2009 Annual Report

H o p e l i ve s h ere.

H o p e l i ve s h ere.

Founded in 1855, The Children’s Hospital of Philadelphia is the birthplace of pediatric medicine in America. Throughout its history, a passionate spirit of innovation has driven this renowned institution to pursue scientific discovery, establish the highest standards of patient care and train future leaders in pediatrics.

For a century and a half, Children’s Hospital has served as a haven of hope for children and families worldwide. www.chop.edu

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The Children’s Hospital of Philadelphia and the logo are registered marks of The Children’s Hospital of Philadelphia. ©2010 The Children’s Hospital of Philadelphia, All Rights Reserved.

An n u a l

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+ Lighting up the cover: Avery,

soccer player, kindergartener, son

This exuberant 5-year-old has sickle cell

disease and has been cared for by

a team at The Children’s Hospital

of Philadelphia since infancy.

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You Gave Us Hope.

These are just a few of the countless children who have been helped by the Hope Lives Here campaign.

Thank you!

Hope lives here.

Three small words that somehow encompass the work of more than 9,000 individuals, and the generosity of more than 216,000 donors. Three small words that have served as a rallying cry for the largest fundraising effort in the history of The Children’s Hospital of Philadelphia.

Over seven years, including several marked by severe economic downturn, the Hope Lives Here campaign engaged thousands of new donors, strengthened our bonds with long-standing supporters and exceeded its ambitious goal of $400 million by $76.5 million.

The results are everywhere you look throughout the institution: breathtaking scientific advances with the potential to change the face of pediatric medicine, re-envisioned models of patient care designed to keep CHOP at the forefront of patient safety, state-of-the-art new facilities commensurate with our clinicians’ and researchers’ abilities, and innovative platforms to advocate for children far beyond our own walls.

But our good fortune is also a reminder of CHOP’s profound responsibility. No institution is better poised to make the next great advances in pediatric healthcare — and no institution has a greater obligation to do so. The well-being of our children, our future, depends on it.

I am immensely grateful to our philanthropic partners for providing the fuel to deliver on our promise of better health for children. I am also proud of the leadership and guidance provided by our Board of Trustees. And I am honored to work side by side with employees and staff renowned for their innovation, resilience and extraordinary commitment to the children we serve.

Steven M. Altschuler, M.D. President and Chief Executive Officer

Report from the Chairman The bottom line for a nonprofit organization is different from that of a business. The critical questions the nonprofit sector must ask are not about returns or revenues, but about how effectively we deliver on our mission and how deep of an impact we make.

At The Children’s Hospital of Philadelphia, we measure ourselves by the lives we save, by the medical discoveries we make, and by the hope we provide to sick kids and struggling families here and around the globe.

The economic downturn of last year tested the financial mettle of charities and businesses alike. For healthcare nonprofits like Children’s Hospital, the potential for systemic reform added another layer of uncertainty. In a defining year when everyone was forced to look hard at their own bottom lines, the leadership of CHOP stayed laser-focused on our core mission of compassionate patient care, research and teaching. This commitment has kept CHOP at the forefront in the fight for healthy children.

The Board of Trustees will remember fiscal year 2009 for its challenges, but also for its many achievements. We celebrated the successful close of our Hope Lives Here campaign, the Hospital’s largest-ever fundraising effort. Many of the fruits of this outpouring of generosity are described in this report. My fellow trustees and I are deeply moved by what our community of donors has made possible at CHOP. In fiscal year 2009, we also saw the breathtaking potential of translational research and medicine at CHOP. We have sped the pace of discovery and pushed the horizons of medicine.

Diseases that have vexed scientists for years, and robbed children of their childhoods, are now yielding their secrets and giving way to hope.

Our goals for the future are bold, as they must be for the children we serve. CHOP will be the safest children’s hospital in the nation. We will create the paradigm of personalized medicine. We will continue to recruit the finest medical and scientific talent. Because our bottom line is a better world for children. That is why hope lives here.

Stephen B. Burke Chairman, Board of Trustees

H o p e l i ve s h ere.

4 – 13 Special Section: The Hope Lives Here Campaign Highlights of the largest fundraising effort in the Hospital’s history.

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Found in Translation

Gene discoveries at CHOP fuel new treatments for childhood cancer in record time. Also: major advances in autism and HIV.

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Keeping Jaylisse Safe

The nation’s top children’s hospital focuses resources at every level on patient safety.

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Tender Loving Care

It’s the big things and the tiniest things that make nursing in the N/IICU so rewarding — and help CHOP to retain its best and brightest nurses.

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Eat Well. Stay Safe. Be Happy.

The first Healthy Kids Day strengthens CHOP’s mission of education, outreach and service to our local community.

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A Voice for All Children

Dr. Altschuler goes to Washington — to keep children’s needs at the center of healthcare reform.

