Outpost of CHOP

Corrections or additions?

This article by Barbara Fox was prepared for the May 21, 2003

edition of U.S. 1 Newspaper. All rights reserved.

Building Boom For Children’s Healthcare

In Victorian times, children were treated like miniature

adults. They dressed like adults, were expected to behave as sedately

as adults, and often worked in adult jobs. In today’s child-centered

age the exact opposite is true, and the child-centered attitude has

trickled down to healthcare. Pharmaceutical companies are being pushed

to study the correct doses for smaller bodies, and there seems to

be a building boom in children’s health care facilities.

Traditionally central New Jersey pediatricians sent their toughest

cases to the Children’s Hospital of Philadelphia (CHOP). Now the

Robert

Wood Johnson hospital system has opened the first freestanding

children’s

hospital in New Jersey, and the Children’s Specialized Hospital (CSH)

is exporting its services to a new facility on Quakerbridge Road (page

43).

Not only did the RWJ system acquire a special child-sized vehicle,

a $500,000 "super ambulance" that acts as an intensive care

center on wheels, but it has also just broken broke ground on the

Child Health Institute in New Brunswick. Meanwhile CHOP strives to

maintain its patient base by maintaining a pediatric outpost in a

small office on Alexander Road.

It’s getting to be a child’s world in healthcare.

Bristol-Myers Squibb

Children’s Hospital

Children are different," explains Phil Toussaint,

the Hillier architect who was the project manager for the

Bristol-Myers

Squibb Children’s Hospital at RWJ University Hospital in New

Brunswick.

"Children need an environment designed to their scale that won’t

intimidate them. When you are going to the hospital, it is a stressful

experience, and we don’t want to magnify that for the child."

Unlike the Children’s Specialized Hospital, which was built for

children

with special needs and needing rehabilitation, the B-MS hospital

treats

sick children in general. The 150,000 square-foot building cost $42

million to construct and has 70 private rooms. It offers same day

surgery, critical care, oncology, and more than 45 pediatric

specialties.

The hospital has even commissioned its very own ambulance, to be both

medically advanced and child friendly.

Architect Toussaint, the son of marketing researcher at Merck, is

a 1977 graduate of Virginia Tech who has been with Hillier since 1994

and has done other healthcare projects, such as Mountainside Hospital

in Englewood. Jan L. Bishop was the principal in charge at Hillier,

which collaborated with Boston-based Shepley Bulfinch Richardson

Abbott.

Before this structure was built in 2001, children had their own

department

within Robert Wood Johnson University Hospital with all of the

appropriate

specialties. But the perception was that really sick children would

go to children’s hospitals in Philadelphia or New York. So the two

goals were to design a hospital of international acclaim for New

Jersey

and to provide a home for New Jersey children — a freestanding

building dedicated only to them.

Another goal was that the hospital be well connected to the community.

"Working with the hospital we organized focus groups with

families,

previous patients and families, and with physicians," says

Toussaint.

"We went into two different schools, asking kids what they were

looking for in a children’s hospital and they did sketches."

The children asked for — and got — beds for their parents

to stay in the room with them (the parents even have work areas in

the rooms), interactive areas for fun and education, and a computer

gallery with play stations.

The hospital sponsored a street fair where children were invited to

put on masks and gowns and participate in mock procedures, and this

concept transferred to the family resource center and child life

program,

which has masks, gowns, surgical equipment, and dummies for playing

doctor. "Usually if you know more of what to expect you will be

more relaxed, which promotes healing," says Toussaint. "We

also wanted to intellectually stimulate them, and make it an

educational

process as well as a healing process, so their minds wouldn’t be

wrapped

up in their illness."

Carrying out the theme of exploration and discovery is the giraffe

in the interactive gallery. Stand under it and it measures your height

and talks to you. A harp looks as if it doesn’t have strings, but

if you stick your hand through it interrupts one or more laser beams,

and it plays those notes. As you walk by the animal heads on the wall,

they ask you questions.

Specialties include pediatric kidney transplant, pediatric dialysis,

pediatric urology, child psychiatry and behavioral pediatrics, and

pediatric hematology/oncology.

Implicit in the fanfare that accompanied the christening of the

pediatric

super ambulance for the RWJ University Hospital in New Brunswick is

the clear message that New Brunswick should be the destination of

choice for premature babies and very sick children who might otherwise

have been helicoptered to Philadelphia.

The new "super" ambulance, called Pediatric Critical Care

Transport, is the only hospital vehicle of its kind, because it serves

only children and has its own team of pediatric medical specialists.

The 10-ton vehicle, built on a Freightliner truck chassis, can even

take a parent along.

