Sacred Heart Medical Center, which opened a Childrens Hospital in its expanded east tower last summer, now plans to build a pediatric emergency department next to the big medical centers general ER.


Separately, the Childrens Hospital has launched two new specialty clinics, one that provides follow-up care for children who had been in neonatal intensive care and the other aimed at children who have suffered their first seizure.


Though it might be late 2005 or early 2006 before a separate emergency department for kids opens at Sacred Heart, the hospital plans this year to spend about $1 million to reconfigure its current ER to help separate the care of children from that of adults until the new structure is done, says Elaine Couture, a Sacred Heart vice president.


It will be staffed by physicians and nurses with specialized training in pediatric care, and will have its own medical director and nursing manager, Couture says.


The planned pediatric emergency department will be located just east and slightly north of the general ER, in an area that overlooks a utility driveway off of Division Street. Because that driveway sits below the grade where the current ER is located, the pediatric emergency center either will be built to cantilever over the driveway or will occupy the second story of a two-story addition that would sit on part of that driveway.


For that reason, says Joe Gilene, executive director of the Childrens Hospital, its unclear yet how much the project will cost. He puts a rough range on the project of between $3 million and $8 million or more, plus furnishings and equipment. The new pediatric emergency department likely would have at least 15 treatment rooms, plus a waiting area and other space. It would be connected to the current ER and would share the trauma rooms there, which are too expensive to replicate, says Couture.


Sacred Hearts emergency department has 15 acute-care treatment rooms, six fast-track rooms for minor medical problems, and four trauma rooms.


She says one of the goals of having a separate emergency department for children is that kids wont be exposed to some of the sights and sounds of an ER that treats adults.


Wed like to separate the children from the adults and the adults from the children, Couture says, adding that currently a child might get a glimpse of an adult bleeding profusely or acting inappropriately.


Sacred Heart, however, isnt waiting for that project to be completed to begin separating the care of children from that of adults in ER. This year, it plans to reconfigure the current emergency department to set aside a corridor of six treatment rooms, as well as a separate waiting area, all exclusively for pediatric care. Currently, three treatment rooms within the general ER are designated for pediatric care, and include paint and decorations aimed at making young patients more comfortable, says Couture. That theme will be used throughout the new pediatric emergency room corridor.


Wed like to take the scare out of it, says Gilene.


To accomplish the reconfiguration, the current ER will be expanded into adjacent space that is used for offices and other nonclinical purposes, and those functions will be moved elsewhere in the hospital, he says.


Once the new full, pediatric emergency department is completed next door and the pediatric-care corridor created this year is vacated, that space will be taken over by the general ER, Couture says, adding that the hospital expects emergency-department use to continue to grow.


Though having separate space for emergency pediatric care is important, the more critical piece is having people on staff who are trained in pediatric emergency medicine, she says.


Adds Gilene, Its not just putting color on the walls, but the people who can take the child through a difficult process.


Sacred Heart already has begun recruiting staff for a pediatric emergency department, and expects to have the medical director on board this summer.


Sacred Hearts emergency department, says Couture, already has some staff members who have interest in pediatric medicine, but the hospital will be adding three to four physicians who specialize in such care, as well as additional specialized nursing support.


Gilene says the hospitals investment in a pediatric emergency program, the amount of which hasnt been determined yet, will be worth it, not just because its the right thing to do for a childrens hospital, but because it would be expected to attract new patients.


Childrens hospitals use ER as a front door, he says. Once the new department opens, The number of visits to our emergency department will grow. Our referrals from the emergency departments of other hospitals in the region will grow. We anticipate a fair amount of growth here as this expertise is concentrated.


Neonatal follow-up


The hospitals new Neonatal Developmental Followup Center will operate one day a week, on Thursdays, and will be aimed at infants who have spent time in a neonatal intensive care unitusually because they were born premature or with medical complications. It will be housed in shared space on the childrens hospitals fourth floor.


Kids that are born premature are at a high risk of having developmental problems, says Dr. Robin McCoy, a staff developmental pediatrician at the hospital and one of five health-care specialists who will work in the center. They need to be monitored closely, and we need to get them to intervention quickly. These are kids who are referred to us before they leave the hospital.


That intervention, McCoy says, typically involves various forms of therapy, ranging from physical or occupational therapy to speech therapy. Children born premature might have motion or mobility problems, hearing problems, or even feeding problems, she says.


The clinic will see patients at intervals of four months, 12 months, and 18 months after they have left NICU, so the team will be able to follow their progress. The center is expected to see about 12 patients per month, McCoy says.


In addition to McCoy, the center will be staffed by speech therapist Sandy Bassette, occupational therapist Margaret Miller, and physical therapist Jackie Teeple, all of whom work for St. Lukes Rehabilitation Institute. Also, Dr. Kathleen Webb, a neonatologist with Northwest Neonatology here, will be doing research at the center, with the intention of evaluating treatment strategies based on outcomes, McCoy says.


St. Lukes had operated a similar center, but decided as a cost-efficiency measure to shift the service to hospitals here. It provides some staff both the Sacred Heart clinic and a similar one launched at Deaconess Medical Center, says St. Lukes spokesman Chad Hutson.


The first seizure


The other new specialty clinic to open within the Childrens Hospital recently is called the First Seizure Clinic, and, as the name suggests, it targets children who have suffered their first seizure, says Stacey Herron, regional manager for childrens clinics at Providence Services, the hospitals parent.


Herron says the clinic is open the third Friday of each month and is located on the fourth floor of the Childrens Hospital, in space also used for other neurology services. It expects to see as many as 10 patients a month, she says.


There, children up to age 18 who have had a recent, first-ever seizure will be evaluated by Dr. Greg MacDonald, a pediatric neurologist, and their parents will attend a class on seizure management and related safety guidelines, Herron says.


Its our hope that these children never have another seizure, she says, but those who do will be referred to a child neurologist for further diagnosis and treatment.


Herron says the Childrens Hospital decided to open the clinic to make it easier for parents to get their children who have suffered their first-ever seizure to be able to see a specialist in pediatric neurology. She says there are only two such physicians in Spokane.