Plays of the Week:
Play of the week goes to Drs. Caballero, Martin, Meyers, Molter, and Warren. There was an RRT called for a sick child on 3W. The floor team residents provided an excellent presentation and had initiated an appropriate escalation of care to stabilize this patient. These same residents followed the patient to the PICU and without hesitation jumped right in to help in multiple different roles. Their presence and initiative was crucial to the care of this patient. Drs. Caballero and Martin, in particular, stayed side-by-side with these worried Spanish-speaking parents and demonstrated outstanding compassion, communication, and family-centered care. Awesome job!
Play of the week also goes to Dr. Gopalasubramanian, for volunteering to cover the ward on a short notice!
Play of the week also goes to CAPT Emerick on her retirement! A resounding salute to her steadfast dedication and immense contributions! 🎉
Play of the week goes to all of our AAP SOUS acceptances:
Using an Innovative Teaching Bundle to Improve Performance of the Infant Hip Exam: Brian Graziose, Sidney Zven, Connor Liggett, Dr. Lopreiato
Congenital Lymphatic Dysplasia and Bone Disease in a Neonate with PIEZO1 Mutation: Sidney Zven, Sharen Wilson, Brian Graziose, Chase Groomes, Elizabeth Ketchum, Alexis Ghersi, Dr. Schacht, Dr. Curtis, Ms. Rebecca Hicks
Food Insecurity and the Impact of Protocoled Screening for WIC Enrollment in the Military: Sidney Zven, Brian Graziose, Colin McNamara, Dr. Chokshi, Dr. Smith
Open Your Eyes to a New Variation of Ethylmalonic Encephalopathy: Amy Davis, Kevin Westbrook, Marianna Caballero, Jack Goetzman, Dr. Kolasinski, Dr. Schacht, Dr. Arora
A Tough Pill to Swallow: Congenital Glottic Stenosis as a Clinical Manifestation of FREM1 Associated Disorders: Taylor Meyers, Kayla Sallander, Dr. Schacht
Juvenile Idiopathic Arthritis: The Effects of Wild-Type GATA3 on Cytokine Expression in Peripheral Blood Mononuclear Cells: Genesis James
To Steal or Not to Steal: A Rare Pediatric Case of Congenital Isolated Left Subclavian Artery: Alexis Ghersi, Alex Mauro, Noelle Molter, Dr. Mulreany, Dr. May
Schedule:
Date | Event | Time and Location | Audience/Notes |
Sunday, 6/18 Father's Day | | | |
Monday, 6/19 Juneteenth | OUTPATIENT CLINICS CLOSED | | |
Tuesday, 6/20 | Education/Reverse Education | STAFF: 0730 - 0850 (America 2525 B/C) RESIDENTS: 0745 - 0850 (Canyon Conf Rm) | Academic/Military Advisors, Rotation Supervisors, Residency Leadership Only Pediatric Residents Only |
| TTP: ID Board Review, Helfrich | 0900 - 1030 Canyon Conf Rm | PGY-3s Only |
| TTP: Cardiology Board Review, Hughes | 1030 - 1200 Canyon Conf Rm | PGY-3s Only |
| TTP: Genetics Board Review, Schacht | 1430 - 1600 Canyon Conf Rm | PGY-3s Only |
Wednesday, 6/21 | Grand Rounds: "Master Learning Teletraining to Ensure Effective Ventilation in Neonatal Resuscitation, "Dr. Charles “Chase” L. Groomes, "Perceptions of Gender Equity in Pediatric Academic Medicine," Dr. Elizabeth V. Schulz | 0745 - 0845 Room A3, Bldg A, USUHS and Google Meet Virtual Platform | All welcome; outpatient providers are highly encouraged to attend in-person |
| TTP: SIM Bootcamp | 0900 - 1100 SIM Center | PGY-3s Only |
| TTP: Library Resources, Mason-Coles | 1100 - 1200 Audiology Conf Rm 5406 | PGY-3s Only |
| TTP: Graduation Rehearsal | 1300 - 1500 Strathmore Music Center | PGY-3s Only; see below for more details |
Thursday, 6/22 | MR: Case & Dysautonomia Lecture, Cook **Award presentations for CPT Kondiles and CPT Jack** | 0745 - 0850 America 2525 B/C | All welcome |
Friday, 6/23 GRADUATION DAY 🎓 | MR: Wellness | 0745 - 0850 America 2525 B/C | Residents and Medical Students Only |
| Staff Meeting | 0745 - 0850 Virtual Meeting | Staff Only |
| Graduation | 1000 - 1200 The Music Center at Strathmore | See below for details |
Save the Date 🗓 | Upcoming Birthdays 🎉 |
26JUN: Intern Welcome Lunch | 29JUN: Taylor Meyers |
28JUN: Pulm Academic Half-Day & PCMH Potluck | |
29JUN: Resident & Medical Student Happy Hour | |
3JUL: Block 1 Starts 🎉 | |
4JUL: 4th of July 🇺🇸 🎆 | Do you have a birthday that you want added to the calendar? Email/text Britt |
Announcements:
Meet our Rotating 4th Year Medical Students!
