Spira 2016 1 by Children's Hospital & Medical Center

Childrenâ&#x20AC;&#x2122;s Hospital & Medical Center

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Contents 4

Project Austin: Bridging the Gap Between Hospital and Home for Medically Complex Children

Biovigil: Infection Prevention and Peace of Mind — at Hand

Saving Alexis: Expert Teamwork Key to Treating Pulmonary Hypertension

Safe, Sound & Healthy: A Statewide Approach to Improving Children’s Health

Child Health Assessment Reveals Top Concerns and Opportunities

Teaming Up to Prevent Childhood Obesity

“All of the Above” Ellen Wright: Advocate. Philanthropist. A Real “Peeps” Person.

Envisioning Our Future

Children’s Recognized Among Nation’s Best Children’s Hospitals

Children’s Hospital & Medical Center is ranked in three pediatric specialties in U.S. News & World Report’s 2016-17 Best Children’s Hospitals rankings: Cardiology and Heart Surgery, Gastroenterology and GI Surgery and Orthopedics. “The pediatric centers that are ranked in Best Children’s Hospitals deserve our congratulations,” says U.S. News Health Rankings editor Avery Comarow. “Children with life-threatening or rare conditions need the kind of care that these hospitals deliver day after day.” “This recognition reflects our enduring commitment to providing the highest quality of specialty care for the children and families we serve,” says Carl Gumbiner, M.D., senior vice president of medical affairs and Children’s chief medical officer. “We’re honored and humbled to be a part of this elite group, and we’ll continue to challenge ourselves to further improve care to benefit children.”

Spira Spira is the biannual magazine of Children’s Hospital & Medical Center, 8200 Dodge St., Omaha, NE 68114. Spira@ChildrensOmaha.org SpiraMagazine.org

U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of children with rare or life-threatening illnesses find the best medical care available. The rankings open the door to an array of detailed information about each hospital’s performance. This year, U.S. News surveyed 183 pediatric centers. Seventy-eight hospitals from across the country ranked in one or more specialties.

PROJECT AUSTIN:

Bridging the Gap Between Hospital and Home for Medically Complex Children

AUSTIN AND OLIVER. Though the two boys will never meet, there is a bond between them. They share a history of medical challenge: congenital heart defects and tracheostomy procedures. They are also united by a potentially life-saving advocacy and outreach effort. “The stress of bringing home a medically fragile child can weigh on a family, especially in rural areas,” says Hanna Gilland, Oliver’s mother. “Project Austin was a vital piece of our son’s homecoming.”

“Project Austin is an invaluable asset to families of medically complex children.” Hanna Gilland, Mother

roject Austin is named in honor of a 15-month-old boy with a congenital heart defect and a critical airway with a tracheostomy whose legacy lies in offering peace of mind to families of other medically complex children. Children’s team members Natalie McCawley, BSN, RN, CCRN, and Tiffany Simon, BSN, RN, CCRN, CPST, were pivotal in launching the program, a concerted effort to educate local emergency medical systems (EMS), emergency departments and primary care providers in rural areas on the care of special needs children. “Ultimately, the goal is to provide seamless care for a child with special health care needs,” shares Simon. For her, it is more than a professional responsibility; it is a labor of intense love. “My personal mission and goal is that all children receive optimal care wherever they are. Being able to develop this program and do this education has given me the opportunity to fulfill that goal in my life.” In addition to serving as Children’s trauma outreach coordinator, Simon is also Austin’s mother. One night, Austin’s trach had become plugged, which prompted an immediate call to 911. “When EMS came in, the best way I can describe it was pure and utter chaos. They had no idea how to care for him,” she recalls. “Only about 10 percent of EMS calls are pediatric, and then when you have a pediatric critical patient with special needs, they can really be out of their realm. They did absolutely everything they could, but ultimately, a couple of days later, my husband and I had to remove him from life support.” Heartbreak planted the seeds for Project Austin. Fate helped seal the deal. Unbeknownst to each other, Simon and McCawley had begun developing the program independently — at the same time. McCawley, Children’s transport outreach coordinator, had created a community education event for a medically complex child returning home to rural Nebraska. She expected 10 people at an hour-long event. Close to 45 showed up for three hours. “The mom of the patient said to me, ‘This is so amazing. I can’t believe there isn’t a program like this.’ That got my mind spinning a little bit,” she says. At the same time, at the urging of Children’s palliative care team, Simon

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had started researching and reviewing literature on similar programs elsewhere. “The American Academy of Pediatrics actually had a template for what the program could look like,” says Simon. “When Natalie took on the transport outreach coordinator position, our cubicles were literally right next to each other. We got to talking and said, ‘Together, we can make this a program at Children’s.’” That was in the winter of 2014. The program became a pilot in 2015. “December 28, 2015, the anniversary of the day that Austin passed away, was the day we made it a full program,” says Simon. The Project Austin process begins when a member of the child’s health care team identifies the child’s family as a candidate for the service. “What we need to have is a parent that is very engaged and willing to participate with their EMS service,” says Simon. Parents fill out an emergency information form (EIF), listing their child’s health care diagnosis and preferred emergency treatment plan. The form, signed by the child’s physician or advanced practice provider, is then sent to the Project Austin team, which processes the information, paying particular attention to where the child lives, the responding EMS and nearest hospital facility. The team, in turn, sends a letter — and the child’s EIF — to the local health care providers, and makes a determination whether an actual visit and thoroughly customized hands-on education/training is necessary. “We base the extent of the program on the child’s needs and the EMS system that’s responding,” Simon says.

