Selected Podcast
NICU: Part 2 – What’s the Impact of a Level III NICU in Our Community?
Part 2: Dr. Steven Van Scoy, Neonatologist and the NICU Medical Director at Tenet Health Central Coast, Sierra Vista Regional Medical Center, explains what a NICU is and what it means to be the only Level III NICU in San Luis Obispo County.
Featuring:
Steve Van Scoy, MD
Dr. Steven Van Scoy is a Neonatologist and the NICU Medical Director at Tenet Health Central Coast, Sierra Vista Regional Medical Center, the only Level III NICU in San Luis Obispo County. He received his Bachelor of Arts from the University of California, Santa Barbara and his Doctorate of Medicine from the University of Southern California, School of Medicine in Los Angeles. He completed his residency and fellowship at Tripler Army Medical Center in Honolulu, Hi. Dr. Van Scoy has served in various leadership roles at Sierra Vista, including: Chief of Staff, Vice Chief of Staff and as a member of the Governing Board and Medical Executive Committee. He is a Diplomate in Neonatal-Perinatal Medicine and a Diplomate of the American Board of Pediatrics. Dr. Van Scoy is married with two children and enjoys the many outdoor activities that San Luis Obispo County has to offer. Transcription:
Prakash Chandran (Host): At Sierra Vista Regional Medical Center, you can take comfort in knowing that there's a Neonatal Intensive Care Unit or NICU that has been providing advanced and critical care over the past 20 years to the central coast's tiniest and most fragile babies. This is part two of our NICU series. And today we'll be talking about local and specific NICU information as it relates to you. Back with us to discuss is Dr. Steve Van Scoy the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. This is Healthy Conversations. The podcast from Tenet Health Central Coast. My name is Prakash Chandran. So, Dr. Van Scoy, it's great to have you back here today. My first question is really around what a NICU means to the community.
Steve Van Scoy, MD (Guest): Well, locally, up to about 25 years ago, any baby who needed to have more than very short term supportive care, needed to be transferred out of town, usually up to Stanford and this displaced mom and dads. It led to much more stress than we currently have. It meant that babies were lost to the local health care system for a while. And re-establishing that contact once they got back was somewhat difficult. So, about 25 years ago, a group of concerned nurses, pediatricians and thankfully friendly administration at Sierra Vista came together and decided it was time to have a higher level of services here in town. And born was our NICU. It originally started out with 10 beds, then went up to 16 beds. And now we are currently at 22 beds. What that did, is that allowed us to keep babies locally. And for parents, that was a huge relief not to have to travel, to be displaced, to be away from their other children. They could sleep in their own beds at home. One spouse may be able to continue work if the baby was in for a long period of time and there was less disruption of their family and professional lives. And not to mention that once the NICU was in place, that brought the game up for everybody else as far as quality of care, having more specialty care in town and better medical resources.
Host: Yeah, you know on the last one, we also talked about the fact that you can service level II and level III needs and all of the collaborative effort that it takes to service level III cases. Is a level III NICU common for a community of this size?
Dr. Van Scoy: It's actually not very common at all. Usually they're in a town that is at least twice our size. And so it was really by luck and happenstance I think that we were able to get this program going and to end up with a great NICU that we have today. It's always a challenge to have this level of services in a small community, and it's incumbent upon us to provide optimal care for these kids. We have been able to do so for the past two decades with the help of our medical community and with the support of high-risk obstetricians that were brought into town at the time of this genesis. These high-risk obstetricians allow more moms to stay pregnant in this town and deliver locally than had occurred before. And we now have followup services in the community that then allow these babies to be cared for after discharge, if they need it locally. And that's really helped us maintain our babies and then kids in town and have their care locally.
Host: So, it really seems like with everything that you have at the NICU that you can take care of or service most cases, but are there ever times where you have to send babies to other hospitals?
Dr. Van Scoy: Yes, there are. Being in a town, our size, we have limitations. Certainly things like cardiac surgery or complex birth defects that need multi-disciplinary subspecialty teams really are not appropriate for us to keep here. Certainly we never want to feel as though we're doing the best for the baby, when we know we're not. We want babies to get to a place where they need to be to get their optimal care. 95 to 98% of our kids can stay here. It's that other two to 5% that maybe need to go someplace else. Sometimes that transfer to a higher level of care is a very quick one, maybe a day or two, and they come back to us, other times they need continuing care for long periods of time.
Host: So, we touched on this briefly last time, but talk a little bit about the types of services or the additional services that make up the NICU team.
Dr. Van Scoy: In the NICU itself, we have a multidisciplinary team that consists of both the bedside folks, the nurses, respiratory therapists, physicians, but in addition to support development and great growth and those sorts of things, we have physical therapists and lactation educators and consultants, a dietician, social workers to help the parents get through the stressful times. And those people coming together, form a team that actually cares for the baby. Some of it in front of the parents, others behind the scenes, but it's important that team works well together. We're very fortunate to have people who are very committed to what we're doing.
And we meet a lot of times just casually because it's a relatively small hospital. So, we see each other, get a lot of good ideas, put back and forth in ways to improve care because one of the greatest parts of being in a NICU of this size is you can improve your care fairly quickly and stay current with care as it's always changing in our area of medicine. Our team has really become more of a family than just a team. And it's coalesced over the past couple of decades, but really the first five to seven years of any NICU is when it becomes a mature system. And now we feel we're a mature NICU, with a good team, and we revolutionize our care as time goes on.
Host: So, Dr. Van Scoy and just hearing everything that you're saying, it really does sound like the NICU is a pretty big part of your institution and a big reason that people come to deliver there. Isn't that correct?
Dr. Van Scoy: Yeah that's certainly true. We certainly do have the highest level of infant care anywhere in the area. But I'd like to caution people that, that truthfully we're much more than that. In addition to having the NICU, we have a lot of services that people aren't really aware of in the community and starting before birth, we have doula services, midwifery and water labor, in addition to in-house obstetrical hospitalists.
And after birth, it's important for people to know that we are a baby-friendly facility. We have very robust and impressive lactation services here. And a donor milk program. So, that babies who are born here really don't ever have to have formula. And we know that is one of the cornerstones of having a healthier baby and a healthier child. So, these are things that, that people may not know, but really make us more of a full service place to deliver your baby.
Host: Yeah. You just touched on this a little bit, but I'd love to learn a little bit more about the additional support that Sierra Vista offers once the babies are released from the NICU.
Dr. Van Scoy: For the parents, we have a Facebook group. And along with what we spoke about last time, which is that there's a fair amount of parents who bond with each other independently, that assist each other as well. They're from the Facebook group is very active, lots of pictures, lots of stories, lots of good times.
We also have a lactation support group and from the medical side, also supporting the parents that we have a NICU follow-up clinic that sees children up until three years of age who are NICU patients and make sure that they are getting the services they need in the community. Those can be services from state and local groups or private groups like Martha's place. Making sure their development is on track. Parents love this clinic because they get to reconnect with the healthcare providers who took care of their kids during a time when they were stressed and vulnerable. And everybody really gets to see those kids doing well for the most part. And we're there as sort of a safety net for the pediatricians as well. And that I think really gives parents a lot of comfort to know that once we discharge their babies, that they're going to see us again in many cases.
Host: It really sounds like you are this ingrained part of their lives, at least shortly after it happens and a really ingrained part of the community. So, I'm curious as to how you see yourself as part of the community and how you see the NICU as a member of the community as well.
Dr. Van Scoy: I feel lucky to be here. I gotta tell you that. I am a native Californian. Moved to Hawaii for my medical training, was over there for eight years and found this opportunity as I was getting ready to leave Hawaii. We moved here when my eldest son was three weeks old and he's 23 years old now. We have raised two children here. We've made great friends and have wonderful neighbors and love living in a town this size with so many outdoor opportunities. And it's really a good fit because I love the intensive primary care aspect. So, it's intensive in that I have to think, and really critically examine what I am doing with a patient. It's primary care, because you are the baby's sole doctor at that point.
And you form relationships with the parents that are long-term and that really resonates with me. I love that. And I feel honored to be a part of some of these difficult situations, because I feel like I can do a pretty good job helping the parents navigate through them and making it feel that they are getting the best that can occur at that time. And I love seeing patients and families around town, and that's one of the advantages of a town this size. In addition, we have a yearly reunion that I've spoken of before. And we generally have 600 plus people there and it's just a real fun time and a chance to reconnect with everybody. My favorite day of the year. Being in a town this size also has allowed me to get involved with the medical staff. I've been Chief of Staff for a few years. I've been on the Governing Board here at the hospital. And I really do that because I believe this is a good program and we do good things here.
Host: Wow. Dr. Van Scoy I have to be honest, I mentioned in the last episode that we're expecting in August. And it feels like we should reconsider where we want to have that baby. It just seems like in the central coast, the community is so closely knit. Everyone is so supportive and there are comprehensive resources available just in case anything happens. So, it's wonderful to hear about. I guess the last question that I have is how might you compare your NICU versus one that is found in a larger community?
Dr. Van Scoy: I think it's real different. I like to use this sort of comparison of different kinds of places where you can go to eat, which sounds odd. But when I think of a big NICU, it's like a big cafeteria. You go there, you don't expect a whole lot of personalized attention. You get the product or the care that you need. It's usually busy and loud and somewhat bright. And you may have to speak with a few people before you get all the answers that you want or need. In contrast, our NICU, I like to think of as like the neighborhood coffee shop. As far as the NICU is concerned, and this is of course that nobody obviously wants to be in a NICU, but really it is a warm and inviting one.
We personalize the care, we try and give the parents and the patient great individualized service and care. And we can do that because there's few of us working there and we can speak with each other regularly and make sure that every baby is getting what is right for them and not just a standardized care plan. We have two way communication back and forth between the parents, every time they come in. Everybody has a different story on why they're there and they have different needs and we try and honor both of those things with each set of parents and each family. And it's really of the place that many parents come to actually enjoy hanging out in because they get to talk to the nurses who are not only great sources of information, but just nice people, from the area, they live here. They want to form relationships as well. And it's really a testament to the family friendly culture that we have here. And we're pretty proud of that.
Host: Well, Dr. Van Scoy, I really appreciate your time today and just appreciate the support that you and that multidisciplinary team give to the community. Thank you so much for your time. That's Dr. Steve Van Scoy the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. For more information, please visit our website at tenethealthcentralcoast.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy conversations, the podcast from Tenet Health Central Coast. Thank you so much. And we'll talk next time.
Prakash Chandran (Host): At Sierra Vista Regional Medical Center, you can take comfort in knowing that there's a Neonatal Intensive Care Unit or NICU that has been providing advanced and critical care over the past 20 years to the central coast's tiniest and most fragile babies. This is part two of our NICU series. And today we'll be talking about local and specific NICU information as it relates to you. Back with us to discuss is Dr. Steve Van Scoy the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. This is Healthy Conversations. The podcast from Tenet Health Central Coast. My name is Prakash Chandran. So, Dr. Van Scoy, it's great to have you back here today. My first question is really around what a NICU means to the community.
Steve Van Scoy, MD (Guest): Well, locally, up to about 25 years ago, any baby who needed to have more than very short term supportive care, needed to be transferred out of town, usually up to Stanford and this displaced mom and dads. It led to much more stress than we currently have. It meant that babies were lost to the local health care system for a while. And re-establishing that contact once they got back was somewhat difficult. So, about 25 years ago, a group of concerned nurses, pediatricians and thankfully friendly administration at Sierra Vista came together and decided it was time to have a higher level of services here in town. And born was our NICU. It originally started out with 10 beds, then went up to 16 beds. And now we are currently at 22 beds. What that did, is that allowed us to keep babies locally. And for parents, that was a huge relief not to have to travel, to be displaced, to be away from their other children. They could sleep in their own beds at home. One spouse may be able to continue work if the baby was in for a long period of time and there was less disruption of their family and professional lives. And not to mention that once the NICU was in place, that brought the game up for everybody else as far as quality of care, having more specialty care in town and better medical resources.
Host: Yeah, you know on the last one, we also talked about the fact that you can service level II and level III needs and all of the collaborative effort that it takes to service level III cases. Is a level III NICU common for a community of this size?
Dr. Van Scoy: It's actually not very common at all. Usually they're in a town that is at least twice our size. And so it was really by luck and happenstance I think that we were able to get this program going and to end up with a great NICU that we have today. It's always a challenge to have this level of services in a small community, and it's incumbent upon us to provide optimal care for these kids. We have been able to do so for the past two decades with the help of our medical community and with the support of high-risk obstetricians that were brought into town at the time of this genesis. These high-risk obstetricians allow more moms to stay pregnant in this town and deliver locally than had occurred before. And we now have followup services in the community that then allow these babies to be cared for after discharge, if they need it locally. And that's really helped us maintain our babies and then kids in town and have their care locally.
Host: So, it really seems like with everything that you have at the NICU that you can take care of or service most cases, but are there ever times where you have to send babies to other hospitals?
Dr. Van Scoy: Yes, there are. Being in a town, our size, we have limitations. Certainly things like cardiac surgery or complex birth defects that need multi-disciplinary subspecialty teams really are not appropriate for us to keep here. Certainly we never want to feel as though we're doing the best for the baby, when we know we're not. We want babies to get to a place where they need to be to get their optimal care. 95 to 98% of our kids can stay here. It's that other two to 5% that maybe need to go someplace else. Sometimes that transfer to a higher level of care is a very quick one, maybe a day or two, and they come back to us, other times they need continuing care for long periods of time.
Host: So, we touched on this briefly last time, but talk a little bit about the types of services or the additional services that make up the NICU team.
Dr. Van Scoy: In the NICU itself, we have a multidisciplinary team that consists of both the bedside folks, the nurses, respiratory therapists, physicians, but in addition to support development and great growth and those sorts of things, we have physical therapists and lactation educators and consultants, a dietician, social workers to help the parents get through the stressful times. And those people coming together, form a team that actually cares for the baby. Some of it in front of the parents, others behind the scenes, but it's important that team works well together. We're very fortunate to have people who are very committed to what we're doing.
And we meet a lot of times just casually because it's a relatively small hospital. So, we see each other, get a lot of good ideas, put back and forth in ways to improve care because one of the greatest parts of being in a NICU of this size is you can improve your care fairly quickly and stay current with care as it's always changing in our area of medicine. Our team has really become more of a family than just a team. And it's coalesced over the past couple of decades, but really the first five to seven years of any NICU is when it becomes a mature system. And now we feel we're a mature NICU, with a good team, and we revolutionize our care as time goes on.
Host: So, Dr. Van Scoy and just hearing everything that you're saying, it really does sound like the NICU is a pretty big part of your institution and a big reason that people come to deliver there. Isn't that correct?
Dr. Van Scoy: Yeah that's certainly true. We certainly do have the highest level of infant care anywhere in the area. But I'd like to caution people that, that truthfully we're much more than that. In addition to having the NICU, we have a lot of services that people aren't really aware of in the community and starting before birth, we have doula services, midwifery and water labor, in addition to in-house obstetrical hospitalists.
And after birth, it's important for people to know that we are a baby-friendly facility. We have very robust and impressive lactation services here. And a donor milk program. So, that babies who are born here really don't ever have to have formula. And we know that is one of the cornerstones of having a healthier baby and a healthier child. So, these are things that, that people may not know, but really make us more of a full service place to deliver your baby.
Host: Yeah. You just touched on this a little bit, but I'd love to learn a little bit more about the additional support that Sierra Vista offers once the babies are released from the NICU.
Dr. Van Scoy: For the parents, we have a Facebook group. And along with what we spoke about last time, which is that there's a fair amount of parents who bond with each other independently, that assist each other as well. They're from the Facebook group is very active, lots of pictures, lots of stories, lots of good times.
We also have a lactation support group and from the medical side, also supporting the parents that we have a NICU follow-up clinic that sees children up until three years of age who are NICU patients and make sure that they are getting the services they need in the community. Those can be services from state and local groups or private groups like Martha's place. Making sure their development is on track. Parents love this clinic because they get to reconnect with the healthcare providers who took care of their kids during a time when they were stressed and vulnerable. And everybody really gets to see those kids doing well for the most part. And we're there as sort of a safety net for the pediatricians as well. And that I think really gives parents a lot of comfort to know that once we discharge their babies, that they're going to see us again in many cases.
Host: It really sounds like you are this ingrained part of their lives, at least shortly after it happens and a really ingrained part of the community. So, I'm curious as to how you see yourself as part of the community and how you see the NICU as a member of the community as well.
Dr. Van Scoy: I feel lucky to be here. I gotta tell you that. I am a native Californian. Moved to Hawaii for my medical training, was over there for eight years and found this opportunity as I was getting ready to leave Hawaii. We moved here when my eldest son was three weeks old and he's 23 years old now. We have raised two children here. We've made great friends and have wonderful neighbors and love living in a town this size with so many outdoor opportunities. And it's really a good fit because I love the intensive primary care aspect. So, it's intensive in that I have to think, and really critically examine what I am doing with a patient. It's primary care, because you are the baby's sole doctor at that point.
And you form relationships with the parents that are long-term and that really resonates with me. I love that. And I feel honored to be a part of some of these difficult situations, because I feel like I can do a pretty good job helping the parents navigate through them and making it feel that they are getting the best that can occur at that time. And I love seeing patients and families around town, and that's one of the advantages of a town this size. In addition, we have a yearly reunion that I've spoken of before. And we generally have 600 plus people there and it's just a real fun time and a chance to reconnect with everybody. My favorite day of the year. Being in a town this size also has allowed me to get involved with the medical staff. I've been Chief of Staff for a few years. I've been on the Governing Board here at the hospital. And I really do that because I believe this is a good program and we do good things here.
Host: Wow. Dr. Van Scoy I have to be honest, I mentioned in the last episode that we're expecting in August. And it feels like we should reconsider where we want to have that baby. It just seems like in the central coast, the community is so closely knit. Everyone is so supportive and there are comprehensive resources available just in case anything happens. So, it's wonderful to hear about. I guess the last question that I have is how might you compare your NICU versus one that is found in a larger community?
Dr. Van Scoy: I think it's real different. I like to use this sort of comparison of different kinds of places where you can go to eat, which sounds odd. But when I think of a big NICU, it's like a big cafeteria. You go there, you don't expect a whole lot of personalized attention. You get the product or the care that you need. It's usually busy and loud and somewhat bright. And you may have to speak with a few people before you get all the answers that you want or need. In contrast, our NICU, I like to think of as like the neighborhood coffee shop. As far as the NICU is concerned, and this is of course that nobody obviously wants to be in a NICU, but really it is a warm and inviting one.
We personalize the care, we try and give the parents and the patient great individualized service and care. And we can do that because there's few of us working there and we can speak with each other regularly and make sure that every baby is getting what is right for them and not just a standardized care plan. We have two way communication back and forth between the parents, every time they come in. Everybody has a different story on why they're there and they have different needs and we try and honor both of those things with each set of parents and each family. And it's really of the place that many parents come to actually enjoy hanging out in because they get to talk to the nurses who are not only great sources of information, but just nice people, from the area, they live here. They want to form relationships as well. And it's really a testament to the family friendly culture that we have here. And we're pretty proud of that.
Host: Well, Dr. Van Scoy, I really appreciate your time today and just appreciate the support that you and that multidisciplinary team give to the community. Thank you so much for your time. That's Dr. Steve Van Scoy the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. For more information, please visit our website at tenethealthcentralcoast.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy conversations, the podcast from Tenet Health Central Coast. Thank you so much. And we'll talk next time.