All Staff Updates
Graduation: Friday, June 23rd 1000-1200
We will have Senator Tammy Duckworth join us to celebrate this amazing milestone. Her bio: https://www.duckworth.senate.gov/about-tammy/biography
Ceremony: Friday, June 23, 1000-1200, The Music Center at Strathmore (arrive NLT 0930 for line-up; if you are not in line at 0930, we will need to remove your name from the list)
Uniform for Ceremony:
Navy: Service Dress White Uniform (No Nametags)
Army: Service Uniform (Nametags required) or AGSUs (Army Greens) are authorized
Air Force: Service Dress Blues (Nametags required)
All services: no covers, wear ribbons not medals
Guests: Guests are invited to attend; no tickets required
Transportation: You have the option for bus, metro, or POV to both Rehearsal and the Ceremony.
Buses:
21JUN (rehearsal): Pick up at 1200 in front of Bldg 1 (tower). | Return from Strathmore at 1500
23JUN (graduation): Pick-up times in front of Bldg 1 (tower) at 0800 for the graduates; and 0900 (front of Bldg 1) for faculty, staff, and families. | Return from Strathmore back to Walter Reed is at 1200
Metro rail: Metro rail is available across the street from WRNMMC, Medical Center Metro Station to Grosvenor Metro Station. The trip is approximately four minutes at a cost of $2.25 with SmarTrip Fare each way. information. Note: you will need your cover if taking Metro. For more information, go to http://www.wmata.com/rider_tools/tripplanner/tripplanner_form_solo.cfm.
POV: Limited paid parking is available in the metro garage or street.
COVID Protocols: None
Department of Pediatrics Meet & Greet
Peds Sedation Unit Reminder
The Pediatric Sedation Unit is still functioning, albeit transiently running operations from PICU bedspace
To schedule: complete the form below and send to our scheduler via dha.bethesda.wrnmmc.mbx.pedsedation@health.mil
Healthy Habits Clinic
If you're not familiar with Healthy Habits, it is a virtual clinic provided to eligible pediatric patients ages 6-18 with stage 1 obesity who are motivated and ready to make changes. Eligible participants and their families should be able to participate in virtual group exercise and in a classroom environment.
Here are 3 Important Changes
In order to align ourselves with the 2023 AAP Guidelines on management of Pediatric Obesity, which recommends at least 26 hours of IHBLT, the Healthy Habits Program now meets twice monthly for 90-minute virtual group health behavior and group exercise sessions. Sessions are offered on the 2nd and 4th Wednesday of every month beginning at 1515. Each session is unique and interactive.
