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Total Patient Care at Shriners
By Judith Phillips Otto Total patient care is a reality, not a dream, at
Shriners Hospitals for Children.
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Janet Marshall, CPO |
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Janet Marshall, CPO, member of the Association of
Children's Prosthetic-Orthotic Clinics (ACPOC) Board of Directors
and prosthetist at the Shriners Hospital for children in Tampa,
Florida, admitted that Shriners' clinicians are fortunate enough to
be living in a world far removed from the private sector.
Marshall is part of a staff of ten pediatric specialist
practitioners who tend to orthotic and prosthetic needs of the
Shriners' young patients; she has been with the hospital for 14
years. Shriners' Tampa hospital was established in 1985 as the
center of total family-centered care, and it considers parents of
patients as vital members of the total care team.
"We are a family-centered care facility where we encourage
family to be a part of the clinic team, where they are asked to
come with their children and stay with them at lodging facilities
within the hospital, if possible," she said. "We want one parent
definitely to be there at all times, just to help with the care and
to be there for the kids."
Making Hospital Stays Easier
Child Life is a hospital department that helps ease the stresses
of being in the hospital, Marshall explained. There, patients are
entertained as well as educated regarding their surgery or their
castings. Staff members bring dolls in to demonstrate how casting
will be done or how a lengthening device is going to be put on.
"This approach has definitely been a benefit to easing the anxiety
levels of our kids and allowing them to get comfortable with the
staff members who will be working with them," Marshall said.
"When we have a clinic appointment, the children will be seen by
a team, not just by the orthopedic surgeon, but accompanying him or
her will be an orthotist or prosthetist, a physical therapist, a
nurse practitioner, or physician assistants," she continued. "We
also have different coordinators to help, and the nurses, of
course, help coordinate in the clinic setting and make everything
work smoothly."
Not Only Free Care--But Quality Care
Members of the extended team also could include physical
therapists and others in the patient's own hometown, since
Shriners' patients come from all over the world--and not only
because care is free, Marshall noted.
"We don't pride ourselves on the free care so much as quality
care," said Marshall. "Doctors' and lawyers' kids come to see us,
not because they can't afford to go elsewhere, but because we do
have this wonderful approach and have the full setting available to
see them in one spot and provide the full-care package.
"The clinic team approach is probably our greatest asset,
because we are dealing with everyone, and we communicate well with
one another and accept advice from one another, keeping the
patient's benefit in mind," she added. "Whatever is going to help
them most is what we want. That open communication is a vital
aspect of it.
"You also get the parents networking. They're in the waiting
area, but they're talking to one another in a setting that is
common ground, where they can talk with other parents about
problems and challenges and network on solutions."
ACPOC: Team Approach to Networking
Why has total patient care taken so long to catch on in other
places? "Total care works because it really starts in our clinic
setting, and as a clinic we have a total clinic team approach. This
actually ties into my organization--because ACPOC also has a team
approach in networking. It is one way that we are reaching more
than just the Shriners systems; we are reaching out to the entire
public with the value of the total-care concept."
"Our guidelines are: they are children, and they have
disabilities that require our attention," summarized Marshall. "The
benefit of ACPOC is that we are communicating on all levels. Too
often the doctors go to their organization, the nurses go to their
organization, and the physical therapists go to their organization.
The communication and networking that is truly an essential part of
total care is missing whenever you don't have them all together and
discussing a single problem from all these different
perspectives."
A joint annual meeting shared by ACPOC and the American Academy
of Orthotists & Prosthetists (AAOP) is planned for March 1619,
2005, in Orlando and may open more doors to the total care concept.
"Like everybody else," said Marshall, "we are feeling budget
crunches; a shared meeting is one way of possibly contacting more
people and yet holding our costs down a bit. So it's a benefit in
terms of budget, and it's a benefit in terms of broadening our
audiences and having a crossover between meetings.
"I've been to other conferences that are helping to encourage
this concept to go further," Marshall said, citing the annual
meeting of the American Academy for Cerebral Palsy &
Developmental Medicine (AACPDM). "It also is multidisciplinary,
including physicians, therapists, orthotists and prosthetists, and
motion analysis lab people. Any time you have a networking of
different disciplines, it encourages communication, and
communication encourages total patient care. Whenever we put up
walls between us--and I don't know why that happens, but it does
happen, out of competitiveness or egos or what-have-you--then
you're limiting the benefit to the patient. But people are
basically good and they want to help, and that's why they're in
their profession."
Marshall noted that there are fewer clinics. "It's a sad
thing--even at ACPOC, we're seeing a reduced number of clinics. The
clinics did bring the different professions together to evaluate
patients, and I assume it's mostly for cost-related reasons that
they are no longer running clinics like they used to, but there's a
definite decline." Healthcare professionals can't discuss patients
as effectively over the Internet or via fax, she pointed out. "When
organizations get together to discuss common problems, it can make
a difference, and hopefully more hospitals will develop settings
that are family-friendly." 
Table Of Contents - July 2004
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