The Gillands live in West Point, Neb., a rural community. They learned about Project Austin after the NICU staff put them in contact with McCawley. “She helped us with everything,” Gilland says. “We were able to set up a meeting where the Project Austin crew gave a presentation about Oliver’s condition and the EMS team could meet Oliver personally and ask us questions.” She continued, “I really enjoyed how Project Austin prepared a presentation specifically over Oliver’s needs — so not a cookie-cutter approach that gives blanket statements about children with medical needs. This way we were able to bypass insignificant information and really train our EMS on Oliver’s conditions.” McCawley says that customization is key: “We very much tailor it to each situation — ‘This is exactly how you’re going to be able to help this child within your scope of practice, within the resources you have available.’” Simon adds, “Most EMS personnel in rural communities are volunteers; this is something they do above and beyond their job. One of our other goals is to continue to provide enough education that they feel more comfortable caring for kids so they can walk away knowing they did the absolute best they could.” Every six months, Project Austin families receive a reminder to both update their EIF and continue to communicate with their EMS. “It’s really us initiating that first contact with EMS and the family, and then it’s up to them to continue that relationship going forward,” Simon says.

Project Austin, also overseen by Shahab Abdessalam, M.D., medical director of Children’s trauma program, does not involve a cost to families or local EMS agencies. Feedback from parents and responders has been extremely positive. “We went to one community and the city’s mayor came out. They were invested in this family,” says McCawley. “We always talk about that old adage, ‘It takes a village to raise a child.’ That’s what we find when we are out there. You’re bringing the entire community in. The key word is collaboration between family, community and EMS.” Gilland says Project Austin helped bridge the gap between hospital and home — in what was a new home for them. “My husband and I are actually new to West Point. So Project Austin was a priceless asset to us during the time we brought home Oliver,” she says. “I know that the West Point EMS, Children’s and our family are all on the same team and the same page with his care. They know our faces around town, and they were able to see how much Oliver meant to us. We even worked out a code word for the dispatch people to correspond and know that this is Oliver who is in need of help.”

Mom says Oliver is very active and “loves to cruise around the house and get into things. He loves being outside and watching his dogs play.” He celebrated his first birthday just last January. A little boy he’ll never meet helped inspire a very special and lasting gift — peace of mind. “We know that this family is in very good hands now, not only for the care of their child, but also they have a safety net and that will help release some of the stress and anxiety,” says Simon. A mother who turned her own loss into outreach, she hopes to extend Project Austin beyond the state of Nebraska. “I think that this needs to be something that is taken to every hospital that cares for children with special needs,” says Simon. McCawley, her cubicle neighbor and Project Austin partner, couldn’t agree more: “We would love to see this nationwide.”

“My personal mission and goal is that all children receive optimal care wherever they are.” Tiffany Simon, BSN, RN, CCRN, CPST Children’s Trauma Outreach Coordinator

Project Austin receives a powerful endorsement from mother Hanna Gilland: “It is an invaluable asset to families of medically complex children and should, without a doubt, be integrated into your homecoming plan and your emergency plans.” Oliver Gilland, born at 28 weeks due to mom’s preeclampsia, initially weighed just 2 pounds, 3.6 ounces. At nine days old, he was diagnosed with three holes in his heart (two being congenital heart defects). He also was suffering from chronic lung disease linked to his prematurity. He had his first heart surgery at 11 days old. A second followed, along with a tracheostomy. All told, he spent almost six months in Children’s Neonatal Intensive Care Unit (NICU). 7

BIOVIGIL Infection Prevention and Peace of Mind — at Hand

Dante Oswald is more than a sweet, laid-back little boy—he is also a bit of a showman. “They sure had fun at the hospital asking, ‘How old will you be on your birthday?’— and out comes that finger,” says Jennifer Oswald, Dante’s mother. One tiny raised finger. One year old as of March 31, 2016.

ver the last 12 months, Dante and his parents have spent a lot of time at Children’s Hospital & Medical Center — and mom and dad have had to learn a lot of complicated terminology: duodenal atresia, antiphospholipid syndrome, gastronomy buttons and more. Against the backdrop of such medical complexity, they count on their son’s caregivers to follow one simple practice: “We watch to make sure the staff is washing their hands,” Oswald says. Now, so does Biovigil, a high-tech hand hygiene alert system that is “on the job” in numerous areas throughout Children’s. The entire hospital and its specialty clinics will be wired for use by the end of the year. “Biovigil helps our health care workers recall when they should perform hand hygiene — and to perform it. It also helps to let our patients and families know that, with every interaction, our hands are clean,” says Kari Simonsen, M.D., clinical service chief of Pediatric Infectious Diseases and medical advisor to the Douglas County Health Department.

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Non-Compliant

Hand Hygiene Required

“It does give you peace of mind knowing there are checks and balances.” JENNIFER OSWALD MOTHER

AMBER R. PHIPPS CHILDREN’S VICE PRESIDENT OF QUALITY & PATIENT SAFETY

HERE’S HOW IT WORKS:

care marketplace, and we’re leading the way in the community,” Dr. Simonsen says.