For patients 6-18 years of age with overweight or stage 1 obesity (BMI at the 85% to ≥ 120% of the 95%) , please consider the following:
Step 1: SMART goals set with PCM and plans for in person follow up with PCM every 3-6 months to track change, assess for weight related co-morbidities and formally reassess goals. Step 2: Referral to the Healthy Habits Program for Intensive Health Behavior and Lifestyle Treatment
For patients 6-18 years of age with severe obesity ( ≥ 120% of the 95%) or stage 1 obesity and a comorbidity including: hyperlipidemia, concern for PCOS, or concern for pre-diabetes, please consider the following:
Step 1 and Step 2 as outlined above
Step 3: Refer to Pediatric Endocrinology at WRNMMC for further evaluation and treatment of severe obesity and metabolic sequela
To refer to the Healthy Habits Program, create a message to Ms. Ramona Sanchez-Brady within Genesis. Search Sanchez,Ramona in messaging and use the dot phrase "..HH" which will auto populate the following message:
Ms. Sanchez-Brady, I would like to refer _______________________ to the Healthy Habits Program. A good contact number for this family is ________________________ and they would prefer to receive information about upcoming Healthy Habits sessions at the following email: _____________________________________.
WRNMMC ED Communication
Please continue to communicate with the ED team anytime you know/believe there is a patient headed their way (the ED’s use of “pre-arrival notes” has helped the workflow tremendously, both to expedite & focus any workup the patient is coming in for), particularly complicated ones.
Also send a message to the 3rd Deck Team (AMS Connect: Pediatric Ward Resident) to make them aware of a patient the child would benefit from a Peds Consult.
Peds Travel Clinic
Referrals are no longer required for Peds ID Travel Clinic but the travelers must be Tricare-eligible. We request that you screen the patient’s destination to determine if travel clinic is required. Please see the information below:
Pediatric Infectious Disease Clinic at WRNMMC offers Travel Clinic appointments for Tricare-eligible families traveling overseas. Due to limited appointment availability, priority is for PCS and high-risk travel. Please note these appointments are NOT for PCS clearance (which should be completed by the PCM).
PCM determines if Travel Clinic is needed. Look at the destination of travel:
2. If Travel Clinic is needed, instruct the parent/guardian to have the following information ready and call Peds Subspecialty Clinic to book.
Destination(s) of travel
Travel Dates
Note that patients should be seen at least 2 weeks prior to departure (ideally 4-6 weeks) but also NO earlier than 2 months prior to departure. Peds ID clinic schedule is available 3 months in advance and will be strict with this timeline/window for travel clinic appointments.
Families MUST CALL the Peds Subspeciality Clinic to schedule their appointment at 301-319-4959. Please advise families to be patient when calling as the Peds Subspecialty Clinic front desk manage many subspecialities and also check in patients while managing the phone.
PCMH Clinic Updates:
Newborn bilirubin orders: Please order BOTH a total and direct bilirubin. The Neobili panel order does not communicate correctly within Genesis that we need both the total and direct.
Telemynd is a great resource for virtual Mental Health care as we no longer have an embedded Behavioral Health Psychologist at the moment. Families can self-refer and request care. Active Duty need a referral from their PCM. As discussed at Morning Report today, it may be difficulty for families with young children or adolescents if they are concerned about their families not giving them privacy at home.
Audiology:Walter Reed does not currently have any pediatric outpatient audiology services for the next 10 weeks. All patients that need hearing tests will be referred out to the network. Newborns will still get screened in the MICC, but there will be no walk in capabilities.
PCM Changes: For future PCM Change Requests please fill out the request form below and send to the email below: dha.bethesda.j-11.mbx.bds-enrollment@health.mil
The POC for Enrollment Management is Ms. Lisa Smith (lisa.m.smith132.civ@health.mil/301-319-5351)
CAPS Provider to Provider consult line: Please see the flyer below
This is for providers to ask clinical questions/assistance, but not to book any appointments
This number is NOT for families/patients
Coding: Please ensure you are documenting a problem and coding each encounter before the end of the day. This also includes all our staff, resident, rotator, and student encounters. Please see the coding cheat sheets attached!
Genesis Updates:
We need to make sure date of signature is the same as date of service. If you are signing on a different day than the day of service, use the “Correct Note Date” attachment to correct this.
There have been lots of medication ordering errors. The “Wave Walter Reed-Wave Belvoir” attachment can be used to see what the most often prescribed meds are in our clinic to help you make favorites. Use the “Provider Favorites Setup Guide” ppt to do this.
The “Pharmacy Info Patient Flyer” has a list of all the NCR pharmacies and instructions on the Q-anywhere for that location if they have it.
