New Pediatric Department streamlines care

Clinical Center assessing how to expand services for children

The NIH Clinical Center is adjusting how it treats pediatric patients, and it marks a culture change.

In 2022, the hospital's Pediatric Consult Service became the Department of Pediatrics. Dr. Deborah Merke was appointed chief of the new department which has been staffed with 12 people on the care team.

One of the first initiatives was to establish the Pediatric Hospital Medicine (PHM) service with the goal of creating 24/7 pediatric, age appropriate care by in-house hospitalists.

"A hospitalist is a physician who practices solely in the hospital environment providing 24/7 care. Actually, this model of care started in the mid-90s and was first developed in pediatrics" said Dr. Jill Rothschild, who joined the Clinical Center as one of its first hospitalists in 2017.

Tied into this new approach is the desire to expand pediatric services offered by the Clinical Center and its intramural (NIH-based) partners, including first in human treatments for young children. The strategy is to use early interventions that may cure diseases and prevent the morbidity and mortality that can occur in some rare diseases.

"The ultimate goal is to be strategic, build capacity and strengthen our infrastructure for Pediatrics to enable us to see more and more kids," said Dr. Deborah Merke, chief of the Clinical Center Department of Pediatrics.

The Clinical Center has about 1,500 active protocols, one-third of which include children.

The pediatric inpatient unit has 18 beds and 11 day hospital stations. There is a 6-bed pediatric behavioral health inpatient unit and a pediatric outpatient clinic with 20 patient care rooms. The Clinical Center has 247 board-certified pediatricians.

Recognizing that there is a lot of work ahead, the Pediatric department is using a phased approach to methodically implement change. The team has been working with other NIH institutes to create this new service, which is providing 24/7 in-house care for pediatric inpatients.

"It's bringing it all together under one umbrella, so it's more efficient use of pediatric resources. The 24/7 care from a pediatric hospitalist, along with daytime care from our pediatric nurse practitioners, is helping improve treatment for pediatric patients in the hospital.…[O]ur goal is safe, high-quality, pediatric care," added Merke.

One huge change has been streamlining patient care. There are 15 NIH institutes that admit children in the Clinical Center. The new department means that instead of each Institute taking the lead for providing care of hospitalized children enrolled in their protocols, there's now pediatric hospitalists and pediatric nurse practitioners within the Department of Pediatrics who are onsite providing care and integrated into a team approach with the Institute investigators. The pediatric hospitalists also work with the pediatric oncologists who are in-house 24/7 taking care of transplant and cancer patients.

"The PHM service is a delight to work with. My service specifically and the surgeons in general value the services provided by the PHM service. The practitioners in the PHM service are approachable, and are a joy to work with. In my opinion, the care of our littlest patients has improved with the PHM service on board at the Clinical Center," said Dr. Prashant Chittiboina, a clinical investigator in the National Institute of Neurological Disorders and Stroke's Neurosurgery Unit for Pituitary and Inheritable Diseases and chief surgeon of the Clinical Center.

With complex care, the Pediatric department maintains flexibility in managing the wide range of studies and different populations seen at the Clinical Center.

"Drs. Deborah Merke, Jill Rothschild and all the members of the CC Pediatric department should be given great credit for the work they've done to revamp and improve pediatric care at the NIH Clinical Center, especially for standing up a first-class pediatric inpatient service. A significant proportion of patients admitted to the Clinical Center are pediatric, and having an inpatient service staffed and run by pediatricians has had an immediate effect on improving patient safety and will go a long way to ensure the children we treat on investigational trials at the NIH receive the best care possible," said Rear Admiral Richard Childs, MD, senior investigator for Transplantation Immunotherapy and clinical director for the National Heart, Lung, and Blood Institute.

- Donovan Kuehn