Pioneers of Hope

At the Monroe Carell Jr. Children’s Hospital at Vanderbilt, our physicians’ work extends beyond patient exam rooms. They are also searching for discoveries to offer better treatments, and hopefully, find cures for their pediatric patients. The four doctors profiled here represent only a sampling of the physicians working tirelessly to make Children’s Hospital a place of unwavering hope.

 

David Hall, M.D., MBA, MPH, came to Monroe Carell Jr. Children’s Hospital at Vanderbilt in November 2013 to begin the new Program for the Medically Complex Child within the Division of Hospital Medicine.

Children eligible for this program are often dependent on medical technology such as feeding tubes, tracheostomy tubes, ventriculoperitoneal shunts or ventilators for their health.  Subspecialty clinics may not be able to provide needed comprehensive care, and primary care physicians often have difficulty providing the time or resources these children and families require.  Hall’s goal is for his team to partner with their primary care providers to coordinate their care and help families navigate what can be a complicated medical system.

“It’s exciting to be able to create a program I hope will have a lasting impact on families in the Nashville community,” he said.

Hall’s team will not focus on children with diseases already cared for in well-established programs for specific chronic conditions, such as those for cystic fibrosis, sickle cell disease, diabetes or malignancy, but instead on children whose conditions don’t fit neatly into a single subspecialty.  Their multisystem illnesses sometimes place them at risk for becoming “medical orphans” with no place to go to unify their care.

Similar programs around the country, including the one that Hall directed at Cincinnati Children’s Hospital, have been able to dramatically reduce hospital days and emergency department use, while improving quality of care and patient satisfaction.

“Medical advances have led to the survival of many children who would not have survived in years past. However, this often creates a chronic condition that requires ongoing management. The percentage of children with multisystem complex conditions is growing rapidly. These children account for about 1 percent of all children but one-third of their health care costs,” Hall said.

The complex care team treats patients who have a host of problems.  Many are neurologically impaired due to brain malformations, genetic or metabolic defects, meningitis, central nervous system bleeds or other conditions.  They may suffer from complications such as seizures, recurrent pneumonia, feeding problems, trouble swallowing, developmental delays, kidney stones, abnormal bladder function and weak bones.

Hall, a graduate of the University of Chicago School of Medicine, served his residency at Johns Hopkins University, where he completed a Robert Wood Johnson fellowship in general academic pediatrics and was chief resident. He said he was attracted to Vanderbilt for its strong reputation, and he and his wife Michelle were eager to be closer to family who live in Nashville and welcomed the opportunity to return to the Southeast.

Hall said of their move to Nashville, “It’s a great city with a lot of energy. I feel like we’ve come home.”

Most of all, he embraced the chance to continue the work he finds “immensely gratifying.”

“The patients and families are so grateful when someone helps take ownership of their problems. I admire their strength and resilience, and it’s a privilege to work with them,” he said.

– by Kathy Whitney

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Bill Russell, M.D., has many titles—pediatrician, professor, investigator, director, father and husband.

His colleagues would add another—coach.

Russell embodies the coach persona—a person who has insight, skills and perspective to foster a relationship that involves two-way dialogue, not “one-way telling.”

For more than two decades, he has treated children with endocrine disorders at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. During that time, the Children’s Diabetes Program at the Vanderbilt Eskind Diabetes Clinic has grown to follow more than 2,500 patients.

“Endocrinology allows for a longitudinal involvement with growing kids,” said Russell. “I will often meet children as newborns and keep following them until they are in college. We develop very personal relationships with these patients and their families.

“With many of the disorders we follow, but especially diabetes, the kids are all in a common struggle and we’re all on the same team. It’s a lot like being a coach. The doctoring part is not complicated … but motivating a child, keeping them on task, holding them to their goals, letting them truly know you are in it with them and we will do it together—that’s how we make an impact.”

