Meeting Families Where They Are

Monroe Carell Jr. Children’s Hospital at Vanderbilt opened in 2004 as the first freestanding children’s hospital in Middle Tennessee. Prior to that, Vanderbilt’s pediatric care was provided on a smaller scale within the larger Vanderbilt University Adult Hospital.

Nashville’s, the state’s and the region’s populations have experienced skyrocketing growth in recent years. That also means people living farther away from the city, and driving longer distances, factors which don’t always make the trip into Nashville for health care convenient for families juggling work, school, extracurricular activities and family life. Children’s Hospital understands how life has changed for many and wants to ensure that quality, compassionate care for children, adolescents and young adults is available where families need it.

Children’s Hospital now has 20 satellite locations in addition to its flagship hospital in Nashville. Nearly 35% of the specialized clinical care pediatric patients receive is delivered at one of these community locations. In addition to care, Children’s Hospital is touching the community in many other ways — advocacy programs like sports safety and automated external defibrillator education; supporting neonatal intensive care units and newborn nurseries; outpatient surgery closer to home; and after-hours clinics.

“Children’s Hospital has always been committed to growing our programs to meet the needs of our community and region. Moving into the freestanding hospital 16 years ago was a pivotal moment that marked the beginning of our journey to continually refine and plan for optimizing how we serve children and families — part of that is meeting families where they are,” said Meg Rush, MD, MMHC, president of Children’s Hospital. “We offer all services under one roof, but we also have been intentional about taking our services to both nearby as well as more distant communities, making our specialty programs more accessible to families.”

More clinics across the state mean shorter travel for care

Brookelyn Baker, 10, enjoys being outdoors at her home, especially with her pets — two alpacas, rabbits and a dog. Several times, Brookelyn and her parents, Melissa and Bryan Moffitt, have made a 90-minute drive from their home in Clarksburg, Tennessee, to Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville. The 107-mile trip to Children’s Hospital saved her life after a diagnosis of heart failure, requiring a heart transplant, which now requires follow up clinic visits.

But Children’s Hospital hopes to make clinic visits easier for patients like Brookelyn so they can have more time for the things they love, like taking care of their animals. Children’s Hospital has been working to bring its pediatric care closer to where families live, work and play so they will have more opportunities to get the same quality of care, designed for infants, adolescents and young adults, near home. One of those clinics in Jackson, Tennessee, where Children’s Hospital offers pediatric cardiology services, is only 33 miles from where Brookelyn and her family live.

A life-saving journey

Brookelyn was the picture of health until Christmas break 2018 when she had what her parents believed was the flu. She recovered and then developed disabling joint pain.

Over a period of weeks, Brookelyn and her parents saw her pediatrician in Huntington, Tennessee, and made two trips to Children’s Hospital to try to determine why she continued to have the joint pain that was often so painful she couldn’t walk.

Her pediatrician at first thought it was reactive arthritis from her bout with the flu, but nothing was confirmed even after a round of tests in the emergency room.

Her pain got a little better, then a few weeks later, worsened. In February, her physician sent her to Thomas Graham, MD, chair of Pediatric Rheumatology at Children’s Hospital. Shortly before her appointment she became short of breath and felt like her heart was racing, Melissa recalls.

“Dr. Graham listened to her heart and tried to check her hip joints. When he had her lie down on the table, she shot up like a daggum rubber band,” Moffitt recalls. “She couldn’t breathe and felt like she was smothering. That’s when Dr. Graham started putting the pieces together.”

Brookelyn was sent to Children’s Hospital’s pediatric cardiology team where she was diagnosed with Kawasaki Disease, a rare disease that causes inflammation in the walls of blood vessels in the body and can damage the coronary arteries, the vessels that carry blood to the heart. If caught early it can be treated, but Brookelyn did not have textbook symptoms. By the time of diagnosis, her heart was damaged beyond repair. Her breathing difficulty was from fluid around her heart and lungs.

She was treated with medication for a couple of weeks to see how much heart function could be regained, and felt better after the fluid was removed. But Brookelyn continued to have very irregular rhythms and her heart function was poor. David Bearl, MD, MA, her cardiologist, told her family it was best to immediately put her on the list for a new heart.

“It was incredibly scary to go from having no idea what was going on with her to finding out she would need a heart transplant,” Melissa said. “We walked into the rheumatology appointment with Dr. Graham talking about where we would eat lunch when we were done, and then we were broadsided by all this information and finding out her heart function was minimal.”

In March 2019, after signing the consent forms to list Brookelyn on the nationwide registry for a new heart, Melissa and Bryan left her at the hospital with her grandfather and began a quick trip home to see their other children. They planned to tell Brookelyn about the transplant when they returned to Nashville the next day.

They got within 30 minutes from home and Bearl called to tell them the unbelievable news they had a heart for Brookelyn. The couple instantly returned to Nashville.

