Children's critical care — information for the referring physician by Legacy Health

Childrenâ&#x20AC;&#x2122;s critical care â&#x20AC;&#x201D; information for the referring physician

Dear Colleague, When a critically ill or injured infant or child needs advanced, highly specialized care, a referral to a children’s hospital is always the wise choice. Studies repeatedly affirm that care provided at children’s hospitals is safer, with fewer complications, than care given in adult hospital settings. And when it comes to which Oregon hospital you should choose for pediatric critical and emergency care, we believe that Randall Children’s Hospital at Legacy Emanuel is the wisest choice. Here’s why: •A n exceptional depth and breadth of pediatric expertise — Our Children’s Emergency Department, NICU and PICU are staffed 24/7 by an experienced team of pediatric emergency medicine specialists, neonatologists and pediatric intensivists, with access to hundreds of specialists in virtually every field of children’s medicine. •A ll patients are seen by a pediatric specialist, all the time — This means that if you have a question about a patient — day or night — you can speak with an attending. •H ighly skilled neonatal and pediatric transport — Our expert KIDS Team (mobile ICU transport team) provides the same advanced level of care during transport that a child receives in one of our critical care units and is the only one in the region providing high-frequency ventilator support for pediatrics and the first providing neuro-protective hypothermia therapy during transfer for neonates. • The region’s most experienced ECMO and cardiopulmonary failure program — Ours is the longest-running ECMO program in the Pacific Northwest, and we have an excellent survival rate for kids with serious respiratory disease/respiratory failure utilizing high-frequency volume diffusive respirator (VDR) ventilation. •T he highest level of trauma care — We are the first hospital in Oregon and the first children’s hospital in the Pacific Northwest to be verified as a Level 1 pediatric trauma center by the American College of Surgeons (ACS) Committee on Trauma. This premier status means that we are staffed and equipped to provide the highest level of care for injured patients around the clock. •S treamlined access to the only specialized burn center in the region — The Legacy Oregon Burn Center is the only facility of its kind between Seattle and Sacramento, and it has special treatment areas just for children. •A state-of-the-art healing environment — Our modern facility offers such innovations as a peaceful nursery that utilizes “quiet” technology, isolette technology that simulates the womb environment, and single, private rooms with family space so parents and infants can stay together. (continued)

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•T ruly family-integrated care — We believe parents are partners in their child’s care, so parents are included in clinical team rounds and offered an array of supportive services and amenities, all focused on making them feel comfortable and welcome. •A regional leader in pediatric rehabilitation — We provide inpatient and outpatient rehabilitation services for all ages, even preemies; it’s an integrated approach that helps children achieve their fullest potential, and it’s unique to Randall Children’s Hospital. •N ational recognition for care quality — Our NICU ranks among the nation’s best in survival rates and outcomes according to the Vermont Oxford Network. Our PICU has superior mortality outcomes according to the VPS database, an international database of pediatric critical care units. Our facility is also one of only 11 in the nation (and the only one in Oregon) to earn the American Association of Critical-Care Nurses (AACN) Gold Beacon Award for Excellence. We are justifiably proud of our critical care services, but their real value always comes down to what they deliver to you, your patients and their families: high-quality, compassionate care and tremendous peace of mind. The essence of quality is how well patients do as a result of the care they receive. At Randall Children’s Hospital, patients do exceptionally well, not only because of our clinical expertise and advanced technology, but also because of our consistently close attention to such vital aspects of care as patient safety, clinical quality, and family support and education. We’ve prepared this report to let you know more about the depth and breadth of pediatric critical care services available at Randall Children’s Hospital. We hope you’ll take the time to look through it — and let us know how we can be of service to you and your patients. Sincerely, Carolyn Shelak, M.D. Medical Director Randall Children’s PICU

Mark Buchholz, M.D., MBA Associate Medical Director KIDS Team (pediatric transport)

Bret Freitag, M.D. Medical Director Legacy Salmon Creek NICU

Valerie Newman, M.D. Medical Director KIDS Team (neonatal transport)

Interim Medical Director Randall Children’s NICU

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Opher Nadler, M.D. Medical Director Randall Children’s Emergency Department Anya Bailis, M.D. Medical Director Legacy Medical Group– Maternal-Fetal Medicine

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For children who need critical care, Randall Children’s Hospital at Legacy Emanuel offers the full range of expert services delivered in a hospital designed exclusively for children and their families.