Russell, the Cornelius Vanderbilt Professor of Pediatrics, professor of Cell and Developmental Biology and director of the Ian Burr Division of Pediatric Endocrinology, said his success hinges on the incredible team that surrounds him. Under his leadership, the division has grown from two faculty members to 10, is one of the largest programs in the country and was named among the top 20 programs by U.S. News and World Report.“We have a spectacular team here,” said Russell.

“We all have a passion for helping this special patient population. We are in this because we want to provide hope for patients and their families and make a very positive difference in their lives.”

Since 2006, Vanderbilt has been involved in Type 1 Diabetes TrialNet, an international network of major research centers funded by the National Institutes of Health (NIH) to focus on the causes, prevention and early diagnosis of type 1 diabetes, a disease that results when the patient’s own immune system destroys their insulin-producing cells.

Russell is the principal investigator for TrialNet at Vanderbilt.

TrialNet screens relatives of patients with type 1 diabetes and identifies those at risk of developing the disease. However, its mission is to engage people who are found to be at risk to participate in clinical trials that will determine ways to prevent or delay disease development.

Vanderbilt’s involvement allows families in the region to be a part of finding a solution and making a difference in the future of type 1 diabetes for all families.

Russell likens the current status of type 1 diabetes to polio before the vaccine.“

Finding a cure is complicated,” he admits. “We never found a cure for polio, but we have highly effective ways to prevent it. We are right on the verge of eradicating polio. I want to see diabetes meet the same fate.“

I want to be able to take a healthy child or young adult and make it so that they don’t have to spend the remainder of their lives counting carbs, getting multiple insulin injections and pricking their fingers to test their blood glucose, all the while running the risk of being too high or too low and experiencing life-altering or life-threatening complications later in life.”

Russell, a graduate of the University of Michigan and Harvard Medical School completed his residency in Pediatrics and a fellowship in Pediatric Endocrinology at Massachusetts General Hospital in Boston.

Although he continues his initial research focused on liver regeneration, preventing type 1 diabetes is among his highest career goals. He hopes that within 10 years there is both a cure and a safe and effective treatment to prevent type 1 diabetes.

“I have no plans to stop what I am doing. I want to have the energy to see this through,” he said. “It is an extraordinary chance to make a difference in people’s lives.

“If all we do is take a 2-year-old who is brewing diabetes and we delay it until the age of 15, then that is a huge improvement,” he said. “But, that is not the endpoint. The endpoint is stopping it, making the disease go away and being as successful as we have been with polio.”

– by Jessica Pasley

•••

Neal Patel, M.D., MPH, has a knack for viewing situations from multiple angles.

That skill has proven useful in every aspect of his life—especially his professional one.

As a freshman in college, Patel wasn’t certain about the direction he wanted to take his career. But one thing was certain—he excelled at solving problems in a team-oriented atmosphere.

His biggest challenge—finding the right career that suited his strengths. He gained perspective by changing schools and transitioning through various majors.

“I initially had a very abstract vision of a career in medicine. Through a variety of experiences I developed clarity as to what I wanted my life in medicine to be.”

He admits that his interest in pediatrics stems from his own personality—fairly informal, pleasantly sarcastic and a child at heart. After experiencing the various clinical rotations, he was most comfortable in an environment working with those who took care of sick children.

As a resident at Children’s Hospital Los Angeles (CHLA), Patel was intrigued not only by the diversity of the clinical cases, but also the complexity of the clinical workflow. He worked to devise processes that would make things easier for his colleagues.

During an on-call night in 1993, he recalls being asked by his attending, who happened to be the medical director of informatics, what could be done to improve the Computerized Physician Order Entry system (CPOE). The system, which had been operational just prior to the start of his residency, had been taken offline because of multiple user issues. The hospital wanted to renew its use by physicians.

“All he did was ask—what would it take for house staff to use this?” said Patel. “I found myself being able to articulate what the obstacles were and offered suggestions for some simple adjustments to make the system useful to clinicians and help with clinical workflow.”

