Inside Pediatrics Spring 2015

Medically Complex Children

said. “All the participating doctors meet with the parents at one time to review all the results.” Following the assessment, the patient is seen in clinic where doctors from all three disciplines evaluate options for medical treatment or other interventions, if needed. Clinic coordinator Ashley Chapman, RN, BSN, attends those visits to coordinate follow-up care. “Sometimes surgery is required. Sometimes a patient needs medical management. Sometimes it’s rehabilitation. And other times, the child may just need to outgrow the condition. This coordinated care helps take away the uncertainty and allows us to confidently care for the child,” Harris said. Program includes new intensive feeding therapy Often the patient is referred to Children’s sleep center for studies or to the new intensive feeding program, one associated with an aerodigestive program. “The intensive feeding program was developed and is directed by clinical psychologist Michelle Mastin, Ph.D. Her comprehensive team includes speech and language pathology, occupational therapy, clinical nutrition, social work, psychology and medicine,” Harris said. “These experts work on changing the learned barriers children sometime face with feeding. For example, even after the anatomical reasons for swallow dysfunction have corrected, comprehensive trans-disciplinary behavior modification may be necessary to overcome aversions and relearn how to eat.” More than 200 patients are currently receiving care through the aerodigestive program. Some are referred by their primary care physicians, some are self- referred and others are referred internally by other sub-specialists at Children’s. “Patients come in from the different disciplines with different symptoms and The collaborative spirit of the program is the backbone of its success. “It’s the quintessential way of breaking down silos to talk about patient care,” Dimmitt said. “We learn from one another. It’s generated a new trust and appreciation for what the other person does. There’s more familiarity with our colleagues in other divisions that’s fostered better communication.” different issues,” Dimmitt said. Collaboration is key of the few in the U.S. and the only one that is directly

Academically, the aerodigestive program provides a wealth of data. “There’s a lot to be learned from these complex patients,” Wiatrak said. “We’ve already enrolled 300, and we’ve started to capture information in an aerodigestive database. Then we can conduct studies and research projects in all three disciplines.” The improvement in patient care has inspired Dimmitt to adapt the structure of the aerodigestive program to four other multidisciplinary programs within the GI division: eosinophilic esophagitis, which is a collaboration of GI and allergy; intestinal rehab/short bowel, which combines GI and surgery; colorectal, another collaboration between GI and surgery; and the hepatobiliary program, where GI, pediatric surgery and transplant surgery collaborate. And it’s not just a local program. Patient referrals have already come from become the destination program not only in the state but regionally, nationally and internationally,” Dimmitt said. More information is available at www.childrensal.org/ aerodigestive . neighboring states. “Our hope is to

“The goal is to comprehensively and efficiently evaluate and manage the medical needs of children with complex airway and nutritional problems by coordinating care.” — Tom Harris, M.D.

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