Children’s Emergency Department Dedicated to children, 24 hours a day Table of contents Children’s Emergency Department . . . . . . . . . . . . . . . . . 1 KIDS Team Mobile ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Neonatal Intensive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Maternal-Fetal Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Family-Integrated Culture . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Pediatric Intensive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Pediatric Sub-specialists . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ECMO Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

There are a lot of reasons why so many physicians trust Randall Children’s Hospital at Legacy Emanuel for expert emergency care for critically ill children, and this is chief among them:

It’s a depth of experience that underscores our expertise in caring for high-acuity pediatric patients — and translates into the best possible patient outcomes.

Our pediatric emergency department is open 24/7 and staffed by board-certified specialists in pediatric emergency medicine.

But that’s not all. Here are other important reasons why you can entrust your pediatric patients to our Children’s Emergency Department:

This distinction ensures a consistently high level of care for every patient we see. And we not only see more pediatric patients than any other hospital in the region — with over 27,000 patient visits a year — but we also see more critically ill patients.

In addition to being staffed by board-certified pediatric emergency medicine specialists, we have an entire team of nurses, technicians and therapists who are specially trained in pediatric

Unparalleled pediatric emergency expertise, around the clock

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• Communication with parents is also a priority. Families are surrounded by skilled professionals who will keep them informed, guide them through the care process and include them in decisionmaking about their child’s care.

emergencies, as well as children’s developmental stages. In addition, radiologists, anesthesiologists and surgeons are on-site at all times.

A separate emergency department designed just for kids

Seamless transition to pediatric intensive care

At Randall Children’s Hospital, young patients are cared for in a welcoming, child-friendly environment. Our dedicated, state-of-the-art pediatric emergency department has 22 rooms, including four large resuscitation rooms and two behavioral health rooms, all for pediatric patients alone. Additionally, our technology, equipment and supplies are designed specifically for infants, children and adolescents.

For critically ill children and teens who require continuing critical care after their visit to our emergency department, we provide a fast, seamless transition to the nationally recognized pediatric intensive care unit (PICU) at Randall Children’s (see page 11).

All it takes is a single phone call. Whether you are an emergency physician at another hospital or an office- or clinic-based primary care physician, we stand ready to accept your referrals 24/7.

We recognize that infants and children aren’t simply small adults; their anatomy and physiology require specialized care. That’s why:

To arrange a transfer, simply contact Legacy One Call Consult & Transfer at 1-800-500-9111.

•W e perform safe, lower-dose X-ray imaging in children to minimize radiation exposure; in fact, we have been nationally recognized by Image Gently, an initiative of the Alliance for Radiation Safety in Pediatric Imaging, for our commitment to this effort.

Unmatched trauma and burn expertise, all in one location No other facility in the region offers more resources than we do when it comes to advanced care for traumatic injuries, including burns. Randall Children’s Hospital is the first ACS-verified Level 1 pediatric trauma center in Oregon — giving patients immediate access to the highest level of pediatric trauma care.

When a critically ill newborn or child requires transport, you can rely on our KIDS Team, a mobile ICU that brings our unmatched critical care expertise directly to your patient.

How to refer a critically ill child to our Children’s Emergency Department

Diagnostic and treatment protocols tailored to children’s unique needs

• The medications we administer are specially formulated and prepared in doses for young patients by experts in pediatric pharmacology.

The KIDS Team Mobile ICU for transporting critically ill children

• Consultation and collaboration — Each transport begins with a consultation between you and either a pediatric intensivist or neonatologist. Then, the receiving physician collaborates with the transport team until the patient arrives in our unit.

Our physicians and nurses are specially trained in pediatric emergencies, with expertise and understanding of children’s developmental stages.

In addition, our campus is home to the Legacy Oregon Burn Center, a national leader in burn assessment, care and rehabilitation, including treatment designed specifically for children. It’s the only facility of its kind between Seattle and Sacramento.

• I nnovative treatment modalities such as high-frequency ventilation and nitric oxide administration are often used to stabilize patients for transport in advance of ECMO or cardiac surgery. We also are equipped to administer neuro-protective hypothermia treatment on transport.

Extensive child and family support resources Your pediatric patients not only receive expert clinical care in our Children’s Emergency Department — we also provide an array of services to support the emotional needs of children and their families:

• Expert staffing by skilled pediatric and neonatal critical care nurses and respiratory therapists who routinely work in our NICU, PICU and Children’s Emergency Department — ensuring they maintain advanced competencies in pediatric and neonatal medicine

We provide responsive, child-friendly treatment in a family-focused environment.