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Financial Information, Our Donors and Who’s Who

Grace, 11, orthopaedic patient since she was 14 months, has had numerous procedures at CHOP, including one as an infant to release a tethered spinal cord.

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T h e H ope L i v es H ere C am p ai gn

A Campaign Concludes, Hope Is Born Anew.

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And so, on January 1, 2003, The Children’s Hospital of Philadelphia embarked upon the largest fundraising effort in its history: the Hope Lives Here campaign.

The enormity and urgency of the campaign became evident at once. Every sick child who came through our doors, every disease that still

We are honored to share with you some glimpses of what support for the Hope Lives Here campaign has wrought at Children’s Hospital.

And we can never say it enough: thank you.

Makai, 6, diagnosed at CHOP at 3 months of age with tuberous sclerosis, has undergone brain surgery and is followed by Neurology.

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All that was missing was the funding — the spark to ignite this fire and make a revolution in pediatric medicine possible.

Today, seven years since the campaign’s start, Hope Lives Here has exceeded its $400 million goal by more than $76.5 million. In this special Annual Report, we look back on an outpouring of extraordinary generosity that has strengthened the fiber of every part of the institution.

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By constructing extraordinary facilities, attracting and retaining the world’s best physician-scientists, and embracing a commitment to translational medicine, Children’s Hospital would seek to become the world’s premier pediatric research hospital.

lacked a cure, reinforced the truth that our work must not stop. And the global economic uncertainty of the past year has been a stark reminder that our resources are precious. Every dollar raised is vital to the life of this institution and to our dream of a better, healthier world for all children.

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A decade ago, the Board of Trustees of The Children’s Hospital of Philadelphia recognized an opportunity to create a bold new model for children’s healthcare.

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Special Section

T h e H ope L i v es H ere C am p ai gn

Hope

Builds In 1855, its first year, 63 patients were treated at The Children’s Hospital of Philadelphia. The three physician-founders and a team of nurses mended, set, stitched, prescribed, healed and offered hope, working in a

small building with 12 beds.

In the past seven years, the Hospital has experienced unprecedented growth, fueled by the Hope Lives Here fundraising campaign. Our Main Campus has nearly doubled in size: The additional 1.2 million square feet represent floor space equivalent to 21 football fields. Today, the Hospital has

443 beds, where children heal and find hope.

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New and Improved (clockwise) E

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(A) A colorful glass faรงade welcomes children, families and visitors. (B) With more imaging suites, the Radiology Department is able to schedule same- or next-day appointments for most patients. (C) Now with 70 beds, the Harriet and Ronald Lassin Newborn/ In Infant Intensive Care Unit treats r more than 1,000 babies annually. n (D) An Emergency D Department expansion included 10 additional treatment rooms aand a larger waiting area.

(E) The chapel was renovated as the Schlimm Center for Prayer and Reflection, a place of peace. (F) Seven additional operating rooms in the main Surgical Suite alleviate waits for nonemergency surgeries.

(G) At the center of every decision about expansion and improvements: the patient.

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T h e H ope L i v es H ere C am p ai gn

Main Lobby The new entrance includes a large information desk and warm lighting.

The Garbose Family Special Delivery Unit More than 250 babies have been born at the world’s first delivery unit for infants with birth defects diagnosed in utero.

Cardiac Operative and Imaging Complex State-of-the-art space for surgery and catheterization is just steps away from cardiac inpatient beds.

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In their h four f decades as trustees and philanthropists, Ruth M. and Tristram C. Colket, Jr. have helped transform Children’s Hospital into a world leader in pediatrics.

Their $25 million contribution opened the Hope Lives Here campaign, and is the largest individual gift in the Hospital’s 155-year history.

As a little girl, Mrs. Colket accompanied her father, a minister, while he offered comfort on his rounds at a local hospital.

She went on to become a nurse.

Children’s Hospital has benefited from her wise counsel, always informed by her experience and her love and concern for children and families.

Mrs. Colket stepped down from the Board of Trustees in 2009. In 2010, she and her husband will be honored during the opening ceremony for the Ruth M. and Tristram C. Colket, Jr. Translational Research Building (shown here). The 11-story, 450,000-square-foot building, across from the Main Campus, will house the world’s most elite pediatric researchers.

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Thank you.

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Someday, scientists in this building may discover a cure for childhood cancer.

And that will be just the beginning.

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T h e H ope L i v es H ere C am p ai gn

Seat of

Honor

T hey come from families grateful for the care their children received here.

And from families grateful that their children have never needed our care.

T hey are a gift from physicians who believe their contribution to pediatric medicine should endure long after their own practice.

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The reasons for endowing a chair at The Children’s Hospital of Philadelphia are as varied as the individuals who do so. But the result is universal: a seat of honor among a very special cadre of leaders. A powerful tool to reward and retain the finest clinicians and researchers.

both longstanding CHOP staff members —

2009 marked the 21st anniversary of the

of the only of its kind in the nation, is held by

Hospital’s first endowed chair — the C. Everett

Susan Friedman, M.D.

