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Taking Surgery to the Patient

Taking Surgery to the Patient

For general pediatric surgeon Daniel Rhee, Thursday, Nov. 2 was not a typical clinic day to assess children who may need surgery or to follow up with patients who have undergone surgery. He usually sees patients in his outpatient clinic at Johns Hopkins Children’s Center, but this was one of the five days each month when he travels 50 miles north from East Baltimore to an ambulatory center near WellSpan York Hospital in south central Pennsylvania. There, along with seven other Johns Hopkins pediatric surgeons who rotate at WellSpan, Rhee sees patients who until a year ago had to travel long distances and navigate unfamiliar children’s hospitals for surgery. Now, thanks to a collaboration with WellSpan Health launched in September 2016, Johns Hopkins Children’s Center is bringing that specialized care to them.

“Previously a lot of pediatric patients in the York area had to travel an hour or more to a children’s hospital for pediatric surgical care,” says Rhee. “Now the surgeons in our group share time in their clinic each week and are on call for consultation. We’re virtually available anytime for York’s pediatric patients.”

The joint initiative is a novel, fresh approach to improving local access to high-level surgical care, notes David Turkewitz, chief of pediatrics at WellSpan. While the community hospital includes a 34-bed neonatal intensive care unit and an inpatient pediatrics unit staffed by pediatric hospitalists and residents, it lacks an in-house pediatric surgery service. In the past, partial pediatric surgery coverage for WellSpan patients was provided at hospitals in the region, but these arrangements were found not to be ideal or sustainable.

“When kids are sick, it’s a struggle for families to move their nidus of care away from home,” says Turkewitz. “We heard from the families in our community, and we knew they had a great desire for appropriate levels of surgical care for their children in York.”

Looking for a partner receptive to that need, WellSpan found Johns Hopkins pediatric surgeon-in-chief David Hackam, who had developed a similar model while at Children’s Hospital of Pittsburgh. Joining Hopkins in 2012, Hackam immediately set out to recruit top, nationally known surgeons and develop six pediatric surgical centers in fetal medicine, colorectal/bowel, short gut/intestinal care, trauma/burn, oncology and vascular anomalies. In all the centers, the emphasis would be on safer, minimally invasive approaches. For Hackam and Johns Hopkins leadership, offering these diverse and deep pediatric surgical services to patients in York made all the sense in the world.

“Our shared vision is to ensure that, whenever possible, pediatric surgery should be delivered in the community where the child and family live to make the experience as stress-free as possible,” says Hackam.

Adds Turkewitz, “In Dr. Hackam’s model, all of the surgeons are part of the same group. They have their islands of expertise and interest, but at their core they are pediatric surgeons committed to providing a high level of care in the community.”

At WellSpan, Johns Hopkins pediatric surgeons manage several conditions that commonly afflict children, including appendicitis, esophageal atresias, hernias, pyloric stenosis and skin lesions. Patients with more complex conditions, or who have special anesthesia needs or who require extracorporeal membrane oxygenation—or non-neonate patients who need post-operative intensive care—can be treated at Johns Hopkins Children’s Center.

Because WellSpan has a high-level neonatal ICU, newborns with complex conditions can now be surgically treated there. In August, for example, pediatric surgeon Isam Nasr rushed up to WellSpan to successfully operate on an infant with twisted bowel, a condition called malrotation with mid-gut volvulus.

“We had to untwist his bowel, release his adhesions and fix the anatomic abnormalities,” says Nasr, a surgical specialist in colorectal conditions. “The bottom line, it was a surgical emergency. If this child had to be transferred elsewhere and there was a delay in treatment for this condition, the bowel could die.”

In addition to improving local access to high-level pediatric surgical care, Johns Hopkins pediatric surgeons are aiding the education and training mission for pediatric and surgical residents who rotate through WellSpan. For Turkewitz, the opportunity to bring the academic rigor of a children’s hospital to the York community has been yet another value of the collaborative.

"Having the Hopkins surgeons here has been a great complement,” says Turkewitz. “Previously our general surgery residents would go elsewhere for pediatric surgery training but now, with the increased volumes and surgeries here, they are working closely with the Hopkins pediatric surgeons on every pediatric surgery admission. The feedback I’ve gotten from the surgical residents has been excellent.”

For referrals and appointments, prospective patients may call 717-812-4390. For more information, visit www.hopkinschildrens.org and www.WellSpan.org.
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