To activate a KIDS Team transport The KIDS Team is ready for immediate activation, 24 hours a day, 365 days a year. Simply call Legacy One Call Consult & Transfer at 800-500-9111.

• Child life specialists help make the emergency department experience less stressful for young patients and their families by using distraction and play to help children cope with anxiety and fear.

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every day. In addition, our nurses also have years of neonatal bedside experience. This also means that, as a referring physician, you can rely on timely, responsive colleague-tocolleague communication about your patients.

Evidence-based best practices for neonates Through our participation in the Vermont Oxford Network, we continually review clinical data to identify and implement the latest evidence-based NICU best practices. For example: • “Kangaroo care” encourages skin-to-skin contact to enhance parent-infant bonding. After birth, a newborn is placed on the mother’s chest even if the infant is too premature to breastfeed. Studies show this contact improves sleep, which is critical for brain development, encourages a more regular heart rate, reduces infection frequency and accelerates EEG signs of brain maturity in pre-term infants.

Neonatal Intensive Care Unit (NICU) The most advanced care for the smallest patients The neonatal intensive care unit at Randall Children’s Hospital is designated as Level IV — the highest designation possible — equipped to care for the smallest and most critically ill newborns. We have more than 700 admissions per year, among them nearly 100 very low birth weight neonates. One-third of our patients are transferred here from other facilities, including other Level III NICUs in the region — a testament to the advanced expertise that resides here. But the numbers that matter most demonstrate how well our tiny patients do. Progressive in our use of evidence-based best practices, our NICU is ranked among the best when it comes to survival rates and outcomes for infants with chronic lung

disease and newborns deprived of oxygen at birth. We participate in the Vermont Oxford Network, an international registry of data from nearly 1,000 NICUs worldwide. What’s more, our babies get better faster — and shorter lengths of stay translate into lower costs. Here’s a closer look at what makes the Randall Children’s Hospital NICU the region’s best choice for critically ill newborns:

A seasoned team of board-certified neonatologists Our specialists have cared for literally thousands of babies, with each tiny patient receiving hands-on care from an attending, not a resident or intern,

• We were early adopters and have many years of experience in the use of hypothermia treatment for infants who experience hypoxic ischemic encephalopathy at birth; it is now the standard of care for newborns deprived of oxygen at birth, because it has been shown to improve neurological outcomes. •W e have a separate, sterile mixing room where all feeds for neonates are prepared safely and to exact specifications — essential for the health of such small and fragile digestive systems, and a Joint Commission best practice.

An environment designed for neonatal health and healing Randall Children’s 38-room NICU — one of the largest in Oregon — features seven twin rooms and the ability to accommodate triplets and quads as needed. The unit incorporates evidence-based Our pioneering Family-Integrated Care (FIC) program design principles teaches parents to deliver hands-on care to their that have been infants in the NICU. shown to improve outcomes, including faster healing and recovery for neonates. Notably, we have private, single-family rooms designed all for babies, including multiples. Each room features: • A day bed so parents can comfortably stay with their newborn 24/7 • The ability to adjust the room environment to each baby’s needs, which is particularly important with premature infants whose developing brains are negatively affected by external stimuli such as lights, excessive touch and sound • Isolettes that simulate the womb environment with adjustable lights, temperature, acoustics and humidity, helping premature infants develop as normally as possible Research demonstrates that when mother and newborn stay together, it improves neonatal outcomes compared to open-bay NICUs, including significant neuro-behavioral improvements such as better attention, thermal regulation and quality of movement, with less hypotonia. Studies suggest that overall length of NICU stay is shorter and parental bonding is enhanced in premature babies whose parents have unlimited NICU access in single-family rooms — an outcome that our experience and commitment to continuous improvement affirms.

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The average length of stay for NICU patients in our most recent year is just under 17 days — a decrease of more than two days from the previous year.

• Dedicated NICU registered dietitians round daily on every baby, monitoring weight, electrolytes and caloric intake.

Further, thanks to the latest in “quiet” technology, we’ve created a peaceful nursery environment for neonates that shields them from excess noise like overhead pages and medical equipment sounds:

•O ccupational and physical therapists are available as needed for NICU babies.

