Packard Children's In-House Pediatricians Enhance Hospital Care

Dr. Lauren Destino visits with a young patient.

Whether they have a simple problem or a complex illness, children who are admitted to Lucile Packard Children’s Hospital need attentive, well-planned care. At Packard Children’s, this care often comes from members of the pediatric hospitalist team: general pediatricians who specialize in caring for inpatients.
 
“We’re the jacks-of-all-trades for our inpatients,” said Joseph Kim, MD, director of the pediatric hospitalist program for Packard Children’s and the Packard-affiliated pediatric unit at El Camino Hospital. During the day, hospitalists run the general pediatrics inpatient units and lead inpatient care, Kim said. “At night, we wear our fireman’s hats and put out fires for clinical and non-clinical issues on several units, including specialty services such as liver transplant and stem cell transplant.”
 
The team also plays significant roles in educating resident physicians, answering emergency code and rapid response team pages, and leading safety and quality improvement efforts.
 
The hospitalist role developed in adult medicine over the last 20 years as hospitalized patients needed in-house, around-the-clock doctors at the hospital to oversee the increasingly complex care they were receiving from many specialist physicians. Pediatric hospitalists are a more recent addition; Packard Children’s has had hospitalists for about six years, with it now having at least 16 on staff. Hospitalists ensure that all aspects of a patient’s care are smoothly coordinated.
 
Establishing good working relationships with patients, their families and referring physicians is another key aspect of a hospitalist’s job.
 
“We come up with a plan for each child that meets the family’s and the child’s needs,” said hospitalist Lauren Destino, MD. “We also like talking to primary care providers—they’ve known the patient longer. They might be able to add not only to medical information, but also give useful details about the whole family’s situation.”
 
All Packard Children’s hospitalists are residency-trained and board-certified in general pediatrics, and individual physicians on the team have specialized expertise in pediatric palliative care, hematology/oncology and doctors’ use of information technology. Subspecialist physicians, nurses, case managers, physical therapists, nutritionists and many other Packard providers collaborate closely with the team each day.
 

Dr. Joseph Kim

To keep inpatient units running safely and efficiently, Packard Children’s hospitalists lead quality-improvement projects. For instance, they recently instituted discharge rounds held 48 hours before a patient is scheduled to go home. These rounds bring together all key caregivers to discuss discharge concerns with the patient and family, a measure that has improved discharge times. “This affects every acute care patient that goes through Packard, so it’s a lot of hours saved over the course of a year,” Kim said.
 
The team has also developed night safety rounds in which a hospitalist, the senior residents and a nursing supervisor see high-acuity patients in each of Packard’s five acute care units at the beginning of the night. “We’re asking what problems could arise and how to head them off,” Kim said. “The project has really improved communication between nurses and physicians at nighttime.”
 
When patients are ready to go home, the hospitalist team contacts referring physicians by phone or fax to update them on their patients’ hospital stays.
 
“If there are any concerns from the referring doctor’s end, we want to hear about it,” Kim said. “We want to make that transition from hospital to home as smooth as possible.”
 
Discharging healthy children who arrived at the hospital in bad shape is one of the best parts of Destino’s job, she said. “It can be really rewarding to know that we’ve followed these patients through thick and thin, and they’re better and ready to go home.”
 
 
Learn more about the Hospitalist Program.