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Health Care

IATE Aprilf your child is sick and is admitted into the hospital for acute issues such as pneumonia or sepsis, a pediatric hospitalist will manage their care. A pediatric hospitalist does clinical work as well as building and supporting the infrastructure needed to do pediatric care — quick admission, working on medication safety issues that may come up and assuring that management plans are appropriate for the specific diagnosis. Hospitalists also work with various surgical specialties to help facilitate care with the medical component as they are working with the surgical component.

During discharge, they help with primary care physician (PCP) communication and what the patient's medical needs are once they transition to their day-to-day pediatrician.

AlvarezDr. AlvarezDr. Francisco Alvarez is an assistant professor in pediatrics at Children's National Health System (CNHS), Mary Washington Hospital (MWH) and Stafford Hospital (SH). Here is what he said about the pediatric hospitalist program.

Q: What is your role as medical director?

A: I oversee the pediatric hospitalist program at MWH and SH, which is basically looking at staffing components, but also their involvement in quality or care management practice of the pediatric unit, the nursery area at MWH and the population in the nursery and deliveries at SH. We also do Emergency Department consults that allow physicians or staff to consult our hospitalists with pediatric questions or concerns.

Q: Why did you decide to become a pediatric hospitalist?

A: I transitioned from residency and got involved in doing a lot more acute inpatient care. I had more interest in acute management of pediatric care versus the day-to-day aspect of clinical.

Q: What do you do on a daily basis?

A: I do clinical work at MWH and Children’s National Health System (CNHS) management along with the administrative component. The physician component is like any other physician. When a patient gets sick and needs to be admitted, we care for them. Pediatric hospitalists also handle floor plan arrival and write orders. We assess the patient and do everything from there on. We talk to the patient’s pediatrician and handle consults as well. While children are at Mary Washington Healthcare facilities, pediatric hospitalists perform all patient management. Like many local PCPs, pediatricians seldom see patients in the hospital anymore. When children are inpatients at Mary Washington, they are cared for by CNHS hospitalists.

The administrative part for me is assuring that the program does what its initial function and purpose is. I am not only making sure we have the staff trained and able to take care of patients in the hospital, but also that the structure within the hospital is built for pediatric care and that it is working with any safety, quality and regulatory issues that may come up. Basically, whatever is needed and whatever needs to be structured to make sure those aspects are taken care of.

girl with bearQ: Once a child is put into your care, who talks to the parents and explains management of care?

A: Pediatric hospitalists are in the hospital day and night seven days a week, so we talk to them at admission, and we round with them in the morning with nurses, students and family. Any issues that come up acutely, we are able to talk with them to go over it and manage it.

Q: Where can parents get more information about hospitalists for their child?

A: There is information on the MWH, SH and Children's National websites as to what a pediatric hospitalist is. There is also a handout that is given on arrival.

Q: How many pediatric hospitalists are on staff at MWH and SH?

A: Twenty hospitalists and one nurse practitioner.

Q: Does CNHS Pediatric Hospitalist Program at MWH and SH have future plans for development?

A: Currently, we are expanding or looking at aspects of how do we continue to manage the population in the nursery. We are also collaborating with the emergency department on expanding pediatric care in the ED so pediatric consults can be provided prior to children being admitted in to the hospital.

Q: How are you involved in studying current trends in pediatrics?

A: I’m looking at aspects of ways health care is managed and finding a cohesive structure of management. Is every person who is admitted getting appropriate treatment? The easiest way to do that is as a hospitalist group rather than each PCP coming to see a patient. 

The average lay person doesn’t know what a pediatric hospitalist is or why programs are being set up. The gist is that pediatric hospitalists are not there to replace your pediatrician. Their goal is to be part of the continuum of care with their pediatrician and what they are doing, but also when they get admitted to the hospital. Pediatric hospitalists are not only there to communicate with the parents about what is happening with their child, but that what they are doing is based on scientific evidence of what should be done and that they have built anenvironment that is safe for them in that area in an adult setting. Pediatric hospitalists are trying to build a mini biosphere in pediatrics within adult hospitals.

Meet the Expert

Francisco Alvarez, M.D., FAAP, is an assistant professor in pediatrics at Children’s National Health System (CNHS) in Washington, D.C., and medical director of the CNHS Pediatric Hospitalist program at Mary Washington Hospital (MWH) in Fredericksburg, Virginia, and Stafford Hospital (SH) in Stafford, Virginia. 

Throughout tenure at CNHS and his current position he has been involved in Computerized Physician Order Entry (CPOE) systems, Electronic Health Records (EHRs), Clinical Workflow Enhancement, Resident and Hospitalist Fellow Education, and Quality and Safety Improvement. He has presented work done on pediatric quality and safety improvement within community hospital settings at the International Quality and Safety Forum in Amsterdam, the Netherlands and London, England. He has also presented similar work at the Pediatric Hospital Medicine Conference in New Orleans, Louisiana, and Lake Buena Vista, Florida.


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