Koop Endowed Chair in Pediatric Surgery.

Today, there are 74 fully funded chairs, among the largest number of any pediatric institution.

Their total value now exceeds $130 million.

In many institutions, endowments primarily support the chair holders’ salaries. At CHOP, the funding supports clinical and research activities in the chair’s area of specialization — a model that keeps the Hospital’s mission to advance pediatric healthcare front and center.

The Hope Lives Here campaign provided a major boost for endowed chairs at CHOP, spanning a host of innovative endeavors.

endowed the Hospital’s first chair supporting a full-time medical ethicist. It is also among the first such endowments at a pediatric hospital.

Chris Feudtner, M.D., Ph.D., M.P.H., holds the chair.

Longtime benefactors Jean and Richard Wood Jr., whose family has been integral to the growth of Children’s Hospital since its founding, stepped up once again — in partnership with Wawa Inc. — to establish the Wawa Endowed Chair in International Adoption. The chair, one

In total, donors to the Hope Lives Here campaign enabled CHOP to double its number of endowed chairs.

As Chief Scientific Officer Philip R. Johnson, M.D., says: “Endowed chairs are a way to recognize what outstanding individuals have done until now and what they will do in the future.”

Surgeon-in-Chief N. Scott Adzick, M.D., himself holder of the Koop Chair, prefers the term “hot seat.” “An endowed chair,” he says, “is a constant reminder of the responsibility to use one’s gifts passionately and well.”

For a complete listing of endowed chairs at The

C.C.C., a senior speech pathologist —

Children’s Hospital of Philadelphia, see Page 61.

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surgeon, and his wife Cynthia Solot, M.A.,

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Steven D. Handler, M.D., M.B.E., an E.N.T.

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A Legion of Contributors

Hope Lives Here:

Thanks to the generosity of more than

Total Gifts by Specific Designation (in millions)

216,000 donors, 190,000 of whom gave

By the Numbers (Jan. 1, 2003, to June 30, 2009)

$8

for the first time, the Hope Lives Here campaign exceeded its $400 million goal

Programs

by $76.5 million.

Research

$28

$165

Unrestricted

The Hospital received a remarkable nine gifts in excess of $10 million, including

Facilities

$186

Social Impact

$89

the largest individual gift in its history, from Ruth M. and Tristram C. Colket, Jr., and the largest corporate gift in its

Total Gifts by Source

history, from State Farm Insurance

(in millions) $55

Companies.

This outpouring of support resulted from outstanding leadership from

$105

Individuals Faculty

$96

$37

Corporations

the Board of Trustees, a commitment

Foundations

to excellence from the Hospital and

Government

$183

medical staff, and a shared conviction that Children’s Hospital was one of the few institutions in the world with

Total Donors by Fiscal Year

the talent, track record and resources to usher in a new era of hope in pediatric medicine.

2003*

25,170

2004

23,496

2005

24,337

2006

25,763

2007

30,795 99,070

2008

114,110

2009+

*Start of the campaign + Completion of the campaign

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A Celebration of Hope and Commitment On Sept. 17, 2009, Children’s Hospital donors, board members and institutional leaders gathered at Karamoor, the home of Nicholas and Athena Karabots, to mark the extraordinary success of the Hope Lives Here campaign.

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Hosts Nicholas and Athena Karabots share in the Hope Lives Here celebration with Robin and Steven M. Altschuler, M.D.

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Trustee and benefactor Lynne Garbose, left, with N. Scott Adzick, M.D., surgeon-in-chief and director of the Center for Fetal Diagnosis and Treatment, and his wife, Sandy. Garbose, with her husband, Bill, funded CHOP’s Garbose Family Special Delivery Unit, the world’s first birth facility devoted to babies with birth defects.

From left: Steven M. Altschuler, M.D., president and CEO, with CHOP supporters Susanna Saunders, Lisa Carr, Ruth Colket, Nicholas and Athena Karabots, and Debbie Weise.

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It was an evening to honor the exemplary commitment of CHOP’s philanthropic partners and to celebrate the Hospital’s unprecedented growth.

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“When Dr. Mosse´ told us that she had found the gene that causes neuroblastoma, we were elated! When she said it would not have been possible without our funding, it made us realize how honored we are to be able to support an incredible doctor’s work and the institution that saved our daughter’s life.”

Jocelyn Hillman, mother of a Cancer Center patient. Hillman and her husband, John, made a major gift to the neuroblastoma research program during the Hope Lives Here campaign.

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Less than two years after researchers discovered the gene for a rare childhood cancer, a clinical trial of a new treatment begins.

Neuroblastoma is one of the most puzzling childhood cancers. In some cases, it simply vanishes. In most others, it kills.