•N urses use individual pager-phones to communicate quietly and are wirelessly connected to their babies’ monitors, so they may be notified of a change when they’re with another baby • Central heart monitors enable every staff member to observe each infant’s status

A collaborative approach to caring for high-risk mothers and newborns In high-risk pregnancies, neonatology care begins prior to birth. Our neonatologists work closely with Legacy’s Maternal-Fetal Medicine specialists — as well as families and other obstetrical providers — to plan for the delivery and care of babies who will require special attention after birth while they are still in utero. For babies likely to be delivered preterm, this means preparing families with expectations for the first few weeks of life. When prenatal ultrasound identifies an abnormality, Legacy’s Maternal-Fetal Medicine fetal therapy program provides diagnostic services, counseling and support, with a team dedicated to walking parents through the prenatal course. Services include fetal ultrasound, genetic counseling, prenatal diagnostic testing and coordination with neonatologists and pediatric subspecialists to provide families with information and facilitate preparation for delivery and postnatal care. Organized, multidisciplinary care ensures a seamless transition and the best possible outcomes for both mother and baby. Read more about Legacy’s Maternal-Fetal Medicine services on page 7.

• Palliative care provides compassionate, focused care to optimize a neonate’s quality of life, manage pain and distress symptoms, communicate with the family about their goals for care and decisionmaking, and provide family support.

• Our onsite pharmacy is staffed by pediatric pharmacists, ensuring accurate dosing and fast medication delivery times.

Our 38-room NICU features seven twin rooms and the ability to accommodate triplets and quads as needed.

A national leader in ECMO and gentle ventilation For patients with acute respiratory distress, Legacy Emanuel Medical Center is home to the most experienced extracorporeal membrane oxygenation program in the Pacific Northwest, giving the most critically ill patients — including newborns and children — access to this lifesaving resource. Read more about our ECMO program on page 14. In many neonatal cases, we use gentle ventilation, a minimally invasive technique to help infants through acute respiratory failure and which may reduce the need for ECMO and respirators. This approach approximates normal infant breathing and reduces the chances of lung injury. Importantly, not every critically ill newborn is intubated at Randall Children’s Hospital. Rather, care is highly individualized based on the unique needs of each tiny patient — and the extensive expertise of our neonatologists.

Comprehensive clinical support services Randall Children’s Hospital offers an impressive array of clinical support services for critically ill newborns, including: • Onsite lactation consultants work with every new mother; every mother is provided with a breast pump, and donor milk is available to all NICU babies to supplement mom’s milk, if needed.

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Care for high-risk moms and infants From perinatology to neonatology, Legacy Health provides a robust continuum of care for high-risk mothers and infants that begins well before birth. The fellowship-trained perinatologists of Legacy Medical Group–Maternal-Fetal Medicine provide comprehensive care for women with high-risk pregnancies, including management of significant health issues. The maternal health issues managed by our MFM team include a history of pregnancy anomalies, diabetes, heart disease, seizure disorders, potential genetic conditions, multiple gestation, hypertension, lupus, thrombophilia and infectious illness. Pregnancy complications we help manage include recurrent pregnancy loss, fetal demise and a history of pre-term delivery. Additionally, our comprehensive range of prenatal screening and diagnostic services includes: • Genetic risk assessment, screening and counseling for couples with a family history of a genetic condition, those who have experienced multiple miscarriages or infertility, and women of advanced maternal age who are known or suspected carriers of a genetic condition

• Onsite, master’s-trained genetic counselors. All are board-certified through the American Board of Genetic Counselors. • First- and second-trimester screening for structural abnormalities, Down syndrome, trisomy 18, spina bifida and genetic indications for cystic fibrosis • Non-invasive screening for an increasing number of genetic conditions through maternal blood • Diagnostic testing (CVS, amniocentesis) for women who are of advanced maternal age; a known carrier of a chromosomal, gender-linked or single gene disorder; or had a screening test result indicating an increased risk for chromosomal abnormalities. We offer particular expertise and experience with chorionic villus sampling (CVS). • Fetal evaluation and growth monitoring •C ollaboration with neonatologists, obstetricians and families to develop a delivery and care plan for high-risk neonates Depending on a patient’s situation and primary care preferences, our perinatologists are available for onetime consultations, collaborative co-management of patients or the complete management of a pregnancy, and our four metro area clinic locations help keep patients close to home for perinatal services. Perinatologists are available 24/7 to consult about inpatients and oversee the in-house management of patients at both Legacy Emanuel and Legacy Salmon Creek medical centers. For urgent referrals or consultations, call Legacy One Call Consult & Transfer: 1-800-500-9111 to speak with the on-call perinatologist. To reach Legacy Medical Group–Maternal-Fetal Medicine offices, please call 503-413-1122 or visit www.legacyhealth.org/maternalfetal for more information.

