Alternate Pediatric Page

YKHC is an unusual and wonderful place to practice medicine and especially pediatrics. Pediatricians at YKHC act as subspecialist extenders for all pediatric specialties that are not available in Bethel and often not in Alaska. There are many unique and interesting challenges (and frustrations) with practicing medicine in a remote region with travel and communication issues that are unique to our area. It is a lot like practicing third world medicine with much better support and infrastructure. The medicine is interesting and spans from primary care to pediatric subspecialty management to critical care with NICU/PICU patient stabilization and transport. Pediatricians at YKHC are primarily responsible for Chronic Peds Patients or complex and chronically ill kids, but we also do a variety of other patient care activities as well.

Pediatrician Specific Practice: Description of How Pediatrics is Practiced Differently at YKHC

Pediatricians manage approximately 1,200 chronically ill patients of mainly Yup’ik Alaskan descent with significant respiratory, genetic, metabolic, cardiac, endocrine, neuro and infectious disease issues. They act as pediatric subspecialty extenders and consultants for family medicine, emergency medicine and village health aide providers. Pediatricians manage ADHD, fetal alcohol syndrome, cerebral palsy, seizure disorders, congenital heart disease, congenital adrenal hyperplasia, asthma, aspiration syndrome, chronic lung disease, and issues related to prematurity. In clinic, we see complex-care pediatric patients, urgent, acute and well child care patients as well as ER follow up patients. The hospitalist pediatricians need to be able to stabilize, manage, and transport critical care and neonatal emergency patients. Occasionally the hospitalist pediatrician will fly on medevacs to villages for potential preterm or high-risk term infant deliveries. The pediatricians assist and collaborate with pediatric sub-specialists when they visit YKHC and via email, text and phone. Occasionally pediatricians make visits to village clinics or subregional centers.

At YKHC, our pediatric patients get more invasive disease than children in the lower 48. We have therefore modified standard lower 48 guidelines and created some of our own for more conservative evaluation and treatment of our patients. In most places, you would not do as many labs and xrays as we do here, but many times pneumonia, bacteremia and serious infections are missed if we do not check. Kids can be running around the ER with a little cough and no significant lung exam findings and have a significant pleural effusion on CXR. Or a well-looking 2-month-old with a low grade temp will have 230 WBCs in their CSF. We also have invasive Hflu A infections with either indolent or aggressive presentations. It pays to be very, conservative, vigilant and to watch kids closely before sending them back to a village where they may get worse and not be able to return due to weather.

Description of Pediatrician Services and Practice

• Outpatient: Outpatient pediatricians work in clinics providing care for routine, acute and complex care pediatric patients. They also provide consultative services to family medicine clinic providers and liaison with sub specialists plus behavioral health, developmental, educational service providers.

• Inpatient: Hospitalist pediatricians work on the inpatient ward and manage hospitalized children with chronic and/or complicated issues. They are also responsible for providing consultation to family practitioners, emergency medicine physicians, midlevels and village health aides; attending all high-risk deliveries and pediatric codes; and providing intensive care while patients are awaiting transport.

• ER: Pediatricians assigned to work in the ER will see urgent care and emergency pediatric patients as needed. They will also provide consultation for family medicine, midlevel and ER providers as well. The ER pediatrician has a range of encounters including minor illnesses and care of lacerations, orthopedics, wounds, trauma patients and coordination of care between YKHC and higher level services in Anchorage.

GENERAL INFORMATION

• General Introduction to Pediatrics

SHARED PEDIATRIC RESOURCES

• Chronic Pediatric Patient Definition
• Pediatric Consults
• CPP Village Assignments
• Chronic Pediatric RMT
• Outpatient Pediatric Encounters
• Medevacs for Inpatient Pediatricians
• Pediatric Case Management
• Pediatric Specialty Services
• Pediatric Psychiatry Services
• Pediatric Village Trips
• Newborn Information Access on RAVEN
• Sexual Abuse Response Team (SART)
• INTRA and INTERhospital Transfers
• Pharmacy Things to Know
• Emergency Stabilization Information

DETAILED PEDIATRIC DEPARTMENT WORKFLOWS

• Outpatient: Detailed Information
  • Medication Refills
  • Preparing For and Navigating Clinic
• ER: Detailed Information
• Inpatient: Detailed Information
• OB/Newborn: Detailed Information
• OR for Peds