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Pediatric Potential


Dr. Hale foresees “humongous potential” for change in pediatric hospital medicine.

Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.

“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”

After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.

“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.

“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”

Floating Hospital has outreach programs at four community hospitals. How do those programs work?

If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.

What is the biggest advantage of those affiliations?

In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.

What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?

Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.

Can you quantify how many more patients are at Lawrence General?

Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.

Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?

We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.

Can you give an example of how that network has improved the quality of care?

We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.

It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.

Did you have to overcome any obstacles when the affiliation launched?

The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.

Do you think these types of affiliations will become more common?

Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.

How pleased are PCPs in the community?

It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.

Do you have to take a different approach to care because you are treating children?

The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.

What is the biggest challenge pediatric hospitalists face?

The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.

What is your biggest professional reward?

Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.

Mark Leiser is a freelance writer based in New Jersey.

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