Children’s staff members and physicians are each assigned a dedicated user key that plugs into a lightweight Biovigil badge. The badge utilizes metal-oxide technology to detect the presence of a hand sanitizer; a lighted image of a hand indicates compliance. Similar to a traffic light, the hand will be either green, yellow or red. Dr. Simonsen explains, “If I were to enter into a room that was wired for patient use, the hand would turn yellow, meaning it’s time for me to perform hand hygiene. I could wash my hands either with soap and water or with alcohol-based hand rub. Then, I wave across the badge; it ‘sniffs’ the alcohol and will go from yellow back to green. If I waited more than the allotted time to accomplish that task, it would go from yellow to red and give me a beep.” JUST HOW IMPORTANT IS PROPER HAND HYGIENE IN A HOSPITAL SETTING? According to the Centers for Disease Control (CDC), hospital patients in the United States contract an estimated 722,000 infections each year during their hospital stays. That’s about 1 infection for every 25 patients.

Clean

Hand hygiene is one of the most basic — and most important — means of infection prevention in hospital settings. “The CDC and the World Health Organization say that proper hand hygiene is the number one component for assurance of reducing hospital infections,” says Amber R. Phipps, MBA, Children’s vice president of Quality & Patient Safety. After evaluating eight different systems, Children’s began using Biovigil in the fall of 2015. The medical-surgical units (floors 4, 5 and 6) were wired for use initially. On April 1, 2016, the system went “live” in the pediatric and neonatal intensive care units and the short stay unit. The next phase includes the operating rooms, the CARES unit, the emergency department and radiology followed by the outpatient specialty clinics. The use of Biovigil represents another area of distinction for Children’s. “It is not common yet for hospitals to use automated systems for hand hygiene. Products like Biovigil are really emerging in the health

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“We’re coming into the 21st century, partnering with technology to help us reduce infections.”

Phipps adds, “When we signed the contract, there were only seven hospitals across the nation that were with Biovigil. We were the only children’s hospital.” As with any new technology, implementation involved a bit of a learning curve and some adjustment. “But I think it’s really been easy to learn and amenable to most types of job descriptions,” Dr. Simonsen says. “We’ve trained a wide variety of health care workers and they’re all using it successfully.” Phipps shares, “It’s not just on the clinical side; it’s on the non-clinical side. So when the environmental care services employee comes in to clean the room or an interpreter or care partner walks in, they’re all performing hand hygiene.” For Jennifer Oswald and parents like her, the Biovigil system means one less thing to worry about. “We were there before they had it. We were there when they first got it, and we watched them transition through. Now, we’re there when they’re used to it. It does give you peace of mind knowing there are checks and balances.” Oswald continues, “I will say, having seen hand hygiene previously, I think they were very good before. We would have people walk through the door and hand sanitize, maybe ask us one question, hand sanitize again and walk out, having only stood in the doorway. I do think they were good.”

The benefit of Biovigil? It proves it. Not only does the system remind staff to practice proper hand hygiene, it records individual activity and produces a report. That was another key driver in implementing the system — it was an easier, more efficient way to prove compliance. Back in 2004, the CDC and the Joint Commission made hand hygiene a national patient safety goal and began requiring a measurement of hand hygiene compliance. Children’s own power analysis suggested at least 350 observations each month. The problem? Direct observation can be inconsistent, potentially biased and difficult to sustain. Plus, manual data collection is not 24/7 — but the opportunity to get a hospital-based infection is. “As an organization, we came together and said we need to find a creative solution,” Phipps says. “The team members that identified Biovigil are truly change agents.” To give an idea just how robust the data output is, consider this: for the month of December 2015, the system “observed” 142,000 hand hygiene opportunities — and that was only in the hospital’s medicalsurgical units. “Before, we were trying to get to 350 observations,” Phipps says. “And, just to let you know how well we did, our compliance was 99 percent.” Ninety-nine percent. Jennifer Oswald says that is a critical number. Her son Dante was born with Down syndrome and was later diagnosed with duodenal atresia

(bowel obstruction) and antiphospholipid syndrome, an autoimmune disorder. But most often, he is going to the hospital when he is not sick — rather when he is having “mechanical issues,” whether it is a problem with his central line or his gastronomy button, which helps deliver nutrition directly to his stomach. “One of the last surgeries he had, the hospital was full of kids with RSV,” Oswald recalls. “We were surrounded by a lot of sick kiddos and we came out not sick. So you know they were doing something right, and I’m sure that Biovigil helped.” Phipps says bringing Biovigil on board was a significant investment for the hospital, but one that underscores Children’s commitment to patient safety. “We’re coming into the 21st century, partnering with technology to help us reduce infections,” she says. “We’re very thankful for the Board’s support and the executive level support with this. They recognize that safety is our core value and the number one thing that the organization is focused on.” For Jennifer Oswald, that peace of mind is priceless. The next time her brand new one-year-old comes to the hospital, she can count on seeing lots of illuminated green hands. Dante’s care team can count on seeing some new tricks. “He can sign ‘mama’ and ‘papa.’ He can put his hands together for ‘Amen.’ We think he’s a little genius.”

SAVING ALEXIS

EXPERT TEAMWORK KEY TO TREATING PULMONARY HYPERTENSION Respiratory syncytial virus, that’s all it was. Amanda and Jarrod McAlevy breathed a sigh of relief. Their 8-month-old daughter Alexis, who had struggled with a cold, fatigue and a “junky throat” over the previous few days, just had RSV, a common respiratory virus. Lots of kids get it. It doesn’t usually get too severe. We’ll put in an IV to get her some fluids, the doctors at Children’s Hospital & Medical Center told them. We have to let her body recover. You’ll be out of here in a few days.

