Provider Perspective

Judy Giel, RRT, CRTT, Senior Vice President of Clinical Service, Pediatric Home Service (PHS)

How did your company became involved with pediatric home ventilation.
Approximately 20 years ago, Susan Wingert, PHS owner and respiratory therapist, determined that a large group of pediatric pulmonologists in the metro area had a rapidly growing population of children with very special needs. Most of our competitors had been working the cradle to grave concept. They were durable medical equipment suppliers — providing traditional HME — beds, wheelchairs, commodes and oxygen systems, but few were calling on or meeting the needs of these pediatric pulmonologists. She began to meet with them and understand what their needs were in order to provide equipment, supplies and services to this underserved population.

What are the special considerations for pediatric patients?
Children are not “little adults.” Pediatric ventilation is much different than adult ventilation. First of all, pediatric (patients) can’t articulate their needs — such as if they’re comfortable or not. They have very distinct developmental stages and milestones. So, when we put adults on home ventilators, we don’t have to worry about the crawling stage, the learning how to walk stage, the going to school stage and the challenges of incorporating them into the community. Those types of developmental milestones are very important considerations when planning for a pediatric ventilator discharge from the hospital.

Will pediatric patients eventually grow out of their condition and stop using ventilation?
With some lung diseases associated with premature infants, there is a possibility that as the child grows and develops, given adequate ventilatory support, their condition may improve as their lungs and airways mature. We work collaboratively with their physicians to wean them off of the ventilator and ultimately see them decannulated. We have hundreds of success stories in that area.

Discuss the educational component of your business.

Many times it’s not just the families in the home with the children. We also have caregivers, nurses, LPNs and personal care attendants. We have to ensure that we have very sophisticated training programs in place, educational literature and safety emergency protocols. We provide these to in-home caregivers and professionals to ensure they not only know how and when to use the equipment and troubleshoot the systems, but that they have the skills and ability to respond in an emergency.

Does pediatric ventilation require creative strategies?
We have to be very creative because there’s not just one simple template to use for pediatrics. We care for all sorts of children with different genetic conditions and anomalies that require customization in applying technology to support their needs. An example would be special masks or circuits because they may have facial anomalies that over the years will be treated surgically but in the meantime still need ventilatory support. At PHS, we started a committee that’s called the New Equipment and Supply Integration Process. We have to keep trying new equipment, new supplies and new products that might work on our children, but we can’t just buy it, put it out there and hope it works. We really have to evaluate it in a very controlled way, and then we have to integrate that product or supply into our procedures and processes. We seek feedback from our customers on it, and then we have to create educational pieces. Our biomedical, electronic technicians and specialists in our equipment processing center who maintain all of our equipment need to be trained and certified by the equipment manufacturers to work on the equipment. Their work is essential to our success in applying creative solutions to the unique challenges our clientele often present.

Talk about your needs from a home care perspective.
We aren’t a Medicare model. For us in the home care sector, we’re out there hanging without a lot of a lifeline. We could really use organizations like the American Association for Respiratory Care and national and local durable medical equipment organizations to recognize this pediatric home care segment is a key piece without a lot of support. So, recommendations for how often we change ventilator circuits in the home, recommendations for infection control practices, equipment functionality, training — these are really important elements that get missed because (home care) is such a Medicare-driven model. We need help and support when discussing pediatric issues with our managed care organizations and state medical assistance programs so that the special and unique needs of this large population are represented rather than ignored by the adult marketplace.

This article originally appeared in the Respiratory & Sleep Management November 2009 issue of HME Business.

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