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The Children's Hospital |  |
| James R. Kasser, MD | ||
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The Department of Orthopaedics at Children's Hospital remains a clinical machine subject to the stresses of the New England health care environment in the year 2000. Our hospital has incurred record losses over the last several years, and with this in mind, there has been a need to focus more than ever on efficiency and the "bottom line". The orthopaedic floor known to most of you as 10 North has been combined into a single floor with 10 West, now known affectionately as 10 Northwest. The focus of the floor is primarily trauma, orthopaedic patients, and thoracic surgery patients. By organizing the patients in this way our hope is that acuity and patient care requirements can be grouped to provide greater staff efficiency and savings. Based on our average length of stay of less than two days, our ward is nearly empty every Sunday and Monday. Dr. Ziegler, the chief of general surgery, and I felt the change would allow us to build a more efficient unit. As with every change, something is given up, and the isolated small unit with 18 beds that felt like home to all the residents who have passed through here over the last 13 years has changed a bit. I am confident that the level of nurs-ing expertise and clinical care will remain unchanged despite this evolution.
On Fegan 2, our outpatient area, we have moved toward a centralized system, which has changed the roles of all of the nurses and ancillary staff. We have added two nurse practitioners to our program in order to increase our responsiveness with a large number of "add-on" patients to be seen each day. We have also adopted a program of surgical coordinators who man-age the patients from the decision to have a surgical procedure through their admission to the hospital. I hope these highly skilled practice assistants will improve our patient satisfaction and help families through particularly stressful times.
With all these changes, the clinical effort continues to increase. We have had about a six- percent increase in the number of outpatients seen in our unit and we continue to see six to seven percent rise in surgeries performed, with a continued shift towards Day Surgery and Observation patients. The Orthopaedic Service within the hospital has achieved top grades in patient satisfaction when compared to other services in five of seven areas questioned. Our goal is not only to be the top in all areas, but to be sure that every patient who comes to Children's Hospital receives optimal care and a positive experience.
The efforts of the orthopaedic residents over the past year have been critical to our goal of providing excellent patient care. We have had five junior residents from the Harvard Combined Residency Program as well as one visiting resident at all times. Previously, we had a senior resident at Children's Hospital, but this was not possible this year. In the future, we will return to our original complement of house staff, which will make the teaching, research and patient care easier in these times of increasing demand. Our teaching program continues to expand with the medical student program under the direction of Dr. Timothy Hresko. We now have third year students in the out-patient area on a daily basis. Their involvement in the service will continue at its present level with a goal of learning basic pediatric orthopaedics and the orthopaedic physical exam. Medical students are also involved in the sports medicine program.
Spinal surgery remains at the forefront of the Children's Hospital program. The use of cages to hold bone graft and sup-plement anterior fixation has provided another step forward in the management of spinal deformity with anterior procedures. An article in this issue written by Drs. Lawrence Karlin and John Hall documents our efforts in this area. A clinical practice guide-line for scoliosis patients is being developed by Dr. John Emans with the hope of being able to decrease cost and provide more efficient care for this complex group of patients. Nearly all combined anterior and posterior fusions are done sequentially on a single operative day, a rather monumental task, but one that yields significant clinical benefit for patients. Dr. Hall has con-tinued to operate one day a week over this year with two half-days of ambulatory consultations. While he enjoys the three days of work, I think he enjoys the four days of vacation at least as much. Although Dr. Hall will no longer be operating after June, he will still be providing consultation and be involved in the operating room at times with other members of our clinical department. The spinal surgery effort continues to represent ten percent of our cases by volume, 25 percent of our relative value units (RVU's) and a majority of our complications. The tradition of excellent continues with Drs. Emans, Hresko, Karlin and Hall providing a majority of the care of patients with spinal problems.
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| Residents and Fellows, Spring 1999 |
Dr. Peter Waters has continued to excel in hand and upperextremity surgery within our department and is recognized as a leader in reconstruction of brachial plexus injury, with nerve grafts, tendon transfers, and osteotomies. His prospective study in this area is continuing and he is working to coordinate an international study on outcome in brachial plexus injury. The clinical guidelines for this study are presented in this issue of the HOJ.
