Ten Things I learned from Loma Linda University Children's Hospital

In the past 8 weeks, I stayed at the Department of Pediatric Nephrology, at Loma Linda University Children's Hospital. I knew that they provided services to children with kidney diseases from Newborns to 21 years of age and medical management with Hypertension, Renal and Urological disorders, Fluid and Electrolytes disorders, Acute and Chronic Kidney Failure, and Renal transplant. All modalities of dialysis were provided in this hospital, including continuous renal replacement therapy, peritoneal dialysis and hemodialysis. There were 45-50 children with chronic renal failure on dialysis at Loma Linda University Children's Hospital. They provided consultative services to the PICU, NICU, Pediatric cardiac ICU and pediatric inpatient units. Children with chronic kidney diseases, dialysis and renal transplant were followed in pediatric renal clinics. A team approach is provided in the clinic. The renal team center had a renal dietician, renal social worker, renal nurse practitioner and a nephrology nurse specialist to provide comprehensive care. 

Here I just share the ten things that impressed me most. 

When I went to the clinic, they would always introduce me to the patients, “we have a visiting physician from China to observe how we working…. That made me feel that I was especial and I was one of the members of the clinic. 

They spend more time in talking with the patients. Even with those were little babies who could not speak, doctors and nurses still talked to the babies very kindly. They talked with the elder patients, so the children would not be afraid of them, helping them to examine the children carefully without antipathy.

They would choose to talk with the patient's parents to the details about the situation about patients patiently. What's more, when there was any confusion, they would always ask that “Any questions?”. They communicated with patients not only during the clinic time, but also any time they found there was something wrong with the patients. Then, they would tell patients what to do.

Every patient should stay in a clean room to wait for a doctor. Before a patient entered to the room, the room should be cleaned. And the doctors should wash their hands, clean the echometer, wear masks and put on isolation clothes to prevent infection. 

They cared the patient not just about their illnesses, but also the dietary and movement of them. They recommended that individuals with CKD receive expert dietary advice and information in the context of an education program, tailored to severity of CKD and the need to intervene on salt, phosphate, potassium, and protein intake where indicated. Children with chronic kidney diseases, dialysis and renal transplant were followed in pediatric renal clinics. A team approach was provided in the clinic. The renal team center had a renal dietician, renal social worker, renal nurse practitioner and a nephrology nurse specialist to provide comprehensive care. While General Nephrology patients (private insurance) went to PSC Clinic at Caroline St Suite J 250 E, which was different from the team clinic. 

There were many forms of agents, such as liquid prednisone, which was suitable for small children. They used G-tube for small ones to take the medications and provide adequate nutrition. 

The Epic app for doctor and nurse is wonderful. They draw growth chart for every patient so that they could observe the way they grew up. Lab results should be listed clearly so that they could list one item from beginning to now, and then could contrast conveniently. The medications also list clearly, so that you could know when to use medications and when to change the dosage, when to stop it.

Let us study basic life support, which was very useful. They trained their employee every two years in order to improve the rescue efficiency.

Last but not the least, Child Life, which really shocked me with their well-done job. In fact, Child life specialists work to minimize fears and stress experienced by children, adolescents, and families during hospitalization. That meant that they should try to enhance the patient's understanding of medical procedures and diagnoses using age-appropriate techniques, implement a wide range of community outreach events, give ear to patients about their fears and/or concerns and to help facilitate coping strategies, develop age appropriate activities for children ranging in age from birth to young adult, lend emotional support and provide relaxation techniques to patients during invasive procedures, integrate play into the healing process by utilizing therapeutic play, facilitate grief support groups for children, and ease the transition from hospital to classroom with the school reintegration program. I am very glad and proud that our hospital also have a team of Child Life to give our children better care.