Most parents would be happy if they never had to step foot in a Children’s Hospital. For those that do, and most of us have at some point, the Children’s Hospital of San Antonio (CHofSA) is a beacon of light and hope, literally: the multicolored panels outside the building match the colors of the mural and will soon be lit at night. One is calm and at peace after walking into the Emergency Department’s only entrance while construction is underway. A beautiful building helps calm a person, but patient care makes the difference.
For many, the first visit to the hospital is in the Emergency Department (ED), which sees up to 70,000 patients each year. To streamline the process and enhance infection control, the units have been combined, so that the ED is like a “little hospital,” said Dr. Mark Gilger, chief pediatrician of CHofSA.
Carol, mom of two active boys, described an earlier visit.
“We had to go to different floors and into and out of different rooms, it was stressful and tiring,” she said.
Last week, she visited again with her son and noted the marked improvements. Needing an X-ray, they only had to move a few feet. The services came to them.
Family Centered Care
CHofSA is focused on caring but for families. When a child is ill, the entire family is the patient. When multiple patients share a room, it is difficult to maintain privacy when the provider must discuss the child with the family. Recognizing this need to involve the family in the child’s care, ChofSA took three in-patient rooms and transformed them into two spacious rooms with comfortable chairs and an area for sleeping. Rooms are spaced along the hall with nurse stations in between, rather than in a central location. This allows the nurses to be close at hand and to look into the window at their patients while they’re working outside the room.
Fragile lives in the NICU
Addison was born at 24 weeks gestation and has been at CHofSA for the past 70 days, continuing to grow stronger. Her mom, Lindsey, is a clinical care coordinator in the hospital, visiting her baby as often as possible. Not wanting to bring a potential deadly disease into the NICU, she changes from her work clothes before entering the NICU. With hospital-acquired infections so problematic across the country, the CHofSA has made itself accountable to the public through its commitment to monitoring and rectifying any potential problems by publishing its quality assurance data on its own website, the only hospital in San Antonio to do so. That this culture of transparency and quality prevails is evidenced by Brown, both an employee and a patient.
Any parent who has had a child in NICU knows the terror of those early days of a child’s life. The team at CHofSA have designed their NICU to accommodate those families. Prior to 2007, the NICU was one large room, with no privacy, few comfortable chairs, and bright fluorescent lights. Finding a place to pump much needed breast milk, bonding with your newborn in a private setting, or dealing with the challenge of a very sick child were not easy in the old facility. The current NICU allows for privacy, with cribs spread out throughout the U-shaped unit, soft lights and darkened spaces allow for peace and quiet, and lactation rooms are provided to new moms (84% of the newborns receive at least 50% expressed breast milk).
With the change to a stand alone children’s hospital, the only in the city, there is now space to expand the NICU, which will be a Level 4 facility with 60 beds, 25 in the open bay for the most critically ill newborns and 35 beds will be in private rooms with sleeping areas for the families, according to Crystal Strickland, RNC, NICU nursing director. There will also be a Ronald McDonald House occupying one floor of the hospital.
From Christus Santa Rosa to CHofSA
It has been a long road to get here. Christus Santa Rosa was a teaching hospital partnering with the University of Texas Health Science Center at San Antonio (UTHSCSA) for many years, but in 2013 the two severed most ties. With the support of the San Antonio Medical Foundation, the university sought to partner with the Children’s Hospital of Philadelphia and Vanguard Health Systems, now part of Tenet, which owned the local Baptist Hospital System, to build another children’s hospital. The plan eventually hit snags, and the SAMF is focusing on enhancing the collaborative efforts of the bioscience and healthcare communities.
Meanwhile, Christus furthered its plan to turn its downtown hospital into a stand alone full service Children’s Hospital in San Antonio, partnering with Baylor College of Medicine in Houston. The Goldsbury Foundation has a long relationship with the hospital by establishing the David Christopher Goldsbury Center for Children and Families in 1999 and contributing to the Center for Miracles. They recognized the need for a unique and dedicated children’s hospital in San Antonio, so they offered a $20 million donation, $5 million of which was dedicated to fighting obesity and diabetes.
H-E-B, Valero, the Klesse Family Foundation, the USAA Foundation, the Najim Family Foundation, the Mays Family Foundation, and SWBC Foundation donated a combined $23.5 million. This commitment from community leaders sent a clear message that CHofSA would have the support of the local community. The CHofSA is the only free-standing, not-for-profit children’s hospital in San Antonio.
The shifting relationship between UTHSCSA and CHofSA has meant a huge change in how medical students are trained in the Department of Pediatrics at UTHSCSA, according to its Chairman, Dr. Tom Mayes. “But we’re in good shape. Our students train with University Health Systems, San Antonio Military Medical Center, and many community and private clinics. It’s just different.” Despite the change in institutional alignment, there still exists a strong relationship between the hospital and San Antonio’s only medical school: The Center for Miracles.
Begun in 2006 through a joint effort of Christus Santa Rosa, UTHSCSA and UHS, The Center for Miracles provides a wide array of services for victims of child abuse. The leaders of all three institutions decided that this collaboration was important to preserve. CHofSA provides the staff and the space to continue the program while UTHSCSA and UHS provide trainees and funding for a three-year subspecialty program in child abuse for pediatricians. Most faculty in the hospital are from Baylor College of Medicine but the Center’s three faculty physicians are from UTHSCSA. Despite the “breakup,” the two institutions have maintained close professional ties, all committed to the health of the community.
Facilities are important, but most critical is the staff. In a city with a high nurse vacancy and turnover rate in the hospitals, many of CHofSA’s nursing staff have been with the hospital for more than 20 years, such as Nurse Strickland in the NICU. While visiting with a young cancer patient, Sal McKeel, RN, Program Director of Hematology and Oncology, talked about his more than 30 years with Christus Santa Rosa and now CHofSA. Many of his repeat patients asked for a particular nurse and room. Having not only a friendly face but a familiar face can make a world of difference for a patient.
Meanwhile, Dr. Gilger and Elias Neujahr, President of CHofSA, have been busy adding to the team of physicians. While doctors like Dr. Debbie Callanan, who has been on staff for 28 years, provide expertise, experience and local knowledge, top quality physicians have also been recruited from across the country with one motto: “I’m in.” They must be committed to the mission: serving the families of San Antonio and the surrounding area.
*Featured/top image: A nurse cares for a child at the Children’s Hospital of San Antonio. Photo by Scott Ball.