Its causes have long eluded researchers, who have spent decades searching for better treatments — and for a cure.

In 2008, a team led by John M. Maris, M.D., chief of the Division of Oncology, and Yael Mosse´, M.D., identified mutations in the ALK gene as the main cause of the hereditary form of neuroblastoma.

The team also found that the same mutations can occur in the cancer cells in the nonhereditary form of the disease.

Less than two years later, in September 2009, Mosse´ opened a clinical trial of a drug that the team hopes will kill cancer cells by deactivating the ALK gene.

It’s a promising new treatment option for a group of patients who have very few — and researchers were able to get it to them remarkably quickly.

These advances have been made possible by support from donors like the friends and family of CHOP patient Andrew Accardi, the Evan T.J. Dunbar Neuroblastoma Foundation, and Jocelyn and John Hillman.

“If you ask most people how long it takes to go from a discovery to a clinical trial, they’ll tell you it typically takes 10 years,” says Maris. “We want this to be the new paradigm.”

Elijah Talley, 9, has participated in several neuroblastoma clinical trials since doctors in his hometown of Little Rock, Ark., first referred him to CHOP in 2008. The Talleys are frequent guests at the Philadelphia Ronald McDonald House, where this photo was taken.

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A Very Good Year The clinicians in our first-of-itskind Cancer Survivorship Program have the great joy of seeing their patients reach some of life’s most significant milestones. In 2008, the program celebrated one of its own: its 25th anniversary. !U.S.News & World Report ranked The Children’s Hospital of Philadelphia No. 1 in Cancer Care in its 2009 America’s Best Children’s Hospitals issue.

H o p e l i ve s h ere.

With a donation of $1 million, GlaxoSmithKline created the Hope for Families Fund, which helps patients with relapsed cancer (like Elijah, opposite page) cover the costs of traveling to CHOP for treatment.

This visionary gift will make it possible for many more children to benefit from our researchers’ remarkable work.

Thank you.

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The view from the 450,000-square-foot Ruth M. and Tristram C. Colket, Jr. Translational Research Building, where researchers will continue to do the kind of work that will change and save lives: (from left) Hakon Hakonarson, M.D., Ph.D., director, Center for Applied Genomics; Philip R. Johnson, M.D., executive vice president and chief scientific officer; and John M. Maris, M.D., director, Center for Childhood Cancer Research, and chief, Division of Oncology. “Translational research” refers to the process that turns laboratory science into effective, evidence-based treatments for patients.

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The Cancer Center is just one of the areas that benefited from the funds raised for translational research during the Hope Lives Here campaign. Here are highlights of the other research discoveries that our generous donors helped make possible. X

Uncovering the Causes of Autism Using highly automated genotyping technology to look at the DNA of more than 10,000 children, researchers, led by Hakon Hakonarson, M.D., Ph.D., director of the Center for Applied Genomics, found that children with autism spectrum disorders were much more likely to have gene variations affecting the way brain cells communicate with each other.

Hakonarson believes these variations may contribute to as many as 15 percent of autism spectrum disorder cases.

The discovery is especially promising because it dovetails with independent findings about the brain from functional magnetic resonance imaging (fMRI) and anatomical research. According to Philip R. Johnson, M.D., executive vice president and chief scientific officer, it “moves the field of autism research significantly ahead and provides a starting point for translating biological knowledge into future treatments.”

“We can never stop working.

Research, like patient care, doesn’t know a calendar, or a schedule.”

Philip R. Johnson, M.D. Executive Vice President and Chief Scientific Officer

New Directions in the Fight Against AIDS Since the 1980s, researchers have had little success developing an HIV vaccine. A decade ago, Johnson decided it was time for a different strategy: Rather than trying to stimulate the body’s immune response, gene transfer technology could be used to introduce an effective antibody against the virus. In 2009, Johnson’s team was able to successfully protect monkeys from being infected by the simian immunodeficiency virus, which is closely related to HIV. The study was so successful that trials of the vaccine in humans may begin within two years.

Johnson is heartened by the success, but recognizes that the pace of discovery can always be accelerated: “We can never stop working. Research, like patient care, doesn’t know a calendar, or a schedule.”

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Broviac catheter

Every Child, Every Day:

Safety Comes First Jaylisse Rivera is a walking — well, toddling — miracle. Now 18 months old, she is alive today because The Children’s Hospital of Philadelphia was there to provide the most advanced treatment for her pulmonary hypertension, a severe condition affecting the heart and lungs.

Born weighing 1 pound, 2 ounces — tiny enough to be held in the palm of a hand — Jaylisse was helicoptered to CHOP at 5 months from another hospital. Over the next 231 days, she was supported by a ventilator, a central line, a feeding tube, antibiotics and blood-thinning medications.

