothoracic surgery, genitourinary surgery, trauma surgery,
ophthalmology, otolaryngology and anesthesia.
Our medical staff is certified in Pediatric Advanced Life Support (PALS) and Advanced Trauma Life Support (ATLS).
Our anesthesiologists specialize in pediatric sedation for our young patients.
Not only are we dedicated to caring for children with traumatic injury, we strive to prevent such injuries from
occurring. SSM Cardinal Glennon is the St. Louis-area sponsor of Safe Kids Worldwide, an organization dedicated to
prevention of childhood injury. In the United States, Safe Kids has contributed to a 45 percent reduction in the child
fatality rate from accidental injury over its 20 years, saving more than 38,000 children’s lives. Locally, the St. Louis
Safe Kids Coalition provides free car seat inspections, bike helmet fittings and education about child safety at home
and in the car.
100
%
Trauma team is at the bedside 100 percent
of the time when patient arrives (within five
minutes with no prior notification).
28
Additional pediatric specialties
Adolescent Medicine
Dianne Elfenbein, MD, Director
Victoria Cornelius, MD
Marianne Dunstan, MD
Meghan Guerra, MD
Allergy/Immunology
Alan Knutsen, MD, Director
Bradley Becker, MD
Manoj Warrier, MD
Anesthesiology
Brenda McClain, MD, Director
Naila Ahmad, MD
Farid Azzam, MD
James DeBoard, MD
Tatyana Demidovich, MD
Orlando Perez-Franco, MD
Marion Svendrowski, MD
Child Protection
Timothy Kutz, MD, Director
Linda Shaw, MD, MSSW
Genetics
Stephen Braddock, MD, Director
Sandra Davenport, MD
James Shoemaker, MD, PhD
Jacqueline Batanian, PhD
Dental
Thomas Veraldi, DMD
Gynecology
Jill Powell, MD, Director
Dermatology
Elaine Siegfried, MD, Director
Hospital Medicine
Chris Sallee, MD, Section Chief
Marta King, MD
Kevin Powell, MD
David Wathen, DO
Developmental Pediatrics
Rolanda Maxim, MD, Director
Shula Portnoy, MD
Petra Swidler, MD
Cristiana Teodorescu, MD
Kimberly Twyman, MD
Barbara Braddock, PhD
Michael Bunis, PhD
Sarah Grafeman, PhD
Debra Zand, PhD
29
General Academic Pediatrics
M. Susan Heaney, MD, MPH, Director
Shahnaz Ahmad, MD
Elizabeth Babusis, MD
Matthew Broom, MD
Mark Eddy, MD
Kenneth Haller, MD
Donna Halloran, MD, MSPH
Gene LaBarge, MD
Jennifer Ladage, MD
Rashmi Narayan, MD
Shahida Naseer, MD
Jay Noffsinger, MD
Heidi Sallee, MD
Michelle Sineff, MD
Elizabeth Sugarbaker, MD
Timothy Warren, MD
Infectious Disease
Stephen Barenkamp, MD, Director
Ed Anderson, MD
Dennis O’Connor, MD
Nephrology
Ellen Wood, MD, Director
Elizabeth Abraham, MD
Craig Belsha, MD
Richard Feldenberg, MD
Neurology
Sean Goretzke, MD, Director
Deepa Arun, MD
Thomas Geller, MD
Vincent Gibbons, MD
Ophthalmology
Bradley Davitt, MD, Director
Oscar Cruz, MD
Gabriela Espinoza, MD
Michelle Beck, OD
Orthopaedics
Elizabeth Engel, MD, Director
John Boudreau, MD
Adnan Cutuk, MD
David Greenberg, MD
Meg Grisell, MD
Scott Kaar, MD
Jasmin McGinty, MD
Joao Panattoni, MD
Howard Place, MD
Aki Puryear, MD
Otolaryngology/ENT
John Stith, MD, Director
Dary Costa, MD
Thomas Donovan, MD
John Eisenbeis, MD
Josh Hentzelman, MD
Anthony Mikulec, MD
Thomas Sanford, MD
Alan Wild, MD
Pathology
Cirilo Sotelo-Avila, MD, Director
Vickie McCullough, Team Leader
David S. Brink, MD
Miguel Guzman, MD
S. Sultan Habeebu, MD
Carole Vogler, MD
Jacqueline Batanian, PhD
Ella Swierkosz, PhD
Plastic Surgery
Alexander Lin, MD, Director
Christina Plikaitis, MD
Psychiatry
Zafar Rehmani, MD, Medical Director
Donna Gfeller, PhD, Director
Annmarie Loth, MD
Psychology
Donna Gfeller, PhD, Director
Barbara Barnes, PhD
Amy Ford, PsyD
Sarah Hanly, PhD
Michael Kenney, PhD
Jessica Luitjohan, PsyD
Joel Nadler, PhD
Megan Ubinger, PhD
Stacey Woodrome, PhD
Radiology
Jeffrey Brown, MD, Director
Karen Caudill, MD
Keith Kronemer, MD
Greg Launius, MD
Josh Owen, MD
Martin Reis, MD
Vilaas Shetty, MD
Joan Zawin, MD
Yihua Zhou, MD
Rheumatology
Terry Moore, MD, Director
Peri Hickman Pepmueller, MD
Reema Syed, MD
Sleep Medicine
Shalini Paruthi, MD, Director
Sports Medicine
Adnan Cutuk, MD
Scott Kaar, MD
Toxicology
Anthony Scalzo, MD, Medical Director
Rebecca Tominack, MD
30
Modern, Kid-Friendly Facilities
The Dorothy and Larry Dallas Heart
Center is a comprehensive care
center with advanced technology
including electrocardiogram,
echocardiogram, cardiac MRI,
oximetry and stress testing. The
center makes cardiac care more
convenient and accessible for
the more than 23,000 patients
treated annually.
