Children’s in the News

Megan Connelly, vice president of Community Pediatrics & Child Health, was featured in a KPTM story on Health Care Workers Appreciation Week.

Connelly is a member of Leadership Omaha Class 44 through the Omaha Chamber of Commerce. Her class initiated Health Care Workers Appreciation Week to recognize the efforts of these professionals throughout Omaha, Douglas County and the state of Nebraska. Children’s showed its support by lighting up the Hubbard Center for Children in white lights through March 6.

Read more here.

Carpediem™ Dialysis System Available for Littlest Patients

In 2021, Children’s received grant funding to purchase two Carpediem™ cardio-renal pediatric dialysis emergency machines. This system provides continuous renal replacement therapy for acute kidney injury and fluid-overloaded pediatric patients weighing 2.5 to 10 kgs. Children’s is one of only five pediatric hospitals in the U.S. with this technology. For the first time, infants with acute kidney injury (AKI) and fluid overload (FO) can be treated with a dialysis system designed specifically for them.

Pediatric patients requiring continuous renal replacement therapy have historically been treated with systems designed and indicated for adults and not approved for pediatric use, which can create potential clinical complications for neonatal patients.

Read more on the Medtronic website.

Children’s dialysis team and providers have completed training, and bedside staff training will be completed this week. Children’s team is ready to utilize this new technology as soon as the need arises.    

Please Conserve Respiratory Viral Panel Testing

Due to nationwide shortages of supplies, we are conserving Respiratory Viral Panel (RVP) testing for inpatients only. Our supply is low, with additional supplies potentially coming in the next few days. Immediately, Laboratory will change all RVP orders to a 4plex (COVID-19, Flu A/B and RSV) test. If RVP results are likely to affect patient management and/or isolation decisions, please contact Laboratory to discuss. 

We are unable to perform RVPs for any outpatients, CP/UC and ER; samples will be frozen in case we get additional supplies. After 4plex results are complete, if a RVP is still indicated, please contact Laboratory to discuss in further detail.   

Routine viral testing is not necessary for the diagnosis and management of bronchiolitis (see the 2014 AAP Clinical Practice Guidelines) and not needed for hospital admission. We thank you all in advance for your assistance in wisely using this limited resource.  Supply changes evolve rapidly, so we will continue to communicate updates as we have new information.

Please direct any questions to George Bedrnicek, M.D., in Children’s Pathology at 402-955-5528 or Tess Karre, M.D., at 402-354-7842.

Ultrasound Call Coverage Moving to Voalte

As of March 2, the Ultrasound Department within Radiology is using Voalte for on-call purposes. We strive to have an ultrasound tech on-site 24/7, but due to occasional staffing issues, ultrasound will only be available on an on-call basis for emergent exams. 

Please contact the following technologist in Voalte if you need a stat ultrasound exam after hours (6:30 p.m. to 6:30 a.m.)

  • “Ultrasound Tech” login to reach an on-site technologist. If no one is online/available, then use:
    • “Ultrasound Tech On-Call” in Voalte to reach the on-call tech.

Children’s Partners with Lutheran Family Services to Support Refugees

Children’s Trauma team recently joined forces with Lutheran Family Services to support the hundreds of Afghan refugees flying into Omaha and relocating throughout Nebraska. The team gathered at Frederick Square to load a box truck with 100 donated car seats and booster seats. With approximately 100 kids under the age of 8 arriving within two months, car seats are an immediate concern.

The Injury Prevention team is donating more than 100 car seats and providing safety tip sheets with step-by-step instructions (and photos) for safe installation. Lutheran Family Services has translated the tip sheets into the families’ two primary languages.

According to Amy Borg, child passenger safety specialist, Trauma Department, motor vehicle accidents are one of the leading causes of unintentional injury deaths among children.

“We do what we do because we want to help kids and save lives. This refugee situation isn’t something you see every day… I’m honored to be able to help parents protect their kids in a culture so new to them. I wish I could do more, but I’m excited to be doing my part by helping to support and educate families,” she said. “This has been a group effort and I’m really impressed at the community here at Children’s that’s stepped up to help, with a special shout-out to Travis Hedlund, Injury Prevention coordinator.”

