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Tuesday, January 19, 2021

Cook Children’s: State-of-art tower serves growing community

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Cook Children’s Medical Center

South Tower

314,000 square feet

No. of floors: Six plus a basement

Cost: The approved budget was $349 million

Architect: CallisonRTKL is the architect of record. DMS Design and FKP also did work on the project.

Lead contractor: Linbeck

The Behavioral Health Center on the top floor of the new South Tower at Cook Children’s Medical Center is an intensive care unit for children with critical psychiatric issues.

Young patients there are often homicidal, suicidal and psychotic.

Eighty percent of them have been exposed to trauma, many to physical and sexual abuse at some point.

They are often admitted through the hospital emergency department, brought in by ambulance or police after a teacher or parent calls 911 for help. They are admitted for crisis stabilization.

“These are children at imminent risk of hurting themselves or others,” said Dr. Hari Kumaresan, medical director of Cook Children’s Department of Psychiatry.

“Typical is a 10- or 12-year-old already on four or five psychiatric medications who has broken a window at school and is using a piece of glass as a weapon to threaten the teacher or other children or is threatening to kill himself with a weapon or by overdosing on meds,” Kumaresan said. “There have been days when we saw eight or 10 such children in one shift.”

The increasing need for intensive inpatient psychiatric care for children 2 to 12, as well as the need for partial hospitalization programs for young children who need continuing intensive treatment as they transition back into their homes and schools, led to finishing out the sixth floor of the new South Tower.

When construction began three and a half years ago, the fifth and sixth floors of the tower were designated for growth in medical/surgical beds, but the hospital has seen “exponential growth in the demand for behavioral health services,” a spokesperson said.

These are very ill children. Many have both medical and psychological disorders. Some have profound autism and intellectual delay in addition to psychiatric disorders such as manic depression.

“We are seeing more younger kids – 7- or 8-year-olds attempting to kill themselves, and that is very alarming, very bad. No one knows why it’s happening,” Kumaresan said. Suicide is now the second-leading cause of death among children 10 to 14 years old, second only to motor vehicle and other accidents.

Psychiatrists, psychologists, clinical therapists, nurse practitioners, family therapists, case managers, two special education teachers and patients were moving into the new Behavioral Health Center in early March.

“The $10 million center was completed with 100 percent donor funding to meet the growing needs of these services for youth in our community,” said Stan Davis, chief operating officer for Cook Children’s Health Care System.

The South Tower will be fully occupied by the end of March when surgery services take over the second floor, including neurosurgery, orthopedic, trauma and general surgery, and the Heart Center moves to the third floor with its own operating rooms, catheterization suites, 14-bed critical care unit and 15 “step-down” beds.

“The approved overall budget for the new South Tower, the South Utility Plant and the on-going renovations made in conjunction with opening the tower, was $349 million,” Davis said.

The plant was built to house the most energy-efficient options to power up all the new high-tech equipment going into the South Tower and increase the medical center’s energy capacity to handle growth.

All South Tower projects are on schedule and on budget, Davis said.

New Emergency Department

In late September, the new Emergency Department opened on the first floor of the South Tower, adjacent to the hospital’s original emergency department. The original ER has been remodeled and expanded into the new tower, and the clinical laboratory and sterile processing unit have been up and running for a year in the tower’s basement.

“The main driver for the South Tower was the need to modernize our surgery suites, lab and emergency department,” Davis said. “The hospital had outgrown those services both in terms of patient volume and space to install the latest cutting-edge technology and equipment such as electronic medical records, integration systems and tracking systems.”

Cook Children’s original emergency department opened in 1990 and was built to accommodate 60,000 to 70,000 visits each year.

In the last year, more than 110,000 young patients were treated in the ER, and an additional 58,000 were treated in the Urgent Care Center (UCC), said Dr. Corwin Warmink, medical director of emergency services.

The UCC was built just south of the new tower to shorten the waiting time for less serious emergencies. It opened in 2014 and expanded in 2016. In addition the Mansfield UCC and the Alliance UCC have opened in the last three years, and plans call for an urgent care center in Aledo as well, Warmink said.

“And our numbers continue to increase on a daily basis,” he said. “One day about two weeks ago we saw 485 patients. That’s one discharged or admitted every three minutes.”

The new emergency center (including the original, totally remodeled ER) opened to patients in late September.

“We see everyone – from near-death and in need of resuscitation to pinkeye. Sick children make their way to us,” Warmink said.

“There’s not a lot of competition. … We 100 percent will see anyone and everyone 24/7. If a child is sick in Tarrant County, this is the place to be. We want them here. We never say, ‘That’s not our job.’ Our job is to give excellent care to every child who shows up.”

Cook Children’s Emergency Department now has 34 physicians, including 28 board-certified pediatric emergency physicians, and six other pediatric subspecialists, 12 pediatric nurse practitioners and about 270 pediatric nurses.

“There are only about 3,000 pediatric ER doctors in the entire country, and we have 28 in our emergency department,” Warmink pointed out.