New updated patient portal guide attached
Setting up your favorites
Resident-Specific Updates
Block 1 Schedules
Don't forget to reach out to your Block 1 Rotation Supervisors regarding your schedule. View the attachment below for the most up-to-date contact information.
Additionally, check MedHub and review updated goals & objectives for your upcoming rotation!
MHS Genesis Message Center/Proxy Workflow
Please review the update message center and proxy workflow document.
Resident Appointment Binder
We have a new follow-appointment binder for residents that will be kept at the front desk . If a residents wants a pt to follow-up add the name in the binder if that resident doesn’t have any open appts.
If a pt calls and wants an appointment with a certain resident add the name to the binder if that resident doesn’t have any open appts. Ms. Holly/Ms. Tamarta (Blue Team) will call the patient when the slots become available or will talk to Dr. Goetzman/Dr. Carr to come up with a solution if the resident is totally booked. Residents can also send messages to PEDS TEAM Blue Messaging Scheduling in MHS Genesis if they want pts to have follow-up appts with them.
Blood Type Ordering in the NICU
When ordering things in the NICU I highly recommend the residents use the NICU quick orders panel (highlighted and shown in the image below). That way they aren’t scrolling through numerous order options to chose the correct combination of STAT, nurse collect etc.
For blood type in the NICU if it comes from the cord please select cord blood profile (this will give you ABO/Rh and DAT status)
If it is not from the cord (for example you need a blood type prior to administering blood products) please use the ABO/Rh (<4mth) also as highlighted below
These blood type orders are also in the NICU admission powerplans. However, the admission power plans also include “type and screen”. Do not order this on babies <4months.
Transition to Practice (PGY-3s only)
Graduation Details: see above
This week's focus: Out-Processing
Educational/Teaching Opportunities
USU Teaching Opportunities
Clerkship Round Robin (recurring throughout the year)
Contact Dr. Brian Hughes (brian.hughes@usuhs.edu) if interested
Tentative Dates and Times:
30Aug2023 1300-1700*
Able to interact with students of the class who have their Peds rotation coming up in the subsequent 3 months. Designed to mimic a clinic half day, each faculty member will be in an MDL room with your particular case. The students have 30 minutes with you to go through the case/skills. Then there is a 10-minute buffer between rooms. The students will move. You stay put and will deliver the same content 5 times. There are 9-10 students per group.
Reproduction and Endocrinology Module Small Group Teaching Opportunities
19SEP: Developmental Delay ICR (1300-1630)
21SEP: Peds Growth ICR (1300-1630)
25SEP: Pediatric Issues ICR (1300-1630)
26SEP: HEADSS Exam Debrief (1100-1430)
Research Opportunities & Upcoming Conferences
Upcoming Conferences:
APPD: Mid-Atlantic Annual Meeting: Wednesday, Sept 20 at CNMC
More details to come soon. Along with this meeting, we will be continuing our annual scholarship competition. The call for proposals is attached and should be shared with your trainees. We are seeking proposals that have a focus on education, community health and advocacy, and cultivation of an inclusive work force and clinical learning environment. We are excited to be able to offer several $1000 grants, so please encourage participation.
6th annual Architecture of High Value Health Care: October 12-14th in Baltimore, MD
Abstract submissions are due by April 30th 2023 at 11:59pm EST. Abstract submission site
Abstract submission categories:
Improving equitable delivery of high value care (Health Equity Award)
Reducing out of pocket costs for patients (Costs of Care Affordability Award)
Improving appropriateness of diagnostic or screening services
Improving appropriateness of treatment/interventional services
Clinical care pathways to improve quality & reduce unwarranted practice variability
Optimization of patient care setting to reduce avoidable ED visits & hospitalizations
Improving the discharge process and other care transitions
Preventive medicine and evidence-based screening for early disease detection
Effective cost transparency for patients
Provider behavior modification (comparative effectiveness of interventions)
Information technology innovations
High value care educational curricula (medical school, GME, CE, CME)
AAP NCE 2023: October 20-24th in Washington, DC
Registration and hotel reservations will open for AAP members on May 2 at 10AM CDT and open for all on May 9 at 10am CDT. The conference schedule will be released on May 2.
