The Next Milestone: Pediatric Operating Suite and PICU Will Complete Vision of a Standalone Children's Hospital
When pediatric surgeon Walter Pegoli, MD, left Johns Hopkins University for the University of Rochester Medical Center in 1997, he saw a region rife with opportunities.
“I knew it could take years to happen, but I saw incredible potential,” says Pegoli, now chief of Pediatric Surgery at Golisano Children’s Hospital. “We had the ability to develop a children’s hospital in Western New York that was second to none. What we’re seeing today is absolutely mind-blowing. But we’re not yet finished.”
The Little Idea That Could
While assessing the Rochester region’s potential to support a standalone children’s hospital 20 years ago, Pegoli considered his own caseload. As a young surgeon in Baltimore in the mid-1990s, he operated on dozens of children whose parents brought them to Maryland from cities like Rochester and from across upstate New York for life-saving surgical care.
“Pediatrics in general was very strong here, but pediatric surgery was almost nonexistent,” says Pegoli, professor of Surgery and Pediatrics. “Patients who needed complex newborn surgery, cancer surgery, gastrointestinal surgery, or non-cardiac thoracic surgery were referred to specialists in larger cities….Boy, has that ever changed.”
Upon coming to Rochester, Pegoli sought to plant seeds of ideas and build collaborations with physicians and administrators across the Medical Center who also believed in Rochester’s potential to be a center of excellence in the care of children.
Conversations gained momentum from hallways to cafeteria lunch tables to board rooms. A picture of the future began to materialize: a single location where people who only focused on children’s health care would collaborate easily as a high-functioning, cohesive team.
Buoyed by an outpouring of philanthropic and community support, “the little idea that could” became reality this summer when the $145 million freestanding Golisano Children’s Hospital opened. Complete with 52 private patient rooms, a brand new Neonatal Intensive Care Unit, spacious meeting places and visiting areas, the hospital is a work of art in itself.
Completion of the eight-story, 245,000 square-foot building—meticulously engineered and colorfully appointed to promote the most nurturing, healing environment for children—has catapulted the Medical Center to the forefront of pediatric care. Yet, longtime URMC leaders, staff, and faculty like Pegoli—who were involved in its embryonic planning stages—can’t wait to reach the next milestone.
“The dream will have truly come to fruition when the second phase is complete,” says Pegoli. “When we are able to enfold pediatric surgery and pediatric intensive care under the same roof, and co-locate all pediatric talent in one physical plant, we will give patients and families the utmost in seamless care completely separated from adult services. It’s something we’ve envisioned for a long time, and it will be the pinnacle for pediatric surgery.”
A Truly Standalone Hospital
Each year, 74,000 children from the 17-county Finger Lakes region and beyond come to GCH seeking complex care they can only receive here. Of these, more than 21,000 undergo surgery, a volume that increases between two and five percent annually.
The last phase of the construction will not only position the hospital to meet these demands, but will give pediatric surgeons the space and resources to advance their field. The pediatric surgical suite will be composed of six adjoining operating rooms, including a dedicated cardiac OR.
“Having ORs right next to each other that are solely devoted to pediatric surgery, with a cardiac catheterization lab nearby, and the PICU just two floors up, will make it so much easier to accomplish what we need to for children and families,” says George Alfieris, MD, director of Pediatric Cardiac Surgery and professor of Surgery and Pediatrics. “We’re very grateful for the philanthropic support for the project that will allow us to grow in our work. It’s just invaluable.”
Expected to open in 2017, the surgical suite will be located on the fourth floor, strategically sandwiched between the neonatal intensive care unit just below, and a new pediatric intensive care unit on the sixth floor. The PICU will be expanded from 12 intensive care beds to 18, and include 10 general pediatric beds. Proximity to pediatric radiology in the basement of GCH will also be a plus for surgical teams.
In addition to the dedicated cardiac OR, the hospital plans to develop a pediatric heart transplant program, capitalizing on the skills of Alfieris, an internationally recognized pediatric cardiothoracic surgeon.