A few days after the baby girl was admitted on Feb. 18, 2014, she wasn’t getting better. Her wheeze was getting worse. Her face was getting puffy from retaining too much fluid. And nobody knew why. An echocardiogram — a test that uses ultrasound to view the structure and function of the heart — revealed that her problem was much more serious. Alexis had severe right-side heart failure, most likely as a result of severe pulmonary hypertension.

If only Alexis’s illness had just been RSV.

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Alexis was transferred to Children’s Pediatric Intensive Care Unit (PICU). While she was stable, there was a chance her heart could fail, and if that happened, doctors wanted her where they could respond quickly. Meanwhile, pediatric cardiologist Scott Fletcher, M.D., assistant medical director of the heart catheterization lab, and Paul Sammut, M.D., clinical service chief of Pediatric Pulmonology, were called in to look at her ultrasound test. It didn’t take long for them to determine that Alexis did, in fact, have severe pulmonary hypertension. The rare — and extremely dangerous — condition occurs when blood pressure in the lungs is abnormally high, making it difficult for the heart to pump blood through the lungs. As the pressure builds, the right ventricle is forced to intensify its effort, causing the heart muscle to weaken and potentially fail.

SCOTT FLETCHER, M.D. Director, Cardiovascular Magnetic Resonance Imaging Medical Director, Cardiovascular Exercise and Noninvasive Blood Pressure Laboratory Assistant Medical Director, Heart Catheterization Lab

PAUL SAMMUT, M.D. Clinical Service Chief of Pediatric Pulmonology

“Alexis’s case was very severe,” says Dr. Sammut. “I had not seen this pattern of the disease before.” The nature of her case — its rapid onset, severity and prolonged nature — came as a surprise to everyone. For years, Fletcher and Sammut have worked to help children like Alexis. However, the two specialists began collaborating regularly in early 2014 as the founding directors of Children’s Pulmonary Hypertension Clinic.

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“It’s a progressive disease and, without treatment, it doesn’t get any better,” says Dr. Fletcher. “It could cause someone to pass out, or in extreme cases, lead to sudden death.” Alexis was diagnosed with pulmonary hypertension on Feb. 23, 2014. Children’s team took immediate action: Dr. Fletcher carried out a catheterization procedure to infuse medicine directly into her pulmonary artery while Dr. Sammut ordered a CT scan to try to determine the root cause of her lung disease. Over the next few days, Alexis began to improve. In fact, just a couple of days after she was diagnosed and began her pulmonary hypertension medications, the doctors in the PICU said she was improving enough to start feeding from a bottle again. Amanda and Jarrod, who had been at Alexis’s side for days, were encouraged to go to their home in Plattsmouth, Neb., and get a good night’s sleep so they could help her with the bottle the next day. “I felt bad that we left,” Amanda says. “But thinking back, had we not gotten a few hours of sleep, everything that happened in the next 24 hours would have been so much more difficult.”

“We realized that children with pulmonary hypertension have a number of caregivers, so they often get fractured care,” explains Dr. Sammut. “We felt comprehensive, focused attention on the disease would help bring all of our efforts together.”

Alexis was fortunate her pulmonary hypertension was diagnosed so quickly. The average time between the onset of symptoms and a diagnosis is more than a year.

In addition to Drs. Fletcher and Sammut, the team includes a pulmonology nurse, a cardiology nurse, two ultrasound technicians, a nutritionist, a dietitian and a respiratory therapist. An average of 10 to 12 patients are seen each clinic day, totaling more than 300 appointments since the clinic opened. And demand for the highly specialized program continues to increase.

That’s because the disease is very rare, and also because its symptoms — including shortness of breath, fatigue, fainting or dizziness — are identical to symptoms of much more common diseases.

Dr. Sammut says this is due to several factors, including higher survival rates for premature births and congenital heart disease, and increased success rates for certain heart surgeries. What separates Children’s program from other pulmonary hypertension clinics in the region — and even across the country — is the consistent collaboration between a heart specialist and a lung specialist; intensive follow-up procedures; and the use of

advanced medications to enhance outcomes for these patients, whose outlook is grim without intervention.

“It usually is recognized when it’s already advanced,” says Dr. Sammut.

“It’s about the 100th thing people think of,” explains Dr. Fletcher. In recent years, more advanced medications have greatly improved life expectancy of patients with pulmonary hypertension. However, “it’s important to note that of the 14 FDA-approved drugs on the market right now (to treat pulmonary hypertension), zero are approved for children,” adds Dr. Sammut. That means every new case can be a new challenge for their team — especially cases like Alexis’s, in which a root cause is completely unknown.

“THEY’RE BOTH WORKING TOGETHER TO SOLVE PROBLEMS BECAUSE THEIR SPECIALTIES ARE SO INTERTWINED WITH THIS CONDITION. THEIR COLLABORATION HELPS ALEXIS EXPONENTIALLY.” JARROD MCALEVY, FATHER