Personalized, family-integrated care in the NICU Randall Children’s Hospital provides comprehensive services to support parents, siblings and other family members when a critically ill newborn or child is in one of our intensive care units. Here are some of these services that are specific to the NICU:

Legacy Salmon Creek NICU keeps patients closer to home Legacy Salmon Creek Medical Center has a Level III NICU, the highest level available in Southwest Washington, for preterm or ill neonates gestational age 26 weeks and older. Through the Randall Children’s network, the same trusted doctors care for children at Legacy Salmon Creek. The NICU has capacity to care for 25 critically ill newborns. The Legacy Salmon Creek NICU features 15 private rooms, three rooms for twins and space for four more babies in our special care nursery. Family space, including a sleeping area, is built into each family room. Emergency transport to Randall Children’s Hospital is available 24/7 if needed.

How to refer a critically ill child to the NICU All it takes is a single phone call. Whether you are a neonatologist or perinatologist at another NICU, or an office- or clinic-based obstetrician, we stand ready to accept your referrals 24/7. To arrange a transfer, simply contact Legacy One Call Consult & Transfer at 1-800-500-9111.

• Parents are encouraged to discuss and review their baby’s care plan daily with their care team — They are invited to participate in daily group rounds, but if they’re not comfortable with that process, we also offer one-on-one sessions with the neonatologist and nurse. • NICView promotes family bonding — When parents and other family members can’t be with their infant physically, they can be there virtually with NICView, a secure, web camera that promotes family bonding by providing real-time, remote viewing of their infant in the NICU. • Mental health screening for at-risk mothers — Working with the psychiatry and psychology services at Legacy, we provide an innovative maternal post-partum mood disorder (PPMD) screening and referral program for mothers with a newborn in our NICU to address the mental health needs of this at-risk population. • Perinatal viability counseling helps parents express their wishes — We have in place a sensitive, formalized and ethical way to discuss a premature infant’s clinical condition with the parents, and honor their wishes to give or withhold care.

The KIDS Team Mobile ICU for transporting critically ill newborns Our KIDS Team Mobile ICU ensures that patients receive the same advanced level of care during transport that they receive in one of our critical care units. Each transport begins with a consultation between you and a neonatologist. For more information about the KIDS Team, see page 3.

Newborn and neonatal Tele-Baby Resuscitation If your facility is part of the Legacy Telehealth network, Randall Children’s Hospital neonatal nurse practitioners provide resuscitation guidance to nursery staff for high-risk deliveries or babies needing support prior to transport to our NICU. For more information, contact Legacy Telehealth at 503-415-5402 or telehealth@lhs.org.

A family-integrated culture At Randall Children’s Hospital, we never lose sight of the emotional and social needs of the young patients and their families we are privileged to serve. We provide care in a gracious and comfortable environment that truly integrates patients and families, starting with the thoughtful design of our facility: • Private, single-family rooms — Parents are encouraged to stay in the same room with their child during hospitalization. • Communication with parents is a priority — Parents are an integral part of the care team at Randall Children’s Hospital. They are invited to participate in daily group rounds, but if they’re not comfortable with that process, we provide oneon-one sessions with their child’s neonatologist, or intensivist, and nurse. • Child life services — Specially trained therapists work with all ICU patients on developmentally appropriate activities as well as distraction

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techniques to reduce fear and anxiety. Child life specialists also are available in our Children’s Emergency Department and for sibling support. • A place for out-of-town families to stay — For families who live more than 30 miles outside the greater Portland area, the Ronald McDonald House East, located near Randall Children’s Hospital, can accommodate 25 families per night. • Spaces for parents and families to enjoy quiet, private time — Our pediatric ICUs have nearby lounges where parents can take a break, yet remain near their child. • Emotional, social and spiritual support — For families with a newborn in our NICU or children being cared for in our PICU, this support includes the services of a chaplain and social worker.