While completing his fellowship in Pediatric Critical Care at CHLA, Patel was appointed as a clinical systems liaison, serving as a link between the clinical and technical world. It was his introduction to informatics.

It seemed to be a natural fit for Patel, who has an aptitude for finding pathways and processes and gleaning what potential pitfalls may exist, whether in his work with clinical informatics or as a clinician.

“At the end of the day I am using the same skills,” he explained. “Functioning as an attending in the critical care unit, it is all about workflow and coordinating activity of a multidisciplinary team. The care of individual patients is about managing the competing priorities of which systems are failing and which are performing well and how to find the right solution set.

“My involvement in informatics allows me to help solve logistical issues. I am not a technical guy, but informatics is a mechanism by which we can make the lives of the people who are delivering care as well as the care that we are delivering better.”

Patel, a graduate of California Polytechnic University, received his medical degree from the University of Southern California and completed his training (internship, residency and fellowship) at CHLA. He joined Vanderbilt in 1997 as a faculty member of the Department of Pediatrics in the Division of Pediatric Critical Care. He also had faculty appointments in the Department of Anesthesia and the Department of Biomedical Informatics. In 2000 he received his Master of Public Health degree from Vanderbilt.

Currently Patel, professor of Clinical Pediatrics and medical director of Pediatric Cardiac Critical Care, is the chief medical informatics officer for the Vanderbilt University Health System.

“I love both aspects of my job,” said Patel. “Balancing clinical care and informatics allows me to have an impact on patient care in different ways. I continue to look forward to using informatics to enable every person on the care delivery team to function optimally—because then they can focus on providing the absolute best care.”

– by Jessica Pasley

•••

Chevis Shannon, MBA, MPH, DrPH, has so many degrees that she jokes she might need a bigger business card.

Raised in Birmingham, Ala., Shannon came to the Monroe Carell Jr. Children’s Hospital at Vanderbilt in January 2013 to serve as the founding director of the Vanderbilt Pediatric Neurosurgery Clinical Research Initiative, allowing her to put all of her degrees to good use.

Shannon held a similar post at the Children’s Hospital of Alabama, as the associate director of clinical research for the Division of Neurosurgery and prior Birmingham site manager for the Hydrocephalus Clinical Research Network (HCRN).  When her colleague Jay Wellons, M.D., MSPH, was tapped to be the chief of Pediatric Neurosurgery at Vanderbilt Children’s Hospital, one of the first things he did was to recruit Shannon to start a clinical research program here.

Serendipitously, Shannon’s husband, who had been living in Orlando, Fla., working as a chef at the Omni Hotel, was offered a job at the new Omni Hotel in Nashville. After living apart for about three years, they decided the time was right to make the move together.

Shannon said she was excited about starting a research program from the ground up.

“When you start a program like this, you come in with the intention of getting grant funding, finding infrastructure and helping others find the value in outcomes research,”Shannon said.

Collaborating with her clinical counterparts, Shannon’s team is charged with gathering and sharing information about Neurosurgery outcomes, specifically how surgery impacts children and their quality of life.

“We are trying to see how we can help these children grow and become typical children who are happy, running and playing,” she said. “Doing clinical research to me is very analytically-based. I want to know how the things we do can improve the lives of children.”

Shannon earned her bachelor’s degree from the University of Alabama, Birmingham, and an MBA from Florida Southern College. She returned to UAB for her Master of Public Health degree and doctorate in Public Health, in Maternal and Child Health.

Her research interests include quality improvement initiatives to reduce surgical site infections, comparative effectiveness, cost-effectiveness and decision analysis research related to surgical intervention, long-term clinical and quality of life outcomes in children with hydrocephalus, traumatic brain injury (including abusive head trauma and sports-related concussions), epilepsy, spina bifida and tumors.

Shannon said she has wasted no time researching ways to get involved in her new community of Nashville and has already volunteered with a number of non-profit agencies.

She hopes to be able to add “community activist” to her business card.

– by Kathy Whitney