At 4 a.m. the morning after the McAlevys left the hospital to get some rest, they received a call from the PICU they’ll never forget. Alexis went into cardiac arrest. We’re giving her CPR. Can we have permission to put in a central line? They arrived at the hospital to find her stable. Alexis had gone into cardiac arrest because her heart was unable to pump against the high pressure in her lungs, causing it to race, Jarrod explains. “Her heart wanted to stop because it was tired and overworked,” he remembers. Hours later, she crashed again. It became clear that doctors couldn’t give her any more medication without doing irreparable damage to her heart and lungs; the organs needed time to heal from the RSV without being strained. So the McAlevys allowed Alexis to be put on extracorporeal membrane oxygenation (ECMO) — or life support. “The machine did the work and allowed her heart and lungs to heal,” Jarrod explains. Meanwhile, Alexis’s parents talked to doctors about surgical options. They discussed a lung or heart transplant. They talked about doing

an experimental heart surgery. Then, Dr. Fletcher decided to start Alexis on a medicine that would help open up her airways. Slowly but surely, Alexis began improving. And 12 days after she was put on ECMO, they turned it off. Her heart beat again on its own. Looking back, several factors contributed to Alexis’s successful recovery. First, Children’s hospitalists recognized her problem as much bigger than just RSV early on, and were able to alert the right specialists. ECMO was available to keep her alive and gave her much-needed time to rest. The final medication infused directly into her artery, combined with steroids and respiratory therapy, were also key to her healing. Her road to recovery was not short or uneventful. She spent a total of 104 days at Children’s recovering from RSV and ECMO — days filled with heartening highs and frightening lows. “Every day when I came to the PICU, I looked to see if there was a crash cart outside the door to find out if she had a good night or not,” Jarrod says.

Alexis has been home ever since. She still has idiopathic pulmonary hypertension, and Dr. Sammut says he believes she also has lung disease. But she is doing well and growing. Every three months, the McAlevys visit Children’s Pulmonary Hypertension Clinic to see Dr. Fletcher and Dr. Sammut. They discuss concerns and celebrate her progress. “They’re both working together to solve (heart and lung) problems because their specialties are so intertwined with this condition,” Jarrod says. “Their collaboration helps Alexis exponentially.” Today, the team is focused on early detection of pulmonary hypertension, developing new clinical protocols and educating their health care peers on how to better recognize this rare disease. “These children need an advocate,” says Dr. Fletcher. Dr. Sammut adds, “We really feel that we have helped some children who would have died without the recognition of the problem and adequate treatment. Many, like Alexis, have had resolution of symptoms — and that is extremely gratifying.”

But on June 8, 2015, a little more than a week before her first birthday, Alexis finally went home. 15

“It is our vision for Nebraska to have the healthiest population of children in the Midwest and in the United States.” RICHARD AZIZKHAN, M.D. Children’s President & CEO

SAFE, SOUND & HEALTHY:

A Statewide Approach to Improving Children’s Health

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A safe environment. Sound nutrition. Healthy relationships. These are some of the basic building blocks of a healthy, happy childhood. A new initiative from Children’s Hospital & Medical Center is designed to make sure that every child in Nebraska has these three critical needs met. Children’s Center for the Child & Community aims to integrate health care and public health efforts to improve the overall health of children statewide. The Center will collaborate with communities across Nebraska to create local solutions to large-scale children’s health issues, such as childhood obesity, poverty, injury prevention and food insecurity. In addition to building partnerships that improve the health of children, it also will strengthen Children’s role in advocacy and health care policy.

Headquartered in Lincoln, the Center is led by Karla Lester, M.D., who also serves as medical provider for Children’s HEROES pediatric weight management clinic in Lincoln. A longtime pediatrician-turnedcommunity advocate and non-profit founder, Dr. Lester has seen first-hand the need for a coordinated approach to children’s health. “There are a lot of positive efforts happening, but there hasn’t been a hub of coordination to ensure the biggest impact,” explains Dr. Lester. “Children’s is a high-level partner that has the expertise and infrastructure to offer communities the support they need. Children’s brings the vision and the resources to move the needle.” Half of Nebraska children live in or near poverty. Nearly half qualify for free and reduced meals at school. Meanwhile, the obesity epidemic continues to rise, disproportionately affecting vulnerable children. Chronic, complex diseases also present complicated health challenges for young people and their families.

These stark realities — and the children who experience them — are the driving force behind Children’s Center for the Child & Community. “It is our vision for Nebraska to have the healthiest population of children in the Midwest and in the United States,” says Richard Azizkhan, M.D., Children’s President & CEO. “The children and families we serve deserve nothing less; we owe it to them to think bigger, take action and work collaboratively.” Formalizing Children’s investment in matters of community health isn’t only the right thing to do; it’s also timely and cost-efficient.

Still in its infancy, the Center’s first task is strategic planning — identifying critical needs and valuable partners. “Asset mapping” is the next step; the Center will analyze existing efforts and data before developing an impact plan. The focus will start in Omaha and Lincoln and radiate to more rural communities with time. “Health care providers, educators and other community health champions across the state need more support than they’ve been getting,” says Dr. Lester. “We hope to be additive — to arm these champions with resources and, ultimately, make all children healthier.”

“Health care is changing from a volumebased approach to one that emphasizes value,” explains Dr. Lester. “The Center allows us to improve the quality of health care while we’re also preventing and reducing diseases and reducing health care costs.” 17

CHILD HEALTH ASSESSMENT REVEALS TOP CONCERNS AND OPPORTUNITIES P

arents in the Omaha metropolitan area say the number one health issue affecting community children and teens is obesity — including the areas of nutrition, physical activity and weight. A close second for parents of adolescents is concern around teens’ mental and emotional health. Children’s Hospital & Medical Center, Boys Town National Research Hospital and Building Healthy Futures are pleased to share these findings and more from the 2015 Child & Adolescent Health Needs Assessment. The three organizations teamed up to co-sponsor the assessment to determine the health status, behaviors and needs of children and teens in Douglas, Sarpy and Pottawattamie counties. Professional Research Consultants (PRC) of Omaha conducted the research endeavor. A similar assessment was sponsored and conducted in 2012. PRC’s process involved a customized local health survey given to 966 area parents/ guardians online and via phone, a