Pediatric Intensive Care Unit (PICU) Award-winning quality, exceptional care The Randall Children’s Hospital Pediatric Intensive Care Unit is one of only 11 in the entire nation — and the only one in Oregon — to earn the Gold Beacon Award from the American Association of Critical-Care Nurses (AACN) in both 2012 and 2015. This prestigious award recognizes intensive care units that achieve excellence in critical care, provide state-of-the-art treatment and continuously improve the quality of care. This means you can have complete confidence that each critically ill pediatric patient you refer to us will receive an exceptional level of expert care. What’s more, according to the Children’s Hospital Association, while our PICU treats the sickest 10 percent of children in the nation, we’re in the top 10 percent when it comes to optimal outcomes and the shortest lengths of stay. It’s another measure affirming why Randall Children’s Hospital is the best choice when a critically ill or injured young patient needs intensive care. But that’s not all. Since 2009 we have participated in Virtual PICU Systems (VPS), a web-based pediatric critical care database to improve practice and operations in 123+ participating PICUs across the U.S. Comparative reports are developed by creating reference groups of peer PICUs, and every patient admitted is included. The Randall Children’s Hospital PICU, which cares for more than 1,050 patients each year, treats patients with a higher severity of illness than our peer PICUs without experiencing higher mortality rates. A comparison of both efficacy and efficiency confirms our PICU has both lower mortality and shorter length of stay than predicted by VPS data. The average length of stay for PICU patients is 3.15 days. Our excellent outcomes are attributed to a dedicated critical care team focused on a collaborative team approach to providing patient care and an emphasis on communication that has fostered a safety culture in our PICU. Our 24/7 physician coverage is another key factor in delivering optimal patient care.

It all adds up to an unparalleled level of expert care you can rely on when you have a critically ill patient. Here’s a closer look at what sets the Randall Children’s Hospital PICU apart:

An experienced pediatric care team, around the clock In our PICU, each child’s care is managed directly — at all times — by one of our pediatric intensivists. These are seasoned, board-certified pediatric specialists, not trainees or specialists in adult care.

A collaborative approach to care and an emphasis on communication have fostered a culture of safety in our PICU.

Further, because Randall Children’s pediatric heart program is one of the most respected in the Pacific Northwest, we care for a significant number of young cardiac patients; these children are treated directly by pediatric cardiologists. Equally important, our PICU nursing staff ratio is 1:2 and, if needed, 1:1 or 2:1 for our highest acuity patients, ensuring a high level of attentive, professional care, 24/7. Plus, our pediatric critical care expertise is augmented by an extensive team of pediatric surgeons and medical specialists, providing streamlined access for consultations and timely interventions.

Family-focused care that goes beyond treating a medical problem Randall Children’s Hospital is designed with families in mind, and we provide an array of services to support parents, siblings and other family members

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when a critically ill child is in one of our intensive care units. These are some of the services available in the PICU: • Parents aren’t just visitors; they’re considered important members of the care team. We respect them as experts on their child, and empower them with information by including them in our daily multidisciplinary rounds.

and PICU, the KIDS Team ensures that patients receive the same advanced level of care during transport that they receive in one of our critical care units. Each transport begins with a consultation between you and one of our pediatric intensivists. For more information about the KIDS Team, see page 3.

•O ur goal is to keep families with their child whenever possible, so all 24 of our single, private patient rooms include a sleep space for two family members at the child’s bedside. These rooms include private bathrooms, and we also have nearby family support areas which include showers.

We offer a robust array of clinical support services for critically ill children, including:

When you refer patients to Randall Children’s Hospital, you are giving them access to hundreds of pediatric surgeons and medical sub-specialists — all of whom work closely together to care for critically ill infants and children. This unrivaled depth and breadth of pediatric expertise includes: • S urgical sub-specialties include pediatric cardiothoracic surgery, general surgery, neurosurgery, orthopedic, ophthalmology, otolaryngology, plastic surgery and urology.

•C hild life specialists assist with age-appropriate distraction techniques and sibling support.

Extensive clinical support services

An extensive and collaborative team of pediatric sub-specialists

Our PICU has twice received the prestigious Gold Beacon Award from the American Association of Critical-Care Nurses (AACN) – a testament to the high-quality care we deliver.

• A dedicated pediatric pharmacy, ensuring accurate dosing and timely medication delivery, is open seven days a week. • Dedicated PICU registered dietitians provide nutritional consultations and support. • Palliative care provides compassionate, focused care to optimize a child’s quality of life, manage pain and distress symptoms, communicate with the family about their goals for care and decisionmaking, and provide family support.