"This vehicle is for all purposes an intensive care room on

wheels,"

says Thomas Bojko, director of clinical operations at the hospital,

when the vehicle was christened on May 13. "Many talented people

spent months designing an ambulance that mirrors the Pediatric

Intensive

Care Unit, with its child-size ventilators, special gases, and

temperature

controlled system to store medications."

In addition to the latest equipment — respiratory ventilation

technology, on-board IV pumps — it has a television with a DVD

player so very sick children can watch the latest Disney movie.

"Metropolitan

areas don’t usually have these high-tech transport vehicles, but New

Jersey is such a highly congested state that even traveling a short

distance could take you two hours," says John Patella, the

spokesperson

for the hospital.

The Mobile PICU is one element in the push for preeminence that

continued

this past fall with the groundbreaking for the Child Health Institute

of New Jersey, a $72 million, 150,000 square-foot facility that will

do research on such diseases as autism.

For the near future: the Children’s Specialized Hospital will

construct

a rehabilitation hospital — different from the Quakerbridge Road

outpatient facility because it will have 60 beds on the campus. Also

under construction is a place where families of hospitalized children

can stay for a nominal fee: a Ronald McDonald House. Says Patella:

"Any of these are a symbol of New Brunswick as an emerging

pediatric

center of excellence for the entire state."

— Barbara Fox

Bristol-Myers Squibb Children’s Hospital at RWJ

University

Hospital, Box 2601, New Brunswick 08903-2601. Daniel A. Notterman

MD, physician in chief. 732-828-3000; fax, 732-937-8837.

Www.bmsch.org

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Outpost of CHOP

Other than right-sized equipment and child-friendly

decor, the primary reason why children go to children’s hospitals

is for the specialists. And though there are many reasons why the

specialists often prefer to work at the children’s hospitals rather

than the pediatric department of a larger hospital, the opportunity

to do cutting edge research is first on the list.

"Pediatric sub specialists are becoming a scarce commodity,"

says Chris Dougherty, vice president in charge of satellite offices

at Children’s Hospital of Philadelphia (CHOP), affiliated with the

University of Pennsylvania Medical School, which recently opened an

office at 707 Alexander Road. Founded in 1855, CHOP ranks second among

children’s hospitals in the nation (and therefore, probably the world)

in research funding. "With our academic and clinical and research

environment, we are able to recruit the specialists."

Ten years ago families had to drive to Philadelphia for treatment.

"Over time, we have become a pediatric healthcare network,

bringing

our services to patients and families," says Dougherty, a 1984

graduate of Allentown College of St. Francis de Sales with an MBA

from Widener.

Now thousands of families get access to CHOP doctors without making

the trip to Philadelphia. "Our patients’ families and referring

physicians have made it very clear to us that they would like to have

the high quality CHOP care closer and more convenient," says

Dougherty.

CHOP opened its first satellite center in Voorhees in 1994 and has

a total of four sites in New Jersey, including those in Linwood and

Atlantic City, and six in Pennsylvania, including one in Bucks County

at Chalfonte. Dougherty estimates that Princeton’s outpost of CHOP

is visited by 2,000 patients annually.

In addition to four full-time staffers, Princeton has a total of 18

CHOP doctors in these specialties: cardiology, gastroenterology,

endocrinology,

allergy, psychology, developmental pediatrics, and nephrology,

urology,

and general surgery. Soon there will be coverage for ophthalmology,

ear nose throat, and pulmonary. The office has enough room for two

doctors to work simultaneously. Except for the specialties of

audiology

and psychology, patients must be referred by their primary care

doctor.

"For the most part we can provide a comprehensive range of

outpatient

services right there in Princeton," Dougherty says. Children’s

offices offer specially-sized equipment or equipment that has been

calibrated for their size. Also the staff knows how to work with kids.

"There are very few pediatric trained echocardiographers,"

he says. "And not many phlebotomists can do a good job drawing

blood from kids who are kicking and screaming."

Some services still require a hospital visit. A child needing a

cardiac

catheterization would go to Philadelphia.

Is there any resistance to out-of-state medical centers opening in

New Jersey? "We might be insulated from that, being a children’s

hospital," says Dougherty. "It is my impression that areas

we go into don’t have pediatric sub specialty care available, and

that the authorities are happy we are providing services. We are

opening

an office in Egg Harbor in January, 2004 and they are already lining

up to welcome us in that community. A lot of kids were already coming

to CHOP."

The Children’s Hospital of Philadelphia, Princeton

Specialty Care Center, 707 Alexander Road, Suite 205, Princeton

08540. Don Nowill, manager. 609-520-1717; fax, 609-520-9333. Home

page: www.chop.edu


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