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review of secondary data (e.g. census data, Youth Risk Behavior Survey, other public health data) and an online key informant survey for key community health care stakeholders. “Before we can effectively address the health needs of children in our community, we have to step back and listen to parents’ perceptions and challenges,” says Richard Azizkhan, M.D., Children’s President & CEO. “Their feedback is incredibly important in directing our efforts and advocacy into the future.” The 2015 Child & Adolescent Health Needs Assessment identified nine areas of opportunity: ❱❱ Asthma & Other ❱❱ Nutrition, Respiratory Physical Activity Conditions & Weight ❱❱ Mental Health ❱❱ Access to Healthcare Services ❱❱ Sexual Health ❱❱ Injury & Violence

A majority of local families, 82.4 percent, rate their children’s overall health as excellent or very good. Respiratory allergies (18.3 percent) are considered the most prevalent health condition, followed by speech/language problems (14.1 percent), ADHD (8.3 percent) and asthma (6.2 percent). Unfortunately, more than 1 in 4 parents report experiencing difficulties or delays in receiving health care services for a child in the past year. “The survey shines a bright light on real challenges that children face; it shows us where the gaps and cracks are,” says Dr. Azizkhan. “The sooner we identify those areas, the sooner we can work on improving them.”

❱❱ Vision, Hearing & Speech Conditions ❱❱ Oral Health ❱❱ Substance Abuse

Complete, detailed assessment results can be found online at: ChildrensOmaha.org/Survey.

Teaming Up to Prevent Childhood Obesity Nine Omaha metropolitan area organizations are joining Children’s Hospital & Medical Center in its efforts to fight childhood obesity. Children’s awarded $225,000 in Preventing Childhood Obesity Community Grants at a special program and presentation on April 28, 2016. Each non-profit organization received a $25,000 grant. This is the fourth consecutive year for Children’s Preventing Childhood Obesity Community Grants program. Children’s 2016 — 17 grant recipients and their initiatives are: Boys & Girls Clubs of the Midlands Initiative: Mind, Body, Soul Program This grant will support the “Mind, Body, Soul” program that champions healthy living through nutrition education and increased fitness opportunities for club members. An emphasis on daily recreational activities will highlight the importance of movement and teamwork. Charles Drew Health Center Initiative: Earn-A-Bike Program North Omaha youth will have the opportunity to earn a new bike through community service and participation in health education classes. Children will learn and engage on a community level as they work toward a positive reward that further encourages physical activity.

Completely KIDS Initiative: Healthy KIDS Grant funding will provide programming that gives children daily access to nutritious food, physical activity and health education. In addition, special fitness classes and family events will engage and educate parents on bringing healthy behaviors into the home.

Nebraska Action for Healthy Kids Initiative: Game On Omaha The “Game On Omaha” program will activate school health teams in 10 under-resourced Omaha metro schools. These advocates will implement healthy eating and physical activity initiatives throughout the coming school year, impacting thousands of young students.

Council Bluffs Community School District Initiative: Creating the Path to Healthy Living Council Bluffs Community School District will offer expanded nutrition education and physical activity programming to students in kindergarten through eighth grade, as well as implement before- and after-school fitness clubs in two high schools. Districtwide “family nights” will promote menu planning, meal preparation and the value of eating at home as a family.

Whispering Roots Initiative: We Grow! The “We Grow!” program will teach students the process of growing food through cuttingedge, soil-less aquaponics systems built in local schools. Whispering Roots aims to change eating behaviors and attitudes through handson learning and growing activities.

Families in Action Initiative: Niños Activos Niños Activos is a multi-faceted program that provides accessible, culturally appropriate health and wellness programming to Latino children and families across South Omaha. Grant funds will support enhanced fitness classes, nutrition and mental health education and mobile health clinics.

Visiting Nurse Association Initiative: Cooking Matters Cooking Matters offers a series of free, fun and interactive cooking classes on-site at Children’s. In a group education setting, professional chefs and registered dietitians will teach nutrition education, cooking skills, food safety, meal planning and food budgeting strategies. The YMCA of Greater Omaha Initiative: Bringing Healthy Lifestyles to Camp The YMCA will use grant funds to make its summer day camps even healthier for kids. They will utilize the nationally recognized “CATCH” nutrition curriculum and offer nutritious daily snacks and fitness activities at all locations, as well as cooking demonstrations by local dietitians.

“All of the Above”

ELLEN WRIGHT:

Advocate. Philanthropist. A Real ‘Peeps’ Person. Jess Wright is 30 years old now, living in Chicago, working for a nonprofit media arts organization with a special affinity for children — a career choice guided, perhaps, by genetic predisposition. He wouldn’t remember his three weeks in the neonatal intensive care unit at the old Children’s Hospital. But his mother remembers it vividly: her newborn’s staph and strep infections and high fever; the care and compassion of Children’s nurses; the skill of the doctors. All of the above. “I would come over with all of my paraphernalia at 1, 2, 3 o’clock in the morning to see him. The NICU nurses were just remarkable, absolutely remarkable how supportive they were. My docs were amazing. Even after we went home, they called me, wanting to know how things were going. I can’t say enough about them.”