“Literally, there was probably a three-hour period from when he told me (she would need a transplant) until the time he called me to say, ‘we have a heart, they’re going after it tonight and she’s going in for surgery first thing in the morning,’” Melissa said. “It was insanely fast. Brookelyn didn’t even know the word ‘transplant’ had been mentioned. And we figured we had a few weeks at least to talk to her about it, but it was bam, bam, bam, with no time to get used to the idea.”

The Moffitts told Brookelyn as soon as they got back to her hospital room. “She was a little upset at first, but surprisingly was like, ‘OK,’ and went right back to what she was doing,” Melissa said. “She really didn’t have time to be scared about it. They rolled her back about six hours later and she just went with it.”

Brookelyn’s transplant in March 2019 and her recovery couldn’t have gone any better, Melissa said. “She has not had the first issue with anything. She’s right back to where she was before she got sick.  She’s getting very big for her britches,” Melissa laughs. “I think this has given her a new fire.”

Brookelyn was seen at Children’s Hospital for her post-transplant visits, but now, on a more routine schedule, she should be able to see Bearl in Jackson, Tennessee, about 33 miles from their home and where Melissa works as a neonatal nurse. Bearl sees patients in Jackson one week out of every month.

“We realized that more communities were requesting our presence,” said Kris Rehm, MD, vice chair of Outreach Activi­ties and medical director of Hospital Operations for Children’s Hospital. She also leads the Division of Pediatric Outreach Medicine, which provides a home for faculty who primarily work away from the main campus.

Children’s Hospital now has 20 locations throughout Ten­nessee, and one in Madison, Alabama, where patients can be seen for specialty care or after-hours care for illnesses when a pediatrician’s office is closed for the day.

“Anything we can do to help families, we need to do. Maybe a parent can work a half day before taking her child to see Dr. (Jay) Wellons (a neurosurgeon) in Alabama or Dr. (David) Bearl in Jackson. Maybe a parent can work all day and bring his child to an after-hours clinic at a time when it’s convenient. As a working mom, I appreciate the opportunity to have care options as convenient as we can possibly make it,” Rehm said.

Expanding the footprint

In 2017, Children’s Hospital began to focus heavily on creating after-hours clinics, primary care and subspecialty care, all in locations away from the VUMC campus. Children’s Hospital physicians also work with inpatients at Williamson Medical Center and provide newborn nursery services at three community hospitals: Sumner Regional in Gallatin, Tennessee, Vanderbilt Wilson County in Lebanon and NorthCrest in Springfield.

Children’s Hospital also has a level IV NICU, the highest state and national rating an NICU can earn, reflecting the hospital’s expertise in treating the most complex problems facing the tiniest and sickest infants. The hospital has brought that expertise to the community, and now manages neonatal intensive care units at four regional hospitals.

Currently, Children’s Hospital’s neonatologists and neonatal nurse practitioners provide care at the Level II NICUs at Maury Regional Medical Center in Columbia, and Tennova Healthcare in Clarksville. Additionally, teams deliver care at the Level III NICU at Jackson Madison County General Hospital, in the western part of Tennessee.

More recently, Children’s Hospital entered into a partnership with Erlanger Children’s Hospital in East Tennessee, to assist in management of its Level III/IV NICU.

“Many of the physicians and nurse practitioners in these NICUs trained at Vanderbilt and bring our protocols and expectations for excellence with them,” said Susan Guttentag, MD, director of the Division of Neonatology and Julia Carell Stadler Professor of Pediatrics. “We recruit others into our practice who have demonstrated that they share our same ideals. Together, we strive to offer the same care in these communities as if these patients were here at Children’s Hospital, but closer to home, which reduces the stress on the parents of our fragile patients.”

Infants at the satellite NICUs who need more intensive care can be transported to Nashville by the Children’s Hospital Neonatal/Pediatric Transport team.

The outpatient arm also continues to expand. Children’s Hospital now has five after-hours clinics with locations in Mt. Juliet, Hendersonville, Spring Hill, Brentwood and Smyrna, also home to a Vanderbilt-run primary care practice. Children’s Hospital’s new surgery and clinics facility in Murfreesboro also features an urgent care clinic, with extended weekday hours.

Because illnesses like fever, sore throat and asthma don’t keep regular business hours, the after-hours clinics, open nights and weekends 365 days a year, provide families the option to get treatment when their pediatrician’s office is closed.

“These clinics are rapidly approaching 30,000 visits a year and we’re seeing more children a lot closer to their homes,” Rehm said.

The specialty clinics allow Vanderbilt subspecialists to provide care in those locations during the day.

“We are able to bring the most specialized care that our patients need, closer to home. We have some presence in almost every part of the state,” Rehm said.

The need to expand these services remains a top priority of the Children’s Hospital leadership team, she added.

“It’s easy for us to come here to this large and beautiful building with a large parking garage. It’s easy for us to navigate this complicated system, but it’s pretty overwhelming for families who need to see multiple providers in multiple specialties.”

Rehm said Children’s Hospital will continue to augment what’s needed at each of its outreach locations.

“We will look at expanding services at existing locations based on the needs of our patients. When we bring in new faculty, they will have outreach as some part of their obligation. It’s part of who we are.”

– By Nancy Humphrey