Pooja Dave, M.D., Joins Pediatric Hospital Medicine

Dr. Dave has joined Children’s Pediatric Hospital Medicine. Dr. Dave received her medical degree from PramukhSwami Medical College, Sardar Patel University, India and completed her Pediatrics residency at Children’s Hospital of Michigan, Wayne State University in Detroit. She will be working with the Lincoln Pediatric Hospitalist group and covering Bryan Medical Center, CHI Health St. Elizabeth and Madonna Rehabilitation Hospitals in Lincoln.

Updates to Vascular Access Coverage

The following schedule will be in effect from Friday, March 4 to Monday, April 4:

  • PICC Coverage (IR): Monday-Friday 8 a.m. to 5 p.m.
    Please reach: Lindsay Ciatti via Voalte from 6 a.m. to 5 p.m.
  • EPIV (Distal and Midline) Coverage (VAT): Monday-Friday noon to 8 p.m.
    Additionally, 4 to 4:30 p.m. 3 days a week

Technically Speaking: Operative Reports

First things first: I’m sorry.

I’m sorry for changing your dictated operative report template without letting you know. There was supposed to be some testing and a scheduled go-live date, but that plan must have gotten lost in our communication with our vendor, and the new template dropped without anyone knowing about it. I quickly found out when all of you started sending me negative feedback. I’ll try to make sure changes are better communicated in the future.

So why did we want to change the template in the first place? One word—compliance. Drs. Maegen Wallace, chair of the Department of Surgery from 2020-2021, and Paul Esposito, surgeon-in-chief, have been keeping their eyes on operative report compliance. According to them, the organization needs to do a better job of documenting the “required elements” in our reports. This is obviously a source of potential trouble with The Joint Commission (JCAHO); incomplete documentation can also compromise patient care. By adding section headings and wild cards that would require providers to address each element before signing the report, we thought we could drive more complete documentation and increase our compliance.

We immediately received feedback about the order of the elements in the template, as well as about the necessity of each of the sections—one surgeon pointed out that JCAHO does not actually require all the elements in the template in operative reports. We based the template on an existing note template in Epic that has been around since 2012, which, in turn, was based on our medical records policy (MS059). Upon more careful research, here’s what I found regarding who requires what in an operative report (I even threw in the Centers for Medicare and Medicaid Services (CMS) for the LOLs):

ElementCMS RequirementJCAHO RequirementChildren’s Policy
Date and time of procedure  
Name(s) of surgeon(s) 
Names of assistants (if any)  
Pre-operative diagnosis  
Post-operative diagnosis 
Name of procedure performed 
Type of anesthesia administered  
Complications (if any)  
Estimated blood loss 
Detailed description of the procedure
Tissues or specimens removed or altered
Surgeons or practitioners name(s) and a description of the specific significant surgical tasks that were conducted by practitioners other than the primary surgeon/practitioner  
Prosthetic devices, grafts, tissue, transplants, or devices implanted (if any)  

As Mr. Spock would say, “fascinating.”  As you can see, Children’s policy is the most rigorous of the three. In response, we are removing the Patient Name, Consent and Disposition sections of the dictation template. That’s the good news. The bad news is that also based on Children’s policy, we are adding Assistants and Complications. And there’s more. JCAHO openly states they were very careful in adding the words if any to the Estimated Blood Loss requirement. This means (their words, not mine) that if there wasn’t any blood loss, it doesn’t need to be documented. However, Children’s policy doesn’t account for this.

So, we’ll make some changes to the headings and re-order them so that the report makes a little more sense, and the wild cards are there to stay so that we can ensure dictated operative reports comply with our documentation policy. I understand your frustration, and at the same time, we are bound by what the policy writers thought was important. If you disagree with the policy, I strongly encourage you to get together with your peers, draft a revision and propose it to the Medical Executive Committee. I joke a lot in these columns, but this isn’t one of those times. We shouldn’t limit ourselves to venting about our frustrations—we should invent ways out of them.

All that said, if portions of your reports aren’t being transcribed into the right sections, let me know, and I’ll relay that feedback to our service provider.

Thanks for understanding and for all you do!

Stephen Dolter, M.D. | CMIO

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