Patient Population and Demographics
Our patient population at LPCH is very diverse, both in ethnicity and socio-economic strata. In the primary care clinic, our patients are roughly 60% Hispanic, 12% Pacific Islander, 10% African American, 7% Asian, and 7% Caucasian. Most of these families are living at or below the poverty level, and qualify for MediCal (Medicaid in California). Beyond the clinics, LPCH is also the local hospital for a large network of community primary care pediatricians, serving a broad patient population from the surrounding communities of the San Francisco peninsula and Silicon Valley. Through the local community residents are exposed to common pediatric illnesses. As a referral center for specialized tertiary and quaternary care clinical services, we attract patients from across the western United States, Alaska, and Hawaii. We also have an international patient population seeking our most highly specialized clinical services such as interventional cardiology and cardiac surgery.
LPCH Intensive Care Units
At LPCH, all residents participate in two excellent intensive care units. The Neonatal Intensive Care Unit (NICU) is part of the Johnson Center and is a Level III, 40-bed unit dedicated to neonates. The unit is a major referral center for northern California. The NICU is adjacent to the high-risk delivery service at the Johnson Center and cares for patients with a wide variety of medical and surgical diseases. The NICU is equipped with ECMO for patients with cardiovascular and multi-organ failure. Residents spend approximately 2 months in the unit over the course of their 3 years of training. Call in the NICU is covered by either an intern or a senior resident with call every fourth night.
The Pediatric Critical Care division includes a Pediatric ICU (PICU) and a Cardiovascular ICU (CVICU). A new 20-bed CVICU has recently opened, allowing the expansion of the PICU to 24 beds. The PICU handles trauma, medical referrals, transplantation and post-surgical cases. The PICU is also equipped with ECMO for cardiovascular and multi-organ failure. The CVICU is primarily pre- and post-surgical cardiovascular patients, and is a part of the nationally prominent LPCH Children’s Heart Center. All residents spend at least 2 months in the PICU. Call in the PICU is covered by either a junior or senior resident with an every other night float system. For pediatric residents with an interest in Cardiology, electives can be arranged in the CVICU.
LPCH Inpatient Wards
Wards at LPCH include the Hematology-Oncology and Stem Cell Transplant ward on the first floor, and the General Pediatric and Subspecialty wards on the third floor. The 15-bed oncology ward and 12-bed bone marrow transplantation (BMT) ward care for new oncology referrals, chemotherapy, acute admissions, and patients undergoing or post stem cell transplantation. All residents spend 1 month on the oncology ward in their second year, and some return for additional weekend coverage as Seniors. The oncology service has a night float covering overnight shifts. This is a junior resident doing a 4 week rotation composed of 2 weeks of night float and 2 weeks of outpatient hematology. The BMT service is offered as an elective to interested residents.
The wards on the third floor are currently organized into five resident teams, divided along sub-specialty lines. The Blue Team is composed of two interns and one senior resident and cares for general pediatric, neurology, and adolescent patients. The Yellow Team consists of one intern and one senior resident who care for pulmonary and endocrine patients. The Red Team cares for nephrology and rheumatology patients and is composed of one intern and one senior resident . The Green Team is composed of one intern and one junior resident and cares for our gastroenterology and liver patients. The Purple Team cares for cardiology patients and is covered by a junior who does two-weeks of inpatient and two-weeks of outpatient. Surgical patients are covered primarily by the surgical services. All residents spend time on all teams at multiple points throughout their three years. Overnight call on the LPCH wards is taken primarily by Night Float Teams. On the wards, a team of two interns and one senior resident care for patients at night. The oncology ward has a separate junior resident covering at night. There is a night time teaching curriculum led by the LPCH hospitalists, which serves as an educational component for the night teams.
LPCH Ambulatory Care
The Ambulatory Care Center has over 134,000 annual clinic visits and provides primary and specialty care in a wide variety of medical, obstetrical and surgical clinics. Our General Pediatric clinics (including the Acute Care Clinic) provide ample well child assessments, sick visits, and continuity clinic patients for our residents. Specialty clinics offer the entire range of pediatric subspecialty care including Adolescent Medicine, Allergy/Immunology, Bone Marrow Transplantation, Cardiac Transplantation, Cardiology, Dermatology, Endocrinology, ENT, Diabetes, Center for Healthy Weight, Gastroenterology & Nutrition, Genetics, Hematology/Oncology, Infant Development, Infectious Diseases, Liver Transplantation, Nephrology, Neurology, Neurosurgery, Orthopedics, Pediatric Surgery, Psychiatry, Pulmonary, Renal Transplantation, Rheumatology, and Urology. Residents participate in many of these clinics during their selective and elective blocks, as well as scheduled rotations. Most of these clinics are located in the Mary Johnson Ambulatory Care Center.
LPCH Family Centered Care
The entire staff of LPCH is dedicated to family-centered care. This commitment is reflected in the design of the facility and in the operations of the hospital and clinics with its dedicated child-oriented support services. We feature special facilities such as recreation therapy and a school within the hospital walls. Our active Child Life department includes the Forever Young Zone with recreational facilities for children of all ages. Parents participate actively in their children's care and are encouraged to stay overnight in special in-room parent beds. Cooking, laundry, shower, and lounge facilities are available for family use. Social service professionals, chaplains, interpreters, and a special sibling program are available to minimize the stress of a child's hospitalization.
SCVMC Units and Clinics
In 1999, SCVMC opened a new state-of-the-art hospital in San Jose with comprehensive pediatric clinical services. The new facility features a 12-bed critical care unit, a 40-bed neonatal unit, and a 30-bed pediatrics unit. Its active obstetrical service with over 6000 deliveries per year provides ample delivery room experience for our pediatric residents. Senior residents help cover the well-baby nursery at SCVMC and intern and junior residents rotate through the NICU. Residents spend a portion of their time each year in the combined ward and PICU. This offers important exposure to bread-and-butter general pediatrics, pediatric subspecialties and pediatric intensive care. SCVMC is also a Level I trauma center with an active trauma service and offers special pediatric services including a burn treatment center and a special unit for rehabilitation and spinal cord injuries. The junior resident performs emergency department and burn unit consultations. The rotations at SCVMC are highly rated by residents for their diversity, autonomy and educational value. Call at SCVMCis every fourth night for juniors and seniors with interns taking night float.
The SCVMC outpatient facility, the Valley Health Center, is located across the street from the hospital and offers more than 60 primary care and specialty clinics. Our residents work in the SCVMC clinics as part of their ambulatory training curriculum. Additionally, some residents choose SCVMC or one of its satellite clinics for their continuity clinic experience. During subspecialty selectives, residents participate in a variety of SCVMC clinics including Behavior and Development, Cardiology, Endocrinology, Gastroenterology, Genetics, Infectious Diseases, Nutrition, Nephrology, Neurology, Neuro-Development, Orthopedics, Ophthalmology, and Pediatric Surgery.
Kaiser Unit and Wards
The pediatric service at Kaiser Santa Clara includes a 26-bed Pediatric Ward and a 8-bed Intensive Care Unit. This intensive care unit and the High Risk Pregnancy Program serve as a referral center for other Kaiser Permanente Medical Centers in Northern California. Some residents spend a month during their intern year as the primary physician on the Kaiser Inpatient Service (the ward and the PICU), with back-up and teaching from a staff of excellent Kaiser physicians. Not only does the rotation provide exposure to a large staff-model HMO setting, but it gives a manageable sense of independence and the opportunity for exploration. There is no call at Kaiser but there is weekend day coverage.