Ellen Wright 20

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“If we don’t grow, if we don’t change, if we don’t take risks, we’re not going to be able to provide the best care for these fragile kids.” ELLEN WRIGHT

The Carolyn Scott Rainbow House

To show her gratitude, she apparently can’t do enough either. The truth is, Ellen Wright is an “all of the above”-kind of human being: Children’s advocate, volunteer and philanthropist, a true “peeps” person and unashamed lover of a tie-wearing sponge who lives in a pineapple under the sea. “SpongeBob SquarePants is one of my idols,” she says. “I think he is brilliantly philosophical.” Much to her surprise, he would come to play a part in one of the “most precious birthday moments” of her life, a highlight of her “all of the above” legacy of service to Children’s that began with that first ask in 1999: Would she be willing to serve on Children’s Board of Directors. Her answer? In a heartbeat. “I’m thankful they thought enough of me and Stavely, my husband, that they would ask us to become involved,” Ellen says. Retired from the Arthritis Foundation in 1999, Ellen served on Children’s Board for nine years before transitioning to Children’s Foundation Board of Directors. In 2010, she was appointed Chair, a position she held until just recently. “It was because we were doing such remarkable expansions and projects,” she says. “I love working with Children’s team, and I wanted to finish those transitions.”

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And now, she’s helping to begin others. Ellen’s latest “in a heartbeat” response to a Children’s invitation involves service as a cabinet member for Children’s new capital campaign. The $50-million initiative — called “Changing Lives Together” — will fund crucial campus expansion plans. “The expansion of the NICU, the expansion of the PICU, our whole heart area is expanding and growing,” Ellen says. “We will be adding 70 more beds. We are at capacity — scary capacity — in layman’s terms.” The campaign also will help enhance the Fetal Care Center, the emergency department and the short-stay observation unit, among others. “If we don’t grow, if we don’t change, if we don’t take risks, we’re not going to be able to provide the best care for these fragile kids,” Ellen says. “It will be challenging, but I have no doubt we will be successful. We live in an incredibly philanthropic community. It’s a phenomenon.” Ellen’s community involvements aren’t limited to Children’s. She is also passionate about her work with Omaha’s Henry Doorly Zoo and Aquarium. “The zoo is very important to me,” she says. “Our zoo is a treasure. It is so entrenched in conservation and prolonging of life.”

Though it’s not about recognition, Ellen’s service has led to numerous honors and awards, including being named 2015 Outstanding Volunteer Fundraiser from the Association of Fundraising Professionals, 2010 Women’s Center for Advancement Tribute to Women Professional Volunteer and the 2005 Rik Bonness Volunteer of the Year award from the Juvenile Diabetes Research Foundation International. She is quick to share the credit, giving a shout to her “peeps posse.” “You don’t do anything by yourself. Whether you’re working on a capital campaign or a program, you hope you have your ‘peeps’ with you, and we do kind of travel in a unit. I’ve been really blessed that way. They don’t question my lunacy; they just jump on board,” she laughs. Not only is “all of the above” Ellen generous with her time — she and husband Stavely are also generous with their success. Years ago, they joined Children’s Foundation’s Poynter Society, a planned giving society that invests in Children’s future through planned or deferred gift arrangements. “We’ve been very blessed in our lives, very fortunate — and I think if you can give, you should,” she says.

“That is what my mother really harped on — and she was right.” Ellen’s impact since has been dramatic, extending to thousands upon thousands of lives. A 60th birthday surprise underscored just how big an impression she’s made — and just how grateful Children’s is for her dedicated service. Drawn to the hospital atrium under the guise of a capital campaign meeting, she found all of her “peeps” waiting — foundation and hospital staff, her friends, even her associates from the zoo — along with a massive collection of more than 1,000 plush SpongeBobs. “They had all raised enough money to — for the next 60 days — give every child who came into the hospital a SpongeBob. It was probably one of the most precious moments of my life. I was totally overwhelmed,” she says, tears in her eyes. The story continues: “That day, we went up to the heart floor, pulling wagons with all of the SpongeBobs. The first room we walked into, there was a 14-year-old. I told her what we were doing. I said, ‘Now you’re probably going to think this is incredibly ridiculous because you’re an adult,’ and she giggled. She pulled back her blanket, and she had SpongeBob pajamas on.” “All of the above” Ellen Wright: advocate, volunteer, philanthropist — and it all comes back to gratitude for life-saving care received in 1986. “If we didn’t have Children’s, what could have happened? We had infectious disease. I had fetal care before I delivered Jess. What would have happened? Where would he have gone for three weeks? I truly don’t think he would have had the kind of care that he did. We’re blessed. We’re very, very blessed.”

mong her many involvements with Children’s Hospital & Medical Center, Ellen Wright served as inaugural cochair of Children’s Wine, Women & Shoes, a fundraiser to benefit the Carolyn Scott Rainbow House. “The Carolyn Scott Rainbow House is one of my love affairs,” she says. Since 1983, the Carolyn Scott Rainbow House has provided lodging, compassionate support and a “home away from home” to thousands of parents and family members of children receiving services at Children’s who live 60 miles or more away from Omaha. A beautiful, new three-story Rainbow House with 56 guest rooms opened in January 2015. There is no formal charge to stay at the Rainbow House — just a small, suggested donation. True to Children’s mission, no one is turned away if they are not able to pay. Next year’s Wine, Women & Shoes — the fifth since 2013 — will be held on Friday, April 14, 2017. “Wine and women and shoes — what’s not to love?” asks Ellen. She and fellow inaugural co-chair Erin Pogge helped to create a smashing success: an evening of wine-tasting; shoe, jewelry and accessory shopping; and auctions and raffles. To date, the event has raised nearly $650,000 for the Rainbow House.