The new and expanded ER added 47 exam rooms to the 28 remodeled in the old area, five designated trauma rooms fully equipped with the newest resuscitation and breathing equipment, MRI, CT and ultrasound scanners and x-ray machines, and 10 new triage rooms.

Laboratory automation

By the time other departments complete their moves (to the South Tower?), Cook Children’s huge new state-of the art medical laboratory will already have completed 1.3 million tests ranging from simple blood chemistry screenings and coagulation studies to highly complex liquid chromatography mass spectrometry.

Completed in March 2016, the lab is installing “Kiestra,” a totally automated sample processing system with its own robots and cameras to watch microbes growing so that the process is not disturbed to check on the growth.

“Kiestra will provide constant temperatures to enable faster incubation and quicker identification of bacteria and other microbes causing disease,” said Amanda Marten, administrative director of the lab.

Kiestra is designed to increase efficiency, streamline processes and provide highest quality consistent results. It will automatically add on and expand testing, depending on initial results, to enable life-saving switches in antibiotic regimens,” (where are open quotes?) Marten said during a recent tour of the lab.

Digital images of each culture will allow 24/7 non-stop incubation, processing and remote viewing, which makes it possible for pathologists to check cultures from just about anywhere.

“We will be the first pediatric hospital in the country to have microbe automation,” Marten said.

The Heart Center

From the time it opened in 1990, Cook Children’s Hospital has been the place to go to close the holes, replace the valves, open and reroute the blood vessels and switch the pumping chambers in babies born with complex congenital heart defects.

“We have been doing everything except transplants,” said Dr. Deborah Schutte, medical director of cardiology at Cook Children’s. “Now we are in the process of recruiting for a transplant cardiologist to develop a transplant program and manage those patients.”

Currently in Texas it is necessary to refer children in need of a heart transplant to either Texas Children’s Hospital in Houston or Children’s Health in Dallas.

Schutte said it could be next summer before Cook finds the right doctor to head the transplant program and probably two years after that to ready a team to perform the first transplants, but it’s coming.

The Heart Center’s medical team now treats all kinds of heart conditions, from those that require minimum medical care to the very complex heart problems that often require numerous surgeries and years of follow-up.

Cook’s heart team already includes 14 diagnostic and interventional cardiologists with a 15th joining the staff this summer. The team also includes three pediatric cardiovascular surgeons and five nurse practitioners.

The heart team is moving into the new Heart Center in the South Tower and recently used new 3-D virtual viewing and printing technology for the first time.

The technology uses MRI and CT scans to actually make a model of a patient’s heart to support pre-surgical planning and family education.

“With the computer-generated model, you can cut out a wall of the heart to actually see inside and figure out exactly what you need to do to fix it,” Schutte said. “We use virtual 3-D to move all around, inside and out.”

The new and expanded Heart Center will include two operating room suites, two catheterization labs, 14 cardiac intensive care beds and 14 step-down beds.

“In addition, many of our heart patients, including some who are diagnosed prenatally and sometimes weigh two kilos, are in our neonatal intensive care unit,” Schutte said.

“It’s going to be beautiful,” she said of the new Heart Center with all its new space and new technology.

Brain surgery MRIs

Neurosurgery will be among the last departments to move into the new South Tower in late March, but its new 3.0 Tesla MRI that promises to revolutionize brain surgery is still being set up and fine-tuned.

The powerful $9.8 million scanner has twice the strength of the 1.5 Tesla currently used during brain surgery. It displays highly accurate, real-time digital images of the brain during surgery.

It is being installed on a rail so that it can move from the special operating room developed for brain surgery to an adjoining diagnostic room, where a child brought up from the ER with head or spinal cord injuries can be precisely diagnosed.

“Some intraoperative MRIs are used in radiology and some in surgery, but this is the first to have a dual function,” said Dr. John Honeycutt, medical director of neurosurgery.

Intraoperative MRI is used during surgery to reduce the risk of leaving behind any tiny part of a tumor or other abnormal growth that is causing epilepsy or other brain disturbances, Honeycutt said. Cook Children’s neurosurgeons have been using I-MRI since 2007, but this new machine is much more precise.

“This is very beneficial technology,” he said. “There has been a revolution in how we surgically treat brain tumors. I-MRI hasn’t changed the operation, but it has changed how well we can do it.

“The old way, we would operate and try to get all the tumor tissue out, do the best job we could. Then we would go back in the next day and get a scan to check on what we had done. Many times there would be a tiny spot left that was suspicious for tumor tissue so we had to go back in and take out a little bit more, and more anesthesia was required.

“Now we know as soon as we are finished whether we have done exactly what we planned to do. If we are unsure of exactly what is normal tissue during surgery, we can do a scan as we operate.

“Most places that have this technology use it for tumor removal, but Cook also uses it to stop seizures. … We are using it more and more in stereotactic procedures – minimally invasive brain surgery to destroy lesions and for deep brain stimulation to treat dystonia, tremors and other movement disorders,” Honeycutt said.

“Cook is a world leader in all of this,” he added.

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