The same aggressive treatments that kept her alive, combined with her already frail condition, made Jaylisse vulnerable to infections and other hospital-acquired complications. But she ended her seven-month stay at Children’s Hospital without a single safety incident.

Just as her care team had planned.

As a world leader in pediatric medicine, CHOP has long embraced its responsibility to advance patient safety as the cornerstone to improving children’s health. “When a child is entrusted to our care, we can never be too vigilant,” says Kathy Shaw, M.D., associate chair for Safety and Quality Improvement.

“By empowering our staff, we are creating a safer environment for our patients.”

More than a philosophy, safety is a core value at CHOP. Throughout 2008 and ’09, incorporating input from across the institution, the Hospital put in place a series of rigorous safety checks and balances.

Drawing upon clinical expertise, advanced technology, a heightened sense of teamwork and simple common sense, staff at all levels have developed innovative systems to prevent mistakes and catch errors before they ever harm patients.

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Before interventional radiologists (who use live imaging tools to insert catheters and perform other procedures) placed Jaylisse’s Broviac® catheter as a permanent way to give medication, they read safety checklists out loud three times. Checklists improve communication to limit misunderstandings and improve safety.

Ventilator Jaylisse needed a ventilator to breathe. To prevent ventilator-associated pneumonia, an infection too common in hospitals, nurses cleaned her mouth and gums every four hours and elevated the head of her bed. Research has shown patients receiving this care are less likely to get this form of pneumonia.

Keeping Jaylisse Safe Central line Jaylisse had a central line, a thin tube that is threaded through the body to deliver medicine to a vein near the heart, and is a potential source of dangerous infections. A Hospital-wide initiative to reduce central line-associated bloodstream infections includes strict protocols for touching central lines, more training and heightened awareness in every unit.

Allergy alert Jaylisse had medication allergies. A red band signaled her care providers to carefully check her chart before giving medicine or food. At CHOP, a patient’s allergies become part of her electronic medical record. Any time the record is retrieved, whether for inpatient or outpatient care, an alert flashes on the screen. X 19

Safe Keeping: Improvements Are Hospital-wide and Personalized for Each Child.

Simulation training

Infection prevention

Nurses and respiratory therapists use simulation mannequins to practice safe care for patients, like Jaylisse, who have tracheostomies (an opening in the windpipe to aid breathing). The mannequin will react as a child would. Providers practice responding to potential emergencies, such as the trach tube being dislodged. (A)

As part of the Hospital-wide effort to eliminate central line-associated bloodstream infections, physicians and nurses must wear sterile gowns, masks and gloves before accessing a central line (to inject medicine or change dressings, for example). To make sure each step in the protocol is observed, another nurse reviews a checklist: Was the warning sign posted on the door? Did everyone don sterile garb? Did the nurse scrub the area for 15 seconds with alcohol, then allow it to dry? (D)

Anticoagulants Receiving anticoagulant medicines (“blood thinners”) was vital to Jaylisse’s treatment. But they are among the drugs most often associated with harmful errors. CHOP requires that a dedicated pharmacist review blood tests and exact dosages daily for each patient on anticoagulants to ensure the child realizes the benefits without any complications. (B)

Transparency To involve families in safety efforts, staff carefully explain safety precautions and encourage parents to speak up if they see anything they feel could be unsafe for their child. Intensive care units have white boards showing how long each unit has gone without a central line-associated bloodstream infection so everyone — patients, families and employees — knows how that unit is doing. (C)

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Executive safety rounds To personally see and hear about challenges clinicians face in keeping CHOP patients safe, an administrator and medical leader are paired to conduct monthly safety rounds in a unit. Here, they learn firsthand about issues so they can direct resources where needed. Staff on the unit know their patient-safety efforts have support from the top. (E)

Antibiotics During her stay, Jaylisse received an antibiotic.

Her medical team made sure it was the right drug for her specific infection, given for the proper amount of time and by the most appropriate method to treat her in the safest possible way.

CHOP’s Antimicrobial Stewardship Program strives to improve patient outcomes, lower the risk of adverse events and reduce resistance to antibiotics by helping care providers make data-driven decisions.

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Tender Loving Care Innovative projects in the N/IICU engage families and staff — and contribute to a remarkable drop in nursing turnover.

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N/IICU nurses work with other Hospital staff to make sure the items donated to Grandma’s Attic are available to every baby on the 70-bed unit, including 2-week-old Satya, shown here with her mother, Harsha. “We’re creating a ‘comfort zone’ for families,” says Donna Zerweck, R.N. (below right).“Blankets and clothes help soften a very stressful environment.”

Hope is a thumbprint-size foot in a too-big sock. Hope is a pair of khakis with a 4-inch inseam.

Hope is a tiny sweater, a colorful blanket, a frilly tutu.

Hope is every dream you ever had for your baby — and it’s everywhere you look in the Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU).