An expectation of generosity and service was part of Ellen’s upbringing. When she moved from the East Coast to Nebraska in the late ‘70s, it became — at the suggestion of her mother — an avenue to get to know the community.

ENVISIONING OUR FUTURE

Commentary by Richard G. Azizkhan, M.D. President and CEO Children’s Hospital & Medical Center

Chief ‘Envisioning’ Officer. That is the hat I am wearing today —

We are driven to train, retain and attract the best medical talent

and it is one I wear with great enthusiasm. When I think about the

in the country so we can enhance our overall care offerings, add

potential of Children’s Hospital & Medical Center, I see a future in

more specialty services and advance life-saving or life-improving

which we are improving the overall health of children on a larger

research, a must when building an enterprise that is world-

scale, touching every child in some way by what we do.

recognized. By 2025, it is our goal to employ 300 specialists.

To achieve this bold vision and continue to meet the needs of the

In partnership with Creighton University, the University of

children and families we serve, we are embarking on a new era of

Nebraska Medical Center and Nebraska Medicine, we continue

growth and transformation — launching a critical expansion project

to train that next generation of caregiver right now. We plan to

to build one of the nation’s leading epicenters of pediatric health

expand our educational offerings, adding up to 12 fellowship

care. This endeavor will forever transform Children’s main campus

programs in the next several years. We’ll also continue to

at 84th & Dodge with the proposed construction of a new clinical

strengthen our superb training programs for residents, fellows

facility. Another exciting element of physical expansion extends

and nurses from 11 different nursing schools.

across 84th Street, with the recent acquisition of the adjacent property currently leased by HDR and the Durham Plaza building.

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growth through technology and enhancing our outreach

To impact the most children, we are in the process of launching

efforts to serve children in rural areas and under-served urban

a $50 million capital campaign — Changing Lives Together —

areas. Telemedicine is going to become a very important

that will help us add at least 70 beds to our main campus and

part of Children’s. It will help our specialists more effectively

support critical upgrades to our Neonatal Intensive Care Unit,

communicate with primary care providers as well as patient

Fetal Care Center, Pediatric Intensive Care Unit, Heart Center,

families, school-based health clinics and federally-supported

Emergency Department and more.

health clinics in areas where we don’t have a local presence.

Our necessary physical growth is not confined to our hospital

Growth through physical expansion, faculty expansion and

campus. We are establishing an even more significant presence

outreach. “What” we are planning is ambitious, but it’s the

in west Omaha with our new outpatient surgery center near

“why” that’s really impressive: a firm belief that families deserve

Village Pointe and sports physical therapy, rehabilitation and

a greater depth and breadth of pediatric services — and the

specialty clinic location at 180th and Pacific. We are evaluating

highest-value care — closer to home; that a strong children’s

other locations (particularly in north Omaha, Lincoln and Iowa)

hospital will attract expertise from around the country; and that

that will allow us to best serve unmet needs in our community

new facilities will also allow our education and research efforts

and offer families the convenience of seeing both our primary

to continue to flourish.

care physicians and specialists closer to home.

As we eye an even more impactful future, we are also pursuing

As the Chief ‘Envisioning’ Officer here at Children’s, I am

Our physical growth — both on campus and in the community —

energized about the future — and I know that together, we

will give us the space we need to expand our Children’s “family.”

will improve the lives of children for generations to come.

Celebrating Excellence For the third consecutive time, Children’s Hospital & Medical Center has attained Magnet® recognition — the highest honor an organization can receive for professional nursing practice — as part of the American Nurses Credentialing Center’s Magnet Recognition Program®. This voluntary credentialing program for hospitals is the gold standard of nursing excellence. Only 7 percent of health care organizations have earned this prestigious credential, and only 2.8 percent of U.S. hospitals have achieved three or more designations. “To earn this recognition once was a great accomplishment and an incredible source of pride; receiving it three consecutive times truly underscores the foundation of excellence that patient families associate with Children’s,” says Debra Arnow, DNP, RN, NE-BC, Children’s vice president of Patient Care Services and chief nursing officer.

Children’s has again been verified as a Level II Pediatric Trauma Center by the American College of Surgeons (ACS), making it the only ACS-verified trauma center in Omaha and the only ACS-verified pediatric facility in Nebraska. Children’s was first verified as a Level II center in 2012. The re-verification announcement follows a rigorous process and on-site visit from two independent physician reviewers. “With a re-verification, everything is looked at much more stringently, with no room for error,” says Shahab Abdessalam, M.D., medical director of Children’s trauma program. “The site reviewers were very impressed, and affirmed that pediatric patients in this region receive the best trauma care at Children’s.”

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C OMMI

Another honor proves that — by ground or by air — Children’s provides the region’s best pediatric and neonatal critical care. Children’s Transport team is now accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS®) — the gold standard for transport quality and safety. The fleet includes two ambulances, two helicopters and one fixed wing airplane. We congratulate our outstanding team for becoming part of an elite group of transport professionals nationwide.

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Q UA LIT Y A P

In May 2016, Children’s received accreditation from the Joint Commission, an independent, not-for-profit organization that accredits and certifies health care organizations and programs. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Surveyors observed, reviewed and provided feedback on practices and systems around the hospital and Home Healthcare for four consecutive days. The surveyors were very complimentary of Children’s dedication to its mission, vision and values, and recognized staff for the excellent care they provide. The outcome was very successful, affirming Children’s high level of quality care and continued perseverance to be a High Reliability Organization.

ChildrensOmaha.org