New Pediatric & Neonatal Intensive Care

Laura Tucker-Longsworth MSN. RN. Nurse Consultant, Belize.

The Karl Heusner Memorial Hospital (KHMH) has entered an exciting stage of service development and expansion with the construction of a brand new building, which will house state of the art Pediatric and Neonatal Intensive Care Units and be fully operational by December 2015.

new picss"The Special Envoy for Women and Children-Mrs. Kim Simplis Barrow, wife of the Prime Minister of Belize recognized the need for a new and expansive building to address care quality issues among neonates and children. She initiated and spearheaded the entire multimillion-dollar project, which has resulted in the construction of new PICU/NICU at the KHMH. Mrs. Simplis Barrow is also the founder of Lifeline Foundation, a philanthropic non-government organization that focuses on improving the lives of children.

The new wing of the KHMH will house both a Pediatric Intensive Care Unit (PICU) and a Neonatal Intensive Care Unit (NICU). This is being done in partnership with KHMH and the Ministry of Health with financing from the Government of Belize, Oak Foundation, a generous anonymous donor and the Belize High Commission in London. This is the second such Project for Mrs. Simplis Barrow who, in March 2014, successfully completed and inaugurated the Inspiration Center, which provides diagnostic and rehabilitation services for children with special needs. As a result, the new PICU/NICU will now be able to offer long-term monitoring and rehabilitation services to children with neurological and other deficits through referrals and collaboration with the Inspiration Center.

The Karl Heusner Memorial Hospital (KHMH) is the only referral hospital in Belize and offers secondary and tertiary level medical services to patients from public and private sectors at subsidized costs. This is in keeping with government's mandate of ensuring that their citizens have access to affordable, effective and quality healthcare services.

This Institution plays an important role in the country's development especially since approximately 43 percent of people are either poor or very poor. The KHMH employs the largest cadre of nurses, pediatricians, physicians and surgeons and have developed internal systems directed at improving health outcomes. However, over the years the institution has lagged behind. Financial constraints have impeded infrastructural development, slowed down the acquisition of much needed equipment and limited the recruitment of specialists and other human resources in health. Despite these constraints, the KHMH continues to save lives and has added specialized services that would normally not be available to citizens in the public sector.

According to the Statistical Institute of Belize, in 2010 there was a 12 percent increase of children less than 15 years old, when compared to the 2000 census (101,791 to 114,748 respectively). Similarly, in the 15-19 age groups for the same census period there was a 26 percent increase between 2000 and 2010 (27,373 to 34,649 respectively). This trend is expected to continue as evidenced by the estimated population of 368,310 at mid-year point in 2015, when compared to 322,452 in 2010.

Since opening its' doors in 1995, the 24 bed Pediatric Unit at the KHMH has had to cope with increasing occupancy rates and management of critically ill children in a general pediatric Unit. The neonatal intensive care unit (NICU) became a center of excellence for newborns with critical illnesses as a result of prematurity, infectious processes, congenital anomalies, cardiac and other medical conditions. However, the facility has become overcrowded with limited space and equipment resulting in increased morbidities and mortalities. The KHMH reports that in 2014, there were 220 admissions to the NICU; at mid-year (2015) they have already surpassed that number with over 330 admissions!

The main goal of establishing the new PICU/NICU is to reduce mortality and morbidity among critically ill neonates and pediatric patients with trauma, post-cardiac surgery, cancers, HIV/TB morbidities and other conditions requiring specialized care. An outcome indicator for the new PICU/NICU is that of reducing mortality rates to less than 50 percent in critically ill, ventilated, neonatal and pediatric patients. It is important to note that only 50% of critically ill neonates survive, resulting in a neonatal mortality rate of 15 per 1000 live births in Belize. Data also show an unsatisfactory infant mortality rate for Belize of 21.1 per 1000 live births (MoH, 2011).
Attendant to the key goals for the PICU/NICU are initiatives that are being undertaken to improve and achieve desired health outcomes.

housess56Those include the recruitment of two neonatologists over the next six months, staff recruitment and additional training of physicians and nurses in critical care and emergency management of children. Standards, protocols, and infection control systems are being revised and developed. Monitoring and evaluation strategies are being adopted and strengthened to address issues of patient care quality and to identify potential threats to the health status of hospitalized children.