The Sports Medicine group, with Drs. Lyle Micheli and Peter Gerbino is thriving, providing musculoskeletal care for high school, college and young adult athletes. The focus of their work is the prevention and treatment of injuries related to sports. Because of space constraints, we have moved the Sports Medicine group across the street for the time being, but we will reunite with them in the near future if all goes well with our con-tinued expansion.
Dr. Brian Snyder continues to work as the Acting Director of the Biomechanics Laboratory at Beth Israel Deaconess Medical Center. In providing this service, he has increased the number of grants received through that lab and has kept the lab on stable footing through its present transition. Dr. Snyder has both a Whitaker and NIH grant and continues to explore the bio-mechanics of bone and bone fixation systems. In addition to this, his clinical responsibilities in cerebral palsy continue to increase.
The Laboratory of Skeletal Disorders on Enders 11 is moving to temporary housing in the area near Fenway Park. Hopefully this will be a brief transition, and we will have space in the research building at Children's Hospital in the near future. Dr. Melvin Glimcher continues his leadership within the laboratory with senior researchers Drs. Peter Hauschka, Samy Ashkar and Erdjan Salih. Two new investigators who came into the lab last year, Drs. Kevin McHugh and Keith Solomon, both have submitted grants and are working toward independent funding within the lab. The current research efforts of their group are summarized in this review.
Three residents are participating in OREF-sponsored research within the department. Dr. Andrew Hecht has been working on a grant in cell signaling related to breast cancer. Dr. Saechin Kim has a grant from the OREF to study nitric oxide metabolism, and Dr. Young-Jo Kim has a grant from OREF sponsoring his study of the articular cartilage response to cor-rective osteotomy as determined by magnetic resonance imag-ing. Dr. David Zurakowski has also joined our group as a biostatistician. He has coauthored over 100 papers and continues to be a great help to our research effort.
There were two clinical fellows who completed our program last year: Drs. Joel Lerman and Thomas SanGiovanni. Dr. Lerman went into the practice of pediatric orthopaedics at Shriners Hospital in Houston where he is thriving and reports that all is well. His project on an analysis of Pavlik harness failures has been accepted for podium presentation this year at the American Academy of Orthopaedic Surgeons meeting and has been submitted for publication. Dr. SanGiovanni returned to the Miami area where he is in private practice in pediatric orthopaedics. His project on triplane ankle fractures was accepted for presentation at the Radiology meeting this year.
This past year, Dr. Hamlet Peterson was the 14th David Grice lecturer. He spoke on the incidence and treatment of growth arrests following physeal fractures. We had a wonderful day of research presentations and patient evaluation, as is the tradition for the Grice lectureship. A second visiting professor this year was Dr. Tony Herring from Texas Scottish Rite Hospital, speaking on polio and showing his recently produced movie "A Fight to the Finish." The dinner honoring Dr. Herring and other stars of his film included Dr. Thomas H. Weller, who won the Nobel Prize for the identification of the poliovirus. Included in the group for the dinner were a cast of characters from Texas who were instrumental in making the film, providing for a diverse group and a wonderful evening for all.
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| Dr. Johnn Herring, (middle) our guest speaker for the Grice Day, Dr. John Hall (left) and Dr, James Kasser (right). |
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| Residents and Fellows, Fall 1999 |
We have enjoyed having visitors to the department this year. Two individuals, Dr. Naum Simanovsky from Israel and Dr. Cemalettin Aksoy from Turkey, have added much to the depart-ment during their extended stays.
It remains a pleasure to work with the individuals, both res-idents and staff, assembled here at Children's Hospital. The pace remains somewhat hectic, the pressures of practice in the New England environment sometimes overwhelming, but the satis-faction is great. I look forward to clinical and research progress in all areas in the coming year.
Sincerely yours,
James R. Kasser, M.D.