Congenital heart defects are found in eight out of every 1,000 newborns, and Alfieris works closely with pediatric cardiologists in Rochester, Buffalo, and Syracuse to meet the needs of these children. Of the 3,500 practicing thoracic surgeons nationwide who are certified by the American Board of Thoracic Surgery, Alfieris is one of only 123 to hold subspecialty certification in congenital heart surgery.
“The University of Rochester has done a masterful job of developing a beautifully designed, full-service children’s hospital,” says James Sanders, MD, director of Pediatric Surgical Services at Golisano Children’s Hospital, and professor of Orthopaedics and Pediatrics. “This is going to be the light of upstate New York, and when the surgical suite is complete we will truly have a standalone children’s hospital that fully supports the expertise of our faculty and provides the highest continuity of care to children and families.”
As an orthopaedic physician, Sanders works with thousands of children who have spinal deformities and other bone and joint issues. Families travel to receive his team’s care from across the state, as well as from neighboring Ohio and Pennsylvania. The pediatric operating suite will be a more welcoming space for families like these, with an exclusive focus on the unique surgical and recovery needs of children.
“It will support our efforts to provide teambased care and attention in an environment centered completely on the needs of children, as well as on the special questions, concerns, and fears that parents have when their child is entering an OR,” says Sanders. “A child going into surgery is one of the most difficult experiences for a parent, but this customized atmosphere will help diminish that. Being able to team with parents to provide education and support in an atmosphere that is all about children, truly supports their recovery.”
Closer collaboration among pediatric anesthesiologists and surgical specialists will also be a natural outgrowth. For example, if a patient needs tonsils removed, but also has an undescended testicle, performing both surgeries on the same day could be accomplished more easily with additional operating rooms at the ready. For the family and the hospital, this is a much more efficient alternative than performing surgeries on different days.
“If all pediatric providers are situated in one place, it might just be a matter of moving from operating room three to operating room four,” says pediatric otolaryngologist Margo Benoit, MD, an assistant professor of Otolaryngology. “It opens up all kinds of opportunities for collaboration.”
In just a few short months since its opening, she has seen the benefits of the dedicated hospital.
“Now I’m able to tell patients and families, ‘When you come in for a CT scan or an X-ray, all of the people you meet are trained to work with children, and you will be in a setting designed just for you,” she says. “Every test and procedure a child goes through can be frightening. The welcoming space and experienced staff can transform that into something positive.”
When developing the blueprint for the new children’s hospital, the input of pediatric doctors like Benoit, as well as nurses, pharmacists, psychologists, social workers, and others across disciplines was collected and synthesized. The process gave them a once-in-a-career opportunity to discuss and improve many of the internal systems and methods they depend on every day to care for patients successfully.
“Our daily interactions and procedures are as important as the infrastructure of the building itself, so this gave us a tremendous opportunity to enhance the ways we work together and improve patient care even more,” says Sanders, who spends an average of 20 hours each week in the operating room. “For example, as we talk about the flow of children through the operating rooms, we’re asking questions like, ‘What’s the patient’s temperature? Are they being kept warm enough? Are the antibiotics being delivered at the right time?’ We are taking advantage of every opportunity to improve what we do.”
A Bigger, Better Classroom
The new operating space will not only offer pediatric surgeons an optimal stage to practice, but it will give them a bigger and better classroom to teach in. A typical pediatric operating room may hold as many as 20 people at a time, including a lead surgeon, surgical interns and residents of varied levels of experience, medical students, anesthesiologists and anesthesiology residents, scrub technicians, scrub technicians in training, nurses, and nursing students.
Walking quickly through the OR early on a busy Friday morning, Pegoli is flanked by eager-eyed students in rapt attention. The sight resembles a flock of geese flying in V formation. In the OR, he is a patient yet perfectionistic conductor, guiding yet testing and pushing, not settling for less than the absolute best each student on the team can contribute.