SSM Cardinal Glennon has the
region’s only pediatric hybrid cardiac
catheterization suite, a unique space
that allows a pediatric cardiologist to
work alongside the region’s top pediatric
cardiac surgeons to find and fix a patient’s
congenital heart defect in the same space.
Having the ability to diagnose and treat
problems at the same time means safer
care, faster healing and a better recovery
process for our young patients.
The Level IV Dana Brown
Neonatal Intensive Care Unit
offers 60 private rooms,
in-suite nursing areas,
breast pumps, personal
refrigerators and unlimited
visiting hours for families.
The St. Louis Fetal Care
Center clinical suite offers
patient-centered care with
two nesting rooms, an
ultrasound examination and
treatment room and a large
conference/consultation
room for families to meet
with a larger care team.
31
Our Imaging Center combines
the most advanced pediatric
diagnostic imaging in the
region with a focus on comfort
for children. The kid-friendly
CT and MRI suites let patients
select a colored theme for their
room and movie to view on
the ceiling-mounted flat panel
television. More on page 4.
The 10 technologically integrated, 700 square
foot operating suites allow for increased
mobility with portable monitors and improved
traffic flow with equipment booms that are
attached to the ceiling keeping the floors
clean and clear. The suites are equipped with
the latest surgical technology, specifically
installed for minimally invasive procedures.
Large flat panel televisions that double as
monitors let patients fall asleep to a DVD of
their choosing and provide surgeons imaging
to navigate through 3-mm incisions.
Our specially-trained pediatric
anesthesiologists maintain
a safe and relaxed state
for children during surgery.
Following the procedure,
children wake up next to their
family in the newly remodeled
post anesthesia care unit.
The Bob Costas Cancer
Center provides a
comfortable setting
for children to receive
prolonged treatment
in quiet, private
accommodations
welcome to family and
friends.
32
Modern, Kid-Friendly Facilities
The Knights of Columbus
Developmental Center moved to a
brand new space next to SSM Cardinal
Glennon in 2013. The comprehensive
center’s new observation rooms are
equipped with two-way mirrors for
parents to observe their children
during treatment and advanced video
equipment that allows for recording
of behavioral changes in patients,
valuable for training and research.
Families are welcome to
make themselves at home
in our all-private, spacious
inpatient rooms.
Our safe, interactive
rooftop playground
is a fun, fresh-air
environment for
kids.
Indoor play areas
throughout the hospital let
kids act their age during
their hospital stay.
33
The Ronald McDonald Room offers
a comforting environment with
some of the amenities of home,
including a full kitchen, dining area,
computers, internet access, shower,
laundry facility, cozy couches and
television.
Our chapel is an
interfaith prayer room,
open 24/7 for private
reflection.
Every corner
of SSM Cardinal Glennon
was designed with kids
in mind. Themed clocks
with beautiful details for
children to take in can
be found throughout
the hospital.
The Café
at Glennon
offers casual
dining and
special
serving
stations for
every taste.
34
Non Profit Org
U.S. Postage
Physician Services Department
1465 South Grand Blvd.
Saint Louis, Missouri 63104-1095
Pediatrics on Demand
SSM Cardinal Glennon and Saint Louis University School of Medicine
pediatric specialists present lectures through the Pediatrics on
Demand education program. These presentations are available online,
free of charge for CME credit at pediatricsondemand.com.
See page 3 for instructions.
For more information on education opportunities
through SSM Cardinal Glennon and Saint Louis
University School of Medicine visit
cardinalglennon.com/education, scan the
QR code or email jessica_hedges@ssmhc.com.
PAID
St. Louis, MO
Permit No. 2412