Weaknesses in KHMH's data management system are being corrected. This is a critical step to ensure that reliable and valid data are available and utilized to support evidenced-based decisions in patient care management, staffing, and quality initiatives. Importantly, this will facilitate comparative analyses of interventions and health outcomes prior to and after transfer to the new PICU/NICU. Additionally, improved data systems will help to quantify the true value of the return on investment in terms of survival rates and desired health outcomes over a specified period of time.

The new 11,400 square feet building, which was designed by Belizean Architect Esther Ayuso Ramirez, is in compliance international standards for hospitals. Extensive consultations were held with healthcare providers in Belize and reviews of similar facilities in other countries were conducted-all of which contributed to the design of the building. The total project budget is U.S. $4,359,007 with over U.S $3,000,000 assigned to construction and medical equipment cost. This impressive "one of a kind" air-conditioned medical facility in Belize is child friendly. Special design considerations were given to the comfort of families who must remain near their hospitalized children without interrupting the flow of medical and nursing services in an area of high intensity care and equipment use.

Lounges, bathrooms, sleeping facilities and a kitchen are unique features of the PICU/NICU. Families have access to three internet stations so that they can easily communicate with families and conduct review of literature on their child's condition. Mothers recovering from C-Section deliveries and breastfeeding mothers will be delighted to discover that apart from the comfort of rest areas and lounges, a designated breastfeeding room will be available to them.

The hospital features of the NICU/PICU are user friendly with special spaces that will enhance the functionality of the facility. Based on epidemiological profiling and forecasting of usage, the PICU now has six designated Units for older children. The NICU has three levels of care intensity: levels one and two with seven units each and level three with six units.

There are four isolation units with special ventilation systems and other features, which are visible from the nursing station. All 30 beds have flat wall consoles with gases, vacuum and facilities for life support equipment. An additional feature is the capacity to increase the bed status in the NICU during an emergency or disease outbreak; each console can actually accommodate another bed and ventilator. Other features include a playroom, blood bank, laboratory, pharmacy and respiratory therapy room as well as administrative offices, a conference room and staff lounges.

Chief of Pediatrics-Dr. Cecilio Eck and Director of Medical Services-Dr. Lisa Johnson are fully engaged in preparations for the opening of the new facility. Apart from identifying training needs and solving issues related to recruitment of specialized staff for the PICU/NICU, they are excited about the opportunity of sharing scarce resources and expertise with Hospitals in the Southern, Western and Northern Health Regions.

For example, the acquisition of new ventilators for the PICU/NICU will not only allow ventilators to be placed at key locations in the KHMH, but will enable placements of ventilators at Regional Hospitals and facilitate training in emergency and life support management.

This offers additional opportunities to reduce high morbidity and mortality rates for children at the district level. They also believe that the new pediatric wing has the opportunity to become a regional center of excellence in Central America. Indeed this is an important and relevant vision given the rapidly increasing global trend of "medical tourism."

The hospital features of the NICU/PICU are user friendly with special spaces that will enhance the functionality of the facility. Based on epidemiological profiling and forecasting of usage, the PICU now has six designated Units for older children. The NICU has three levels of care intensity: levels one and two with seven units each and level three with six units. There are four isolation units with special ventilation systems and other features, which are visible from the nursing station.

All 30 beds have flat wall consoles with gases, vacuum and facilities for life support equipment. An additional feature is the capacity to increase the bed status in the NICU during an emergency or disease outbreak; each console can actually accommodate another bed and ventilator. Other features include a playroom, blood bank, laboratory, pharmacy and respiratory therapy room as well as administrative offices, a conference room and staff lounges.

Chief of Pediatrics-Dr. Cecilio Eck and Director of Medical Services-Dr. Lisa Johnson are fully engaged in preparations for the opening of the new facility. Apart from identifying training needs and solving issues related to recruitment of specialized staff for the PICU/NICU, they are excited about the opportunity of sharing scarce resources and expertise with Hospitals in the Southern, Western and Northern Health Regions.

For example, the acquisition of new ventilators for the PICU/NICU will not only allow ventilators to be placed at key locations in the KHMH, but will enable placements of ventilators at Regional Hospitals and facilitate training in emergency and life support management.

This offers additional opportunities to reduce high morbidity and mortality rates for children at the district level. They also believe that the new pediatric wing has the opportunity to become a regional center of excellence in Central America. Indeed this is an important and relevant vision given the rapidly increasing global trend of "medical tourism."

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