Community Pediatrics Updates:
LGBTQ+ Pride Month:
USU Spectrum Pride Events
Project ASPEN training
Multiple dates/times/Zoom
Learn more about inclusive language to support effective work, learning and healthcare environments.
Note: Ask your department leadership if ASPEN training is planned for your department, too.
Check out these self-education resources: https://drive.google.com/file/d/1LotubG_Qg9HHu4t4ut_Z9Hvm3YsxOeyk/view
Register here: https://docs.google.com/forms/d/e/1FAIpQLSdswAIv8R96nyvzCuayFHFtmxsfUYLWUT2cMugi2K1o80mImg/viewform
Please see the flyer below for information on additional activities sponsored by Spectrum.
ARMY NEW!
Alpha Company Orderly Room Hours Update
A CO ORDERLY ROOM HOURS on THURSDAYS
OPEN for NORMAL BUSINESS 0830-1200
LUNCH 1200 -1300
CLOSED for SERGEANT’S TIME TRAINING 1300-1600 (Open for In-/Out-Processing and Emergencies Only)
Maternity convalescent leave
CLARIFYING GUIDANCE ON MATERNITY CONVALESCENT LEAVE FOLLOWING CHILDBIRTH AND MILITARY PARENTAL LEAVE, 2 JUN 23. From the Secretary of the Army: The Army is committed to ensuring that birth parents have ample time to recover from giving birth and that birth and non-birth parents are able to care for their child or children. As such, maternity convalescent leave following childbirth and military parental leave are two separate non-chargeable periods of absence. DTM 23-001, Expansion of the Military Parental Leave Program, dated 4 Jan 23 and ALARACT 018-2023, Expansion of the Military Parental Leave Program (MPLP) Implementation Guidance, dated 6 Mar 23 do not change the intended purpose of maternity convalescent leave, which is limited to a birth parent after a qualifying birth event. Maternity convalescent leave is intended to provide the birth parent time for appropriate recovery from giving birth. Parental leave should not be considered by the medical provider when determining the appropriate time for recommending maternity convalescent leave for the birth parent. Six weeks remains the appropriate amount of time for recovery from childbirth. Additional maternity convalescent leave may be authorized when specifically recommended, in writing, by the medical provider to address a diagnosed medical condition and when approved by the commander. See the memo for additional information. https://www.milsuite.mil/book/docs/DOC-1258635
Current leave process
Please use IPPS-A for all leave/absence requests; go to https://myaccess.dmdc.osd.mil/identitymanagement/app/login and login with your CAC
Make sure you change your email in order to receive email notifications -> My Profile -> My Current Profile -> down arrow next to name -> Personal Details -> Contact Details
Submit leave
Continue to submit DA31s to Britt for signature
Once your DA31 is reviewed and signed, follow these instructions:
Click My Absences in the home page
Complete the appropriate information, an example of chargeable leave is below:
Absence Type: 1-Chargeable Absence
Absence Name: Absence
Absence Reason: 01- Annual (Ordinary) Absence and complete the remainder of the page
Enter Start and End Dates
For supervisor ID: direct it to 1SG Michael Leinweber
Complete address information with the location of where you are going
Attach your DA31 with my signature at the bottom
Click submit
Make sure you continue to send leave dates and locations to the Peds Leave Listserv: dha.bethesda.j-11.mbx.pediatric-alpha-co-leave@health.mil
See the powerpoint below for instructions
Training dates:
Personal Readiness (ASAP/Suicide/Gambling)
MS Teams
20 June 2023 @ 1000-1100
No pre-signup required
Link available on the SharePoint Calendar Event
AIR FORCE
Laurie Creel is on extended leave; please forward any questions/concerns to Dr. Zanetti or Britt Bumgardner
PT Tests:
To schedule a test, please contact the following individuals:
TSgt Wilson: jonathan.a.wilson41.mil@health.mil
Every Thursday @1400
SSgt Starr: cody.j.starr2.mil@health.mil
Mondays and Fridays @1400
NAVY
Training Schedule
**Pending AY 23-24**