Medical Department
Scope of Service
Medical care services at the Massachusetts Hospital School include primary care, comprehensive medical case management, and specialty and subspecialty consultation.
Levels of Care:
The Massachusetts Hospital School provides a continuum of medical care for children, adolescents and young adults with physical and other disabilities. Inpatient management of minor acute illnesses and chronic medical problems is provided by pediatric nurse practitioners, pediatricians, attending and resident orthopedists, with other specialty consultation as necessary.
Clinical Services:
Medical services at the Massachusetts Hospital School are organized as a Medical Staff of the whole, providing clinical services in the following areas, according to the Bylaws of the Medical and Dental Staff:
- Pediatrics and Adolescent Medicine
- Orthopedics and Rehabilitation Medicine
- Dentistry and Oral Surgery
In addition, clinical services include specialty consultation including radiology and laboratory support, such that radiographs and specimens for laboratory study can be obtained and interpreted.
Pediatric and Adolescent Medicine
Comprehensive medical and rehabilitative services are presently provided to Massachusetts Hospital School patients admitted to the Hospital.
Primary care, management of acute but minor medical problems, and general medical case management are provided by four experienced pediatric nurse practitioners, in consultation with staff pediatricians.
Staff pediatric consultation is available at all times, providing oversight and care through frequent discussions with staff, monthly interdisciplinary team meetings, comprehensive annual reviews, and complete consultation for all acute illnesses.
The Associate Medical Director has the responsibility for the quality and appropriateness of all cares provided by the Division of Pediatrics and Adolescent Medicine.
Orthopedics and Rehabilