Transcription:

Melanie Cole (Host): From technology and innovation to changing demographics and new regulations, the healthcare landscape is in a near constant state of reinvention. Here to tell us about what St. Louis Children's Hospital is doing to expand their services within the community, my first, Dr. Mark Lowe, he's the Vice Chair of Clinical Affairs and Strategic Planning of the Department of Pediatrics at Washington University School of Medicine, and he's a pediatric gastroenterologist at St. Louis Children's Hospital. And Michele McKee, she's the Vice President of Finance and Strategic Planning at St. Louis Children's Hospital. Welcome to the show, both of you. So Dr. Lowe, I'd like to start with you, tell us a little bit about the main St. Louis Children's Hospital campus, as being the hub of patient care. What do you want listeners to know about what you're treating there?

Mark Lowe, MD, PhD (Guest): Well the campus is the hub of our patient care, and we treat all variety of illnesses and injuries that happen to children from minor injuries to life-threatening health conditions. We have a highly trained group of physicians and staff that are able to take care of pretty much anything- actually I should say anything that affects children.

Melanie: Very comprehensive. And Michele, is there a strategy behind incorporating physicians and the expertise in areas in off-site facilities? Because not everybody can get right to the hospital itself.

Michele McKee (Guest): Absolutely. One of the things that we've heard from our patients about is clear, is that we want you to be where we are. So one of our strategies is geographic distribution and being where patients are, and they live, and we know that by virtue of going out into the community and bringing our pediatric expertise into the community, we're providing access points that are much greater- we have a greater ability to getting patients to see our sub-specialists. The academic campus, while wonderful, it's hard to park here, it's hard to navigate these large buildings, and so creating these off-site locations that are easy to park, easy to get in and out of, are more convenient for our families and our patients. It's absolutely the strategy that we're undertaking right now.

Melanie: So expand on that just a little, Michele. When you talk about incorporating them and these community services, what kinds of services? Are they opening up offices all around? Or is it more are they coming to the community, and for other physicians to know that there's maybe things they can attend, or reach-outs, or those kinds of things?

Michele: Right, well our first attempt at doing this is obviously our big building on Mason Road, and the Mason Road campus has most all of our sub-specialists that have a timeshare there, so that our sub-specialist physicians are going to that site and having clinic there. So patients that just need a clinic visit with an orthopedic surgeon, for example, can go there. And then paired with that is all of the ancillary services that you could typically get down at the main hospital, but we have them now in a much convenient location. So there's outpatient surgery, MRI, a lab, tests, a simple x-ray, those kinds of things are handled at the Mason Road facility.

Now that doesn't mean that all of the things that we're trying to do include a big building like that. The other thing that we are actually doing is providing clinical spaces and clinical care, multi-specialty clinical care in other locations off-site and on different campuses across the region. So for example, Mark Lowe has been instrumental in helping us get a sub-specialty clinic up and running in the Shiloh location located across the way from our Memorial Shiloh Hospital, which is also a BJC facility, and they will have sub-specialty care like GI, cardiology, pulmonology, those kinds of things will be- there will be a clinic in that medical office building across the street.

The other thing that we've done recently is that we are- we opened a Convenient Care that was in South County, and a Convenient Care is staffed with nurse practitioners - pediatric-trained nurse practitioners - and they are seeing children after hours. So when your primary care physician closes for the evening and your child is awake at 8:00 at night with an earache, that's a location where you can get children's care, nurse-practitioner staffed, and go to that location and have your child seen for that earache. So it's just an extension of the physician's office, and you can receive that care after hours, making it much more convenient for some of our patients' families that have those types of situations.

Melanie: Are you considering opening additional specialty care locations for either the outpatient services or the Convenient Care services, Michele?

Michele: Yes. Yes, we have more in the works. We obviously look at different market demographics, we look at where we don't get our disproportionate share of pediatric patients, and there will be more to come for sure.

Melanie: So Dr. Lowe, as far as pediatric orthopedic coverage in the ERs, give us a little bit about the importance of this coverage, why it matters, and what you're seeing.

Dr. Lowe: Well pediatric trauma is very common in children, and broken bones happen, and they need to be taken care of in a timely fashion, and the ability to reach a pediatric orthopedic specialist that's near your home I think is very important and will greatly help with care and the convenience for families. So I think it's all about providing very timely care close to where the families live and where our patients are.

I think it's also important that the pediatrician has an on-call person who can be contacted by any of our pediatricians or family practitioners of a child that may need their care, and that will help facilitate having them seen very quickly.

Melanie: And that was going to be basically my next question, how this overall strategy that you're coming up with affects referring physicians. Where do you see this benefiting them as far as nearness of locations and this whole outreach to the community?

Dr. Lowe: Well I think that there are a couple benefits. First of all, it will give us more locations and offices where we can see patients, which will help improve our access. One of the longstanding issues with care has been the ability for pediatricians to have their patients seen quickly by a sub-specialist, and we work very hard to improve that access. Part of that strategy is to bring the physicians closer to where the families are, closer to where the practices are so that we're available, and it's easier for the families to get to us. So the strategy of bringing physicians to our patients is a major part of our strategy as we move forward. I think this benefits both families and physicians.

