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Dartmouth-Hitchcock Medical Center DEVELOPMENT

A little comfort means a lot to sick kids
By Barbra Alan

Given the choice, most children would rather confront the monster under the bed than go to the hospital. To a kid, a hospital can be a scary and uncomfortable place, both physically and emotionally. Because the Children's Hospital at Dartmouth (CHaD) is dedicated to providing the best possible care to its young, vulnerable patients and their families, its pediatric intensive care unit (PICU) has recently undergone some significant changes to improve the experience for children who must be hospitalized.

One of the changes was the expansion of the PICU from six beds to 10—as a result of increased demand for the cutting-edge pediatric intensive care that CHaD provides to its young patients. Dartmouth's PICU is the only free-standing pediatric intensive care unit in the region, and it serves a total population base of more than a million.


Dartmouth's PICU was established as a separate unit in 1989. The PICU is where the most critically ill and injured patients receive their care. There, a team of specialists in pediatric critical care, anesthesiologists who specialize in pain management, subspecialists in various other disciplines, pediatric residents, and a specially trained staff of pediatric critical care nurses and nurse practitioners treats children ranging from one month to 18 years of age.

The current leader of the care team is Dr. Daniel Levin, medical director of pediatric intensive care and a professor of pediatrics and of anesthesiology. Credited as one of the nation's founders of the pediatric intensive care unit, Levin left his post as medical director of the PICU at Dallas Children's Medical Center and Parkland Memorial Hospital in 1996 to help design, build, and oversee the operation of a spacious, new, state-of-the-art pediatric intensive care unit for CHaD.

While the high-tech equipment helps critically ill children survive, it's human contact that helps them thrive.

And in 1999, the Butler PICU— named in honor of the J.E. and Z.B. Butler Foundation of New York, which provided leadership funding for the construction of the new unit—was unveiled to great enthusiasm from kids and parents alike.

Consideration for the comfort of children and their families was at the heart of the plans for the PICU's development. In fact, patients and their families, as well as physicians, nurses, and staff, were invited to provide input about the arrangement of the new facility. As a result, the PICU features increased space between beds, private bathrooms for each patient, walls and partitions between the beds to ensure privacy, and familyfriendly touches such as the presence of rocking chairs in each brightly-colored room.

Wooded views

All of the unit's rooms feature expansive wooded views, which create a soothing, peaceful environment for children, their parents, and staff. A 12-bed Critical-Care Family Sleep Space was also part of the construction project, so family members can spend the night near their child or get some much-needed rest without leaving the Medical Center.

In the years since the new unit opened, the number of patients in the Butler PICU has grown significantly, in tandem with the region's increasing population. In fact, throughout 2002, the unit was almost constantly at capacity. And during the winter months, beds were at such a premium that some patients had to be placed in other locations within DHMC or moved to other sites. Because such circumstances were hardly conducive to the comfort of patients and their families, plans were made to expand the PICU to 10 beds.

In May of 2003, an open house was held to celebrate the expansion, which includes not only the addition of the four new beds but also more equipment to provide optimum monitoring and care for the increased number of PICU patients.

And, of course, a rocking chair was essential for each new room to promote some of the best care of all—snuggling. One-to-one interaction, whether it comes from a loving parent, a caring PICU staff member, or a volunteer, is powerful medicine. For a sick child who must endure all sorts of daily indignities—from needle pricks for intravenous lines to the constant presence of beeping equipment—gentle, human contact provides a desperately-needed feeling of comfort and security. While the PICU's high-tech equipment helps critically ill and injured children survive, their families and the PICU staff know that it's human contact that helps them thrive.

New knowledge

The expansions and improvements are not limited to the physical realm at CHaD. Advancing research is critical to its mission of providing the highest quality care to children. And so, with support from the Susan J. Epply Pediatric Intensive Care Research and Education Quasi-Endowment Fund, the Butler PICU has been able to advance the frontiers of knowledge about childhood illnesses by sponsoring three important studies.

One study, being performed by residents, is evaluating the effectiveness of four different medications designed to improve breathing in infants with a condition called respiratory syncytial virus bronchiolitis. This potentially deadly disease swells the smallest airways of the lungs and fills them with mucus, blocking the airflow in the neonates' tiny lungs.

Another study, being conducted by members of the faculty, is measuring the impact of having parents present for physicians' daily medical rounds.

Skillful and sensitive

The third study, which is being conducted by members of the nursing staff, is evaluating the best way to manage sedation for children who are able to breathe only with the help of a mechanical ventilator.

With a skillful and sensitive staff, sophisticated technology, and a comfortable, family-friendly setting, the Butler PICU embodies CHaD's commitment to providing the best care for its young, vulnerable patients and their families. And while it's likely that children would still prefer to face the monster under the bed than a hospital bed, the Butler PICU is ready and waiting for when they— and their families—need it.

Dan Levin—pictured above checking out a wee patient —is the medical director of Dartmouth - Hitchcock Medical Center's pediatric intensive care unit. The unit emphasizes a collaborative approach to care, as represented by the team below, as well as a myriad of high-tech equipment, as seen in the newly renovated room below.

All photos: Mark Austin-Washburn

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring—all of which have the potential to turn a life around.
— Author Leo Buscaglia (1924-1998)

Partners in pediatrics

The Butler Pediatric Intensive Care Unit (PICU) at the Children's Hospital at Dartmouth (CHaD) is grateful for the generous support of donors such as the J.E. and Z.B. Butler Foundation and the Susan J. Epply Charitable Foundation. Such funding has enabled the PICU to sponsor innovative pediatric research, enhance and expand its facilities, and provide the most advanced, family-centered care to the children of northern New England.

CHaD has always done its best to keep costs low and the quality of care high. However, children's care requires more people—with specific training in pediatrics; more specialized equipment—in all sizes; and more attention to individual patients' needs—and the needs of entire families. Patient fees cover only part of what it costs to sustain ChaD's pediatric programs and services. Historically, other sources of revenue— such as reimbursements from medical plans, payments from the federal government for providing teaching and research, and philanthropy—have helped to offset costs. But in today's changing financial climate, a way to ensure CHaD's ability to continue to serve the needs of the children and families of New England without regard to their ability to pay is by endowing CHaD's operations—including personnel, facilities, research, and teaching.

Exciting progress has been made in the care of children over the last 20 years, and the future looks even more promising. The 21st century clearly presents new challenges, but it also is bringing new ways to heal sick children. Charitable gifts will be key in helping sustain CHaD's position as a national leader in pediatric health care, training, and research.

Barbra Alan is assistant director of development communications at DHMC.

If you would like to offer any feedback about this article, we would welcome getting your comments at DartMed@Dartmouth.edu.

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