For parents of critically ill infants, hope is seeing their babies dressed in colorful, cheerful clothes. That’s the premise behind Grandma’s Attic, a closet in the N/IICU where nurses pick out special outfits for patients.

The nurses benefit from Grandma’s Attic just as much as the parents, says Donna Zerweck, R.N., the 24-year N/IICU veteran who started the project. “The N/IICU is a very sad place sometimes, very intense. Just being able to do something like put an outfit on a baby is so meaningful for a nurse.”

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Gary Dipple shares a special moment with his 1-day-old son, Connor, in Children’s Hospital’s N/IICU.

Encouraging more nurse-initiated projects like Grandma’s Attic was a particular focus in the N/IICU in 2009, when the unit was one of eight CHOP departments that participated in a remarkably successful effort to improve staff retention.

In the year since Grandma’s Attic opened, it has become one of the best-loved places in the Hospital. “I melt every time I walk by,” says Ursula Guillen, M.D. And for parents, she observes, the Attic’s pull must be even more powerful: “I’m sure they have all the same clothes at home, waiting.”

Better and Better: In 2009, the American Nurses Credentialing Center awarded CHOP Magnet status — the profession’s highest honor — for the second time, a testament to the Hospital’s ability to keep improving patient outcomes. “The bar gets higher every time,” says Anne Mohan, M.S.N., R.N., N.E.A.-B.C., director of Nursing Practice and Patient Safety.

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Here to Stay With approximately 300 nurses, the N/IICU has the largest nursing staff in the Hospital — and one of the happiest.

In fiscal year 2009, the unit had no nursing turnover.

Such a statistic would be impressive for any department, says director of Nursing Practice and Patient Safety Anne

“You build a more collaborative team when you have people who are long-term. It’s a big deal when you have the same players.”

Tyonne Hinson, M.S.N., R.N., nurse manager of the N/IICU and leader of the unit’s retention project

Mohan, M.S.N., R.N., N.E.A.-B.C., “but when you’re talking about such a large unit, it’s truly, truly amazing.”

Just as amazing are some of the things N/IICU nurses did as part of the unit’s yearlong effort to improve staff retention and engagement. With the support of leaders like Tyonne Hinson, M.S.N., R.N., the unit’s nurse manager, they developed projects like Grandma’s Attic, took on leadership roles in improving patient safety, and collaborated with CHOP’s Center for Quality and Patient Safety to find ways to improve patient outcomes — all work that continues today.

They also got to know each other better at special staff appreciation events hosted by the department — and

Nursing Turnover Rates: N/IICU 13.36%

that’s a good thing for patients. When nurses feel comfortable together, they are more likely to bring up patient care and safety issues, says Hinson. “We’re building a culture where people can be listened to, can be heard and can feel safe sharing their concerns.”

H o p e l i ve s h ere.

7.69%

0 2007 2008 2009

Gifts like those that established the Ruth M. Colket Endowed Chair in Pediatric Nursing and the Colket Endowed Lectureship in Nursing give CHOP nurses many opportunities: to enhance their practice, pursue their research interests and explore new ways to make a difference in children’s lives.

Thank you.

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First Healthy Kids Day Draws Thousands

Eat well.

Stay safe.

Be happy.

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As an institution, The Children’s Hospital of Philadelphia is dedicated to one of the most effective tools in promoting good health: outreach to children and families in our own community.

CHOP is the home visitor helping parents of kids with asthma reduce allergens and triggers in their homes, through the Community Asthma Prevention Program. CHOP is the Mobile Safety Center visiting Philadelphia and its suburbs with car seats, smoke detectors and bike helmets.

CHOP is the nurse on the other end of the line when a parent calls the region’s Poison Control Center. CHOP is the team of nurses and doctors providing checkups for kids at Philadelphia shelters, through the Homeless Health Initiative.

And CHOP is Healthy Kids Day. More than 4,000 kids and family members attended and more than 225 CHOP employees volunteered at this free, first-time event, on a sunny Saturday in May 2009. Organized by the Office of Government Affairs, Community Relations and Advocacy and held at the Mann Center for the Performing Arts, the event demonstrated how much fun a healthy lifestyle can be.

Safety: Staff distributed items such as bike helmets and shared information about vaccines, car seats and other topics.

Active body: Professional sports teams, a climbing wall and obstacle courses kept kids moving. Sensible diet: Everyone was treated to a delicious, healthy lunch.

H o p e l i ve s h ere.

Thousands of families spent a day together learning about good health thanks to a gift from Wal-Mart Stores Inc. The corporation’s generosity made Healthy Kids Day possible.

Thank you.

Healthy Kids Day will be an annual event. This noisy, joyful day represents a message: CHOP cares about its community, and is always here to help.

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A Voice for

All Children Amidst fluctuations of economy and policy, CHOP maintains a constant focus on how healthcare serves the needs of children.

