Multidisciplinary Clinic Focuses on Technology Dependent Children

The Multidisciplinary Technology Dependent Child Clinic at St. Louis Children’s Hospital offers comprehensive services for patients with respiratory, neuromuscular or airway disease requiring chronic mechanical ventilation. Its goal is to safely and seamlessly transition children from the hospital to the home environment by:

• Establishing optimal ventilation with portable equipment and stabilizing other medical conditions.
• Providing training and education of at least two caregivers in all aspects of patients’ care.
• Ensuring a medically and socially safe home environment for the care of a medically fragile child.

“Our multidisciplinary clinic is a cooperative effort between otolaryngology and pulmonary, the two subspecialties that play significant roles in stabilizing and managing these children’s airways and ventilation,” says Katherine Rivera-Spoljaric, MD, MSCI, the clinic’s pulmonologist. David Molter, MD, is the clinic’s pediatric otolaryngologist. “Our patients benefit from the convenience of having the expertise of both services in one location. It also enhances communication among team members, which means decisions about patient care are made quickly and are based on up-to-date information regarding patients’ conditions and needs.”

The clinic meets on the fourth Tuesday of every month in the hospital’s third-floor otolaryngology suite. In addition to Drs. Rivera-Spoljaric and Molter, the team includes Jodi Carter, RN, CPNP, chronic mechanical ventilator specialist nurse practitioner; Debbie Prater, RN, CNS, tracheostomy nurse specialist; Jennifer Gaedike, RN, nurse coordinator; and Margaret Hachman and Holly Lemuth, respiratory therapists. Depending on patients’ needs, they may be seen by a pulmonologist, pulmonary nurse practitioner, otolaryngologist, tracheostomy nurse specialist and respiratory therapist.

“We see more than 75 patients, typically on a biannual basis, but more frequent follow-up may be necessary depending on an individual child’s condition,” says Dr. Rivera-Spoljaric. “We advise patients and their families to plan for a three-hour visit, which ensures there is adequate time for them to be seen by the services they need and to undergo necessary testing.”

The clinic’s outpatient evaluations include a comprehensive history and physical examination, assessment of growth, measurements of oxygenation and ventilation and, when possible, other measurements of lung function.

To refer patients to SLCH’s Multidisciplinary Technology Dependent Child Clinic, call Children’s Direct at 800.678.HELP (4357).

The Clinic’s Programs and Services

• Otolaryngology and pulmonary subspecialties at a combined clinic.
• Thorough evaluation of ventilator settings by practitioner and experienced respiratory therapist.
• Evaluation of tracheostomy needs by otolaryngologist and tracheostomy-specialized nurse.
• Bedside laryngoscopy and airway evaluation.
• Parental education on tracheostomy, ventilator, airway clearance techniques, respiratory medications, evaluation of illness symptoms, and acute illness plans.
• Pulmonary function testing.
• Coordination of sleep studies, therapy services, social services evaluation, and dietitian evaluation and follow-up services.
• Close monitoring during hospitalization.