I'd also like to say that one of the big advantages of Convenient Care, that we talked about earlier, is that it is staffed by pediatric-trained providers, which is not the case in many Convenient Cares. And we also are committed to providing timely and accurate documentation back to the pediatricians whose children we see at the Convenient Care, and this has been something I've heard from pediatricians in our area frequently, and that is they don't have good communication from other Convenient Cares. And so we've made this a focus not only of the Convenient Care, but also of our care in general. So we also have a major focus on making sure we provide timely communication back to referring physicians.

Melanie: So important. Michele, you guys are expanding your presence in Illinois with pediatric emergency and neonatology coverage. Speak about that a little bit and why it matters.

Michele: Absolutely. So we are, we'll be staffing the emergency room at Shiloh and the Memorial Belleville campus- and actually I said we will be, I think they've already started that April 1st, so that's very exciting. And it's important because primary care physicians, when they get the after-hours call, they want to be able to send their patients to a pediatric-trained specialist. So we know that by virtue of having them in the emergency room, that community and those pediatricians will have a place to refer their patients when they're not in the office or when an emergency does exist.

And so we're very excited to be able to offer that. I think from a marketing and branding standpoint, I think people feel confident, parents feel confident and comfortable sending their kids to an emergency room knowing that there's going to be children-trained professionals to take care of their children in times of need. So we are absolutely thrilled to be in that market, and we think that our patients and families, including our referring physicians, will be pleased with that as well.

Melanie: Dr. Lowe, as you continue to grow with all of these incredible changes, how do you think, or how do you see this affecting how you communicate to referring physicians? Will any of that change?

Dr. Lowe: Like I mentioned earlier, one of our important aspects of care is that we communicate efficiently and completely back to the referring physicians because many times they will be following the patients after we see them, and oftentimes families will go and ask questions of their pediatricians related to the care that they received from the sub-specialist, so it's critical that we communicate.

I think that not just the expansion, but also the implementation of our new electronic medical record, which will give us better ability to communicate with many of the pediatric practices throughout the area. In fact, as soon as the note is generated, it'll be available to the referring physician. So this is also an important facet of the changes that are happening in how we provide care to our patients.

Michele: I would like to add that we are doing a lot around communication back to our primary care physicians, even on the main campus. About a year ago we set up a new physician communication standard, in which any time a patient was admitted, or even transferred from one location to the other within the hospital, for example from an ICU to a med surgical floor, or if a patient expired, or if a patient was discharged we are in fact letting that physician know.

So as Mark alluded to and has mentioned about our strategy, physician communication- referring physician communication is extremely important. And so in addition to all of these off-site locations, the Convenient Care, and responding back to these physicians, we know that it's extremely important to make sure they're up to speed and up to date in terms of their patient's status as we are collectively caring for them.

Dr. Lowe: Yeah, I would like to expand a little bit and mention Children's Direct, which is a telephone service that has been around for a number of years now, but we have increased its capability to help connect our referring physicians and sub-specialists directly, and also to help with referrals for appointments. And as I've gone around to talk to different pediatric practices, this is a service that they greatly appreciate and have found helps them contact us, which is an important part of the equation when you're looking for sub-specialists to help care for their patients.

Melanie: Michele, looking forward to the next ten years or so, what are some of your goals? What would you like to see happening? Or what are you thinking you will see happening that's really exciting for the community of St. Louis Children's Hospital?

Michele: Well I would say over the next ten years, or in ten years you would expect to see St. Louis Children's services in every market in our community. So when I mean market, I mean you will see our presence in North County, you will see our presence in South County. You're already starting to see our presence in Illinois and in West County. But in addition to what we currently have in place, I would say that that's going to grow exponentially and that parents and families can be excited about the fact that we will be where they are, and that we will be more convenient, we will provide scheduling options that are easier- much easier, and even self-directed, and we will continue to make it easy for you to access our hospital.

I think Mark would agree with me that referring physicians and patients with families really do want to come to St. Louis Children's because they recognize we are the premier organization to care for pediatric medical issues. I think some of the challenges they've had in accessing us will- and my goal is that those will all be over kind of in the next ten years, if not sooner.

Melanie: And Dr. Lowe, to wrap things up, tell other physicians what you'd like them to know about community services from St. Louis Children's Hospital, and when to refer. What would you like to tell them now?

Dr. Lowe: I'd like them to understand that we're here to help them, and any time they have a question or a concern about one of their patients, we'd like to hear about it. It doesn't matter how minor or how severe the problem may be, we're here to help them take care of their patients. That is our mission, and we have taken it very seriously, and as we've discussed throughout this podcast, we're committed to bringing our physicians out to the community. And that can only benefit the families and the pediatricians.

Melanie: Thank you so much, both of you, for being on with us today. It's great information, and good luck, and thank you for all the great work that you're doing. A physician can refer a patient by calling Children's Direct Physician Access Line at 1(800) 678-HELP. That's 1(800) 678-4357. You're listening to Radio Rounds with St. Louis Children's Hospital. For more information on resources available at St. Louis Children's Hospital, you can go to www.StLouisChildrens.org. That's www.StLouisChildrens.org. This is Melanie Cole, thank you so much for listening.