stand-alone children's hospitals

[14022]

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Hw important is this for you guys when choosing a residency? For those of you who have done work at a hospital where the pediatrics center is a few floors in the main hospital, how has this worked out? I am just curious.

 

[gvmatt]

here is my 2 cents on the topic.

i am a msiv at a u that does not have an independent children's hospital - but has one floor in the main hospital. i interviewed mainly at true children's hospitals and a few that were with in the main. and there are several important issues that this brings up.

children's floor - the things i found to be most important are 1)are the support staff specifically trained in peds or are they shared by the entire hospital (ie phlebotomy, etc). 2)a true peds radiologist 3)child life specialists
4) do they have all the ped specialists available and in multiples- ex. some may only have one given peds nephro and then that person leaves - now there is no one to consult with and it stinks when that happens! 5)are the specialists covering more than one hospital - makes it a whole lot harder to talk to

now i found that some children's floors truely act like a children's hospital - the above issues are not a concern and the same true for actual children's hospitals.

hope that helps some.

 

[GeneGoddess]

I agree. The only issue seems to be the ancillary stuff (techs/nurses being trained in Pedi, child sized "stuff", etc). Most "newer" hospitals (ours opened in 2000) do have child specific things, even though they may have to share a CT scanner with adults (shudder). However, a good question is "Where is L&D?", since you will have to go there to GET your newest patients. I've seen good and bad things about both set-ups. I think my preference is more "newness of hospital" versus built-in/stand-alone. Also, some stand-alone may not have a large enough population to have their own equipment (a helipad, for example), so kiddos might have to be transfered to a larger adult hospital to receive certain treatments (like trauma resus).

 

[notstudying]

I think there are advantages and disadvantages to both. I'm at a hospital within a hospital-we have a separate name, and a dedicated floor, but are within a larger hospital. We are a quaternary care facility, drawing from a 9 county area, so we have a pretty good volume (40+ NICU beds, 20 PICU, and 60 something floor beds), but I think it would be hard to have the same level of ancillary services (radiology, phlebotomy, etc) at a free standing hospital in a similar sized community. We do have a helipad (2 actually). We have lots of peds specific people-radiologists, pharmacists, anesthesiologists. Not sure about a pedi CT though! We have attendings in all the specialties, and a pediatric division for most (I think rheum and derm are the only exceptions). We have child life (both on the floors and in the ED-which is a separate peds ED), a school room, a playdeck, and an onsite Ronald McDonald house. One drawback to a children's only hospital is that some have no well-babies-I think most programs have alternate sites for newborn, but I like having it on site (and of course we do lots of deliveries on our NICU rotation!). It's also nice to have adult services to consult when our older adolescents come in with adult issues (OB/gyn issues, advanced kidney disease from type2 diabetes)-not only do we have their advice but I find it's easier to transition them to adult providers when we have them onsite. We also get adult patients with pediatric problems (Ewings sarcoma, CF) who still are attended on by the pediatric specialists, but can be on adult floors. We also have med peds residents, which I don't think you usually have with a freestanding peds hospital, and they add a nice perspective to the program. I think the ideal might be an attached but physically separate children's hospital (I think Yale might be this way). But I like where I am 🙂.

Downside: The lobby isn't very child friendly!