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He presides over the hospital that has brought hope to thousands upon thousands of sick children.

Yet Steven M. Altschuler, M.D., is not content to help only those who receive direct care from The Children’s Hospital of Philadelphia. He views it as his mission to improve the level of healthcare available to children everywhere.

Which is why a crisp fall morning finds Altschuler boarding a train to Washington, D.C. There he will spend the day meeting with legislators, helping to ensure that as the debate over healthcare reform plays out, pediatrics has a prominent place at the table. “As the nation’s leading hospital for children, we have an obligation to serve as their voice,” says Altschuler, CHOP’s president and CEO. It comes down to dollars and cents. Pediatric health services are generally reimbursed at much lower rates than adult services — as a result, care for children may suffer.

Low reimbursements also discourage talented young doctors from specializing in pediatrics.

Funding for pediatric training is undersupported and fluctuates annually depending on Congressional appropriations. Altschuler argues tirelessly for a fair share of the pie and for changes to Medicaid, the single largest payor of pediatric services.

Also key to the discussion is more effective delivery of healthcare services. “Dr. Altschuler and CHOP are uniquely positioned to lead improvements in delivery,” says Roosevelt Hairston, Esq., senior vice president, Government Affairs, Community Relations and Advocacy.

With its innovative regional network structure, supported by use of the electronic medical record, the Hospital has created a replicable model in which centers of excellence such as CHOP partner with community providers to extend quality care to more children. CHOP’s care models for chronic illness, such as asthma, also provide a platform for efficient care that other systems can replicate.

As legislative debate began in earnest in 2009, CHOP released “Healthcare Reform for Children Pillars,” a document clearly outlining the principles above and others that need to be considered in any new legislation.

The efforts are making a difference. Healthcare reform legislation pending in Congress is expected to include record funding for Children’s Hospitals Graduate Medical Education, as well as provisions that adjust Medicaid reimbursements for pediatric primary care to 100 percent of Medicare rates.

Altschuler’s is not the only CHOP voice heard in Washington. The Government Affairs team organizes visits by staff and patient families to interact with lawmakers, providing their own compelling perspectives in the debate.

Together, with firsthand knowledge and unswerving conviction, they articulate a critical need for those who cannot speak for themselves.

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About Children’s Hospital The Children’s Hospital of Philadelphia Foundation and Subsidiaries – Obligated Group

Financial Summary FY 2009

FY 2008

FY 2007

$1,127,118,000

$1,051,795,000

$926,656,000

Other Operating Revenue

12,373,000

168,252,000

11,888,000

Contributions (1)

53,407,000

65,624,000

56,378,000

168,694,000

178,428,000

157,720,000

$1,361,592,000

$1,464,099,000

$1,152,642,000

$579,808,000

$538,809,000

$485,693,000

Supplies and Expenses

311,363,000

307,771,000

270,157,000

Depreciation

107,877,000

98,299,000

80,734,000

7,706,000

12,016,000

8,479,000

238,561,000

223,112,000

195,325,000

Uncompensated Care

54,166,000

50,443,000

40,207,000

Provision for Programmatic Investments

62,111,000

233,649,000

72,047,000

$1,361,592,000

$1,464,099,000

$1,152,642,000

FOR THE FISCAL YEARS ENDED JUNE 30

Sources of Revenue Net Patient Service Revenue

Research Total Sources of Revenue Uses of Revenue Salaries, Wages and Employee Benefits

Interest Research Expenses

Total Uses of Revenue

(1) Includes unrestricted, temporarily restricted and restricted contributions.

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Combined Balance Sheet FOR THE FISCAL YEARS ENDED JUNE 30

FY 2009

FY 2008

FY 2007

Cash and Short-term Investments

$96,682,000

$73,003,000

$97,545,000

Receivables

225,734,000

207,440,000

142,184,000

Other Current

159,214,000

195,917,000

92,314,000

Total Current Assets

481,630,000

476,360,000

332,043,000

Investments

1,091,365,000

1,540,019,000

1,603,926,000

Property Plant and Equipment, Net

1,480,422,000

1,310,062,000

1,130,962,000

Other Assets

22,026,000

11,442,000

19,495,000

Total Assets

$3,075,443,000

$3,337,883,000

$3,086,426,000

Current Portion of Long-term Debt

$11,252,000

$10,751,000

$8,316,000

Accounts Payable and Accrued Expenses

297,449,000

348,380,000

212,800,000

Total Current Liabilities

308,701,000

359,131,000

221,116,000

Long-term Debt

606,710,000

617,963,000

631,548,000

Other Liabilities

221,967,000

162,731,000

161,448,000

1,707,323,000

1,911,391,000

1,746,474,000

Temporarily Restricted Net Assets

94,459,000

125,638,000

170,269,000

Permanently Restricted Net Assets

136,283,000

161,029,000

155,571,000

1,938,065,000

2,198,058,000

2,072,314,000

$3,075,443,000

$3,337,883,000

$3,086,426,000

Assets

Liabilities and Net Assets

Unrestricted Net Assets

Total Net Assets Total Liabilities and Net Assets

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Hospital and CHOP Care Network Statistics Outpatient Visits For the fiscal years