“Pediatric surgery is an epicenter for education,” he says.“Not just surgical residents, but so many different disciplines are rotating through and learning in here.”
Pegoli looks at surgical education as an apprenticeship, and “our job is to tailor every educational event to the readiness of the student. After many years of teaching you know innately what they can do and what they can’t, but it is always about raising the bar a little higher each time.”
Specializing in neonatal surgery, non-cardiac thoracic surgery, complex gastrointestinal surgery, and surgical oncology, Pegoli routinely spends more than 50 hours a week in the operating room. Recently, he operated on a two-day-old baby from Syracuse, N.Y., born with an omphalocile, an uncommon abdominal wall defect.
“During surgery, you might hear me asking the young doctors in the room, ‘How would you do this? Why? Where do you want to cut? Are you sure you want to cut there? Why? What tools are you going to use? Why?’” he says.
In addition to UR medical students, students come to Rochester from surgical training programs across the state, particularly to observe complex cases.
The new surgical suite will support their learning with high-definition video monitors, enabling everyone in the room to see as much as possible.
“Most of the laparoscopic work we do requires the senior resident to be up close to the table, learning next to me, and that limits the number of people who can see what I’m doing and why,” Pegoli says. “There are permutations to how we do things that need to be understood. The updated technology will give everyone an opportunity to participate, and offer a superior learning experience.”
If you Build it They Will Come ...and Stay
Hospital leaders can recall many instances in which an outstanding surgeon completed their initial training in Rochester only to pursue a pediatric surgery career at a freestanding children’s hospital elsewhere. But that’s all about to change.
“We’re transforming into a full-scale, full-service children’s hospital that will attract top faculty and retain our promising young physicians—which is exactly what Upstate New York needs,” says Sanders.
During a typical year, for example, there may be as few as two-dozen physicians completing their pediatric surgery fellowships across the entire country, which makes for fierce competition among hospitals looking to recruit pediatric surgeons. By the time many of these doctors complete their fellowships in pediatric surgery at freestanding children’s hospitals such as Children’s Hospital of Boston or Johns Hopkins Children’s Center, they are accustomed to working in those facilities.
“So it was difficult in the past to attract someone to the floor of a general hospital,” Pegoli says. “They would come here and say, ‘Wow, I’m taking a step back.’ But now we lack for nothing in comparison. Our facility truly puts us among the best in pediatric care, and makes Rochester a superb place to build a career.”
Even before the paint was dry, three pediatric surgery fellows from around the country scheduled tours of the new children’s hospital.
“This has important implications for the future,” says Benoit. “We are looking at serving generations of children for years to come, and that makes it easier to appreciate why it is critical for us to train and keep the best specialists in Rochester.”
She says the Department of Otolaryngology is also in the process of recruiting more specialists.
“We have been looking for another pediatric otolaryngologist for some time and recently hired someone who will be joining us in the summer of 2016,” she says. “As the new hospital was going up, we started to see more interest, and it helped us attract the most qualified candidates.”
The new recruit, John Faria, MD, says the children’s hospital was the main reason he chose to come here.
“I was looking for a pediatric otolaryngology position at an academic teaching hospital,” he says. “It’s great to be part of a hospital from its inception, to establish a career here, and to hopefully help grow its reputation throughout the region.”
When the surgical suite opens in 2017, doors also open to a realm of other possibilities—a pediatric surgery fellowship program among them.
“Right now, there are only about 30 places in the country that train pediatric surgeons by offering two years of additional training after general surgery training,” says Pegoli. “Before I retire, I would like to see us develop our own fellowship training program. This will be the next rightful step, to nurture a supply of talent who will become the next generation of faculty.”
Whether a fellowship program is established or not, Benoit, who joined the URMC three years ago, has already witnessed the difference the hospital has made for children and families. “Everyone associated with the University should be very proud,” says Benoit. “It’s exciting to see the direction we are moving in. As a parent, I feel hopeful that my community is investing in the health care of children, and as a medical provider and faculty member, I feel grateful that people understand and support the important work we do here every day."