The KIDS Team Mobile ICU for transporting critically ill children When you need to transfer a critically ill pediatric patient to Randall Children’s Hospital, we ensure the safest possible transport. Staffed by highly skilled nurses and respiratory therapists who routinely work in our pediatric emergency department, NICU

Pediatric critical care and telemedicine For contracted facilities, Legacy Telehealth — Pediatric Critical Care provides 24/7 consultations by pediatric intensivists for pediatric patients throughout the region. Referring emergency physicians can use this service to enhance ED stabilization prior to transport. For information, contact Legacy Telehealth at 503-415-5402 or telehealth@lhs.org.

•M edical specialties include pediatric cardiology, child abuse, dermatology, development and rehabilitation, eating disorders, endocrinology/ diabetes, gastroenterology, genetics/metabolism, hematology/oncology, infectious diseases, nephrology, neurology, neuropsychology, psychiatry, pulmonology, radiology, rheumatology and sleep medicine. In the greater Portland area, some of these specialties are only available at Randall Children’s Hospital. Importantly, Randall Children’s Hospital has one of the Pacific Northwest’s most comprehensive pediatric heart programs. We use leading-edge

technology, along with advanced surgical and minimally invasive techniques, to diagnose and treat the full range of congenital and acquired pediatric heart conditions, from fetal life into young adulthood. In addition, we have the region’s only dedicated pediatric physical rehabilitation team, with three board-certified physician specialists and an entire team of specially trained physical and occupational therapists and speech language pathologists who know how to engage and encourage children to achieve their personal best after an illness, injury or surgery. Offered on both an inpatient and outpatient basis, our pediatric rehabilitation program uses age-appropriate strategies to meet each child’s physical, emotional, academic and social challenges. And this comprehensive program ensures that patients don’t have to be transferred for rehabilitation after their hospitalization. For a full list of sub-specialists, visit our online Children’s Services and Provider Directory at www.legacyhealth.org/randalldirectory

How to refer a critically ill child to the PICU All it takes is a single phone call. Whether you are an emergency room physician or intensivist at another facility, we stand ready to accept your referrals 24/7. To arrange a transfer, simply contact Legacy One Call Consult & Transfer at 1-800-500-9111.

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We’re committed to working with you When you refer a critically ill patient to Randall Children’s Hospital, you can feel confident that your patient will receive quality care from a respected team of experienced, board-certified pediatric critical care experts. And as the referring physician, you will remain an informed and valued member of this team. We are committed to working closely and collaboratively with you, starting with our simplified Legacy One Call Consult & Transfer system, available 24/7 for provider consultation or for transferring or admitting patients. Legacy One Call Consult & Transfer at 1-800-500-9111.

The Pacific Northwest’s most experienced ECMO program For neonates and children with acute respiratory distress syndrome (ARDS), refractory sepsis or critical cardiac dysfunction, we offer the most experienced extracorporeal membrane oxygenation (ECMO) program in the Pacific Northwest — having served as a regional referral center since the 1980s. Notably, Legacy’s ECMO program was one of the first three in the nation to earn a Center of Excellence designation from ELSO (the Extracorporeal Life Support Organization). This objective, third-party recognition is a testament to the comprehensiveness of our ECMO program, the depth and breadth of our specialists’ expertise, and our superior outcomes in treating patients with ARDS.

For the critically ill pediatric ARDS patient, we implement a rapid, carefully escalated series of pre-ECMO interventions, consistent with ARDS net protocols, designed to protect young lungs while achieving optimal oxygen delivery. We also utilize a lung-sparing, high-frequency volume diffusive respirator (VDR) whenever possible to prevent pediatric patients from requiring ECMO, and to assist in their recovery on ECMO should it be necessary. For the best patient outcomes, please call the Legacy ECMO program early. ECMO is more effective if utilized before ventilator-induced lung injury and the consequences of hypoxemia occur.

For ECMO consultation or referral Simply call us. A single phone call will start the referral process and activate our transport team: Legacy One Call Consult & Transfer at 1-800-500-9111. Ask for the pediatric ECMO physician.

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Randall Children’s Hospital at Legacy Emanuel 2801 N. Gantenbein Ave. • Portland, OR 97227 Phone: 503-276-6500 www.legacyhealth.org/kidsonly