2009

2008

2007

Specialty Care

289,265

281,785

260,159

Kids First

605,241

599,712

581,946

Primary Care

107,689

99,845

94,530

Emergency

85,450

82,058

75,664

Day Medicine

21,910

22,001

18,763

Day Surgery

17,162

15,912

14,287

1,126,717

1,101,313

1,045,349

Total

121,991

130,088

134,363

Hospital Admissions and Patient Days

26,714

25,699

24,239

Hospital Admissions

FY 2009

FY 2008

FY 2007

Patient Days

Number of Beds 514 (Estimated)

2012

443

2009

421

2008

396

2007

12

1855

Employees 9,116

FY09 FY08

9,762

FY07

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P h i l a d e l p h i a

Admissions from Pennsylvania Total: 18,887 By selected counties Berks Bucks Chester Delaware Lackawanna Lancaster Lehigh Montgomery Northampton Philadelphia

343 1,827 910 2,679 106 185 223 2,441 214 9,340

Admissions from New Jersey Total: 6,736 By county Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren

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560 38 1,177 1,342 161 414 121 814 53 62 411 236 341 76 593 29 68 90 29 74 47

h e r e .

Charitable Giving by Source FY09 Outright gifts and pledges

Corporations

23%

Individuals

Foundations

18%

41%

State/Federal

18%

The Children’s Hospital of Philadelphia Research Institute At end of fiscal year 2009 Number of investigators: more than 450 External Grants and Contracts: $141,332,306 All Sources of Funding: $210,504,000 Includes funds from Endowed Chairs, royalty income, Hospital support and other miscellaneous funding.

Federal Stimulus Funds CHOP has received 45 American Recovery and Reinvestment Act (ARRA) awards totaling $31,611,445 over two years. Many requests for ARRA grants are pending.

33

CHOP Care Network

Saint Peter’s University Hospital (Cardiac Center) Grand View Hospital

MONTGOMERY

High Point

Chestnut Hill

CHESTER Exton Coatesville West Chester North Hills Kennett Square

Roxborough

Paoli Chester Co. Hospital

Haverford Broomall

Springfield Springfield Chadds Ford Media

DELAWARE

West Grove

MERCER

University Medical Center at Princeton

BUCKS

Flourtown

King of Prussia Phoenixville Hospital

MIDDLESEX

Princeton

Doylestown Hospital Indian Valley Central Bucks Bucks County

MONMOUTH

Newtown

Abington Hospital Holy Redeemer Hospital Salem Road Pennsylvania Hospital University City Market Street Mt. Laurel

PHILA.

Cobbs Creek Drexel South Hill Philadelphia

OCEAN

BURLINGTON Voorhees

GLOUCESTER

CAMDEN

SALEM

NEW CASTLE

ATLANTIC Harborview/Smithville

Atlantic County Harborview/Somers Point

CUMBERLAND

Shore Memorial Hospital

CAPE MAY CHOP Newborn Care CHOP Pediatric Care CHOP Newborn & Pediatric Care

Harborview/Cape May Co.

Pediatric & Adolescent CHOP Newborn CareCare Pediatric & Adolescent Specialty Care

CHOP Pediatric Care

Pediatric & Adolescent Specialty Care and Surgery Center

CHOP Newborn & Pediatric Care Pediatric & Adolescent Specialty Care; Home Care Pediatric & Adolescent Care Pediatric & Adolescent Specialty Care Pediatric & Adolescent Specialty Care and Surgery Center Pediatric & Adolescent Specialty Care; Home Care

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+

+

+

+ Lighting up the cover: Avery,

soccer player, kindergartener, son

This exuberant 5-year-old has sickle cell

disease and has been cared for by

a team at The Children’s Hospital

of Philadelphia since infancy.

+

You Gave Us Hope.

These are just a few of the countless children who have been helped by the Hope Lives Here campaign.

Thank you!

H o p e l i ve s h ere.

H o p e l i ve s h ere.

Founded in 1855, The Children’s Hospital of Philadelphia is the birthplace of pediatric medicine in America. Throughout its history, a passionate spirit of innovation has driven this renowned institution to pursue scientific discovery, establish the highest standards of patient care and train future leaders in pediatrics.

For a century and a half, Children’s Hospital has served as a haven of hope for children and families worldwide. www.chop.edu

3190/4100/02-10

The Children’s Hospital of Philadelphia and the logo are registered marks of The Children’s Hospital of Philadelphia. ©2010 The Children’s Hospital of Philadelphia, All Rights Reserved.

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