Richmond is fortunate to have great health care providers,” says Melissa Nelson, MD, a Richmond pediatrician and mother of four, “but as a pediatrician, I don’t have one place I can tell families to take their children for everything. I’m sending them all over town.”
Dr. Nelson is one of eight board members of Pediatricians Associated to Care for Kids (PACKids), a group of doctors united to establish a hospital in Richmond that is exclusively for children. Dr. Nelson estimates there are close to two hundred pediatricians behind the mission of PACKids.
Richmond has no shortage of great pediatric health care, but children who are hospitalized here are placed in pediatric units of hospitals that are made for adults. Interim steps to provide enhanced children’s services across the area include VCU Health System’s Children’s Pavilion, a new structure on the MCV campus exclusively for children that will consolidate outpatient services in one central location and include parking. In addition, next month Bon Secours will open its expanded pediatric emergency department at St. Mary’s, which will have a dedicated entrance, waiting room, and triage area just for pediatric patients.
For now, however, instead of relying on one pediatric headquarters, families often find themselves driving from one end of town to another.
The PACKids’ mission to bring a full-service inpatient and outpatient hospital to Richmond gained some traction in the spring, when a feasibility study indicated that a 200-bed children’s hospital would not only be supported by the regional market, but would also bring $370 million in revenue by 2022.
Coordination of Care
Consolidating the area’s pediatric services under one roof would certainly make things more convenient, but Dr. Nelson says it’s about much more than reducing drive time. For children with complex medical needs, it would mean better coordination of care among specialties.
“For example, allergies and asthma are pretty common in children,” says Dr. Nelson. “But right now, there is no [dedicated children’s hospital] where pulmonologists and allergists are getting together to coordinate care for children who have both.”
Research shows that coordination of care is crucial to favorable outcomes for adult patients. That need is multiplied for children, who are likelier to have emergent problems that involve various specialties, and are less able to communicate with their providers than adults are.
“We have amazing physicians in this city,” Dr. Nelson says, “but if they can’t work together efficiently, then the standard of care is lower.”
A Kids-only Environment
In addition to having all pediatric specialties under one roof, PACKids aims to have them in an environment that’s only for kids.
“In hospitals that are made for adult patients, children can become an afterthought,” says Dr. Nelson. “If you bring a child to an emergency department that isn’t equipped for kids, even the waiting room is intolerable.”
But having a kids-only environment isn’t just for comfort, or to shield young eyes from some very adult sights. Even when a pediatric unit is well isolated from a hospital’s adult population, ancillary services like lab and dietary may not be optimally equipped to serve tiny customers.
In fact, studies have shown that hospital pharmacies are particularly prone to error when preparing medications for pediatric patients in a largely adult hospital.
Richmond is one of the largest metro areas in the United States without a dedicated, free-standing children’s hospital. Knoxville, Tennessee, and Akron, Ohio, both have lower populations than Richmond, but they boast highly regarded medical centers that are especially for kids.
And Richmond is right in the center of an area that has demonstrated a need for elevated pediatric health care. Consider these statistics:
A recent national study by the Commonwealth Fund revealed that Virginia ranked fourth from last when it came to “children with special health care needs whose families received all needed family support services.”
According to the National Association of Children’s Hospitals and Related Institutions, free-standing acute-care children’s hospitals provide more than ten times as much patient care to low income children as community hospitals do. That means a lot to a city whose rate of free/reduced lunches is nearly twice the national average.
A report by Voices for Virginia’s Children found that mental health care for children in the state is inadequate and hard to access, leading too many kids to residential facilities or the juvenile justice system.
What Parents Want
Jennifer Palazzo, a West End mother of two, is excited about the push for a new hospital. When her son, Thomas, was ten years old, he developed a mysterious illness that required the involvement of several specialists to figure out. He’s since recovered, but Palazzo says the experience taught her how important it is to have these people and services available in one place.
“Had this not happened to our family,” she says, “I would have no idea what Richmond was lacking.”
In addition to what she calls “one-stop shopping,” Palazzo also strongly supports having a hospital where kids are the only patients. She recalls visits to one area hospital where she and her son saw inmates being escorted through the halls for treatment.
“He thought that was pretty exciting,” She says, laughing. “I did not.”
Having lived in New Jersey and Ohio before settling in Virginia, Palazzo says that these plans seem long overdue for the River City.
“It’s just hard to believe,” she says, “that a city as vibrant and economically sound as Richmond doesn’t already have a dedicated children’s hospital.”
Shannon Hubbel, a Chesterfield mother of three, agrees. Her 5-year-old daughter, Emily, was diagnosed with a type of cancer called neuroblastoma two years ago. Emily’s treatment has taken them to hospitals in several states. The family has seen the ins and outs of kids-only hospitals as well as standard hospitals, gaining insight into the differences.
“Hospitals that are made for adults seem to be less organized,” says Hubbel. “At hospitals where there are only kids, you have a schedule and a time, and those times are honored.”
Hubbel says kids with cancer especially benefit from having a more controlled environment.
“Children who are undergoing chemotherapy have extremely low blood counts and are subject to catch anything going Around,” she says.
A dedicated hospital for children could offer more room for privacy to prevent harmful exposures, Hubbel says, and also to group pediatric patients by their conditions instead of their age – just as adults are.
“These are things I never would have thought about before,” she says. “But now that we have been on this journey for a while, I can totally see where improvements can be made. I think a true children’s hospital would be a big one for Richmond.”
Right now, site studies are underway to determine where in Richmond a hospital would be easily accessible, with lots of green space and room to grow.
Dr. Nelson says she hopes that more families who recognize the need will speak up about it, writing letters to editors across Central Virginia and talking to their doctors about what it means.
“I don’t know anyone who doesn’t think this would improve care for our kids,” she says. “And the more we hear from the community on this, the faster it will move forward.”
Bruce P. Kupper, president and CEO of MEDARVA Healthcare, agrees. “The voices of parents and physicians are important,” says Kupper. “We believe that the community needs to participate in the discussion at this time – on the need for, and benefits and role of a dedicated children’s hospital in Central Virginia.” MEDARVA Healthcare provided $25,000 in funding to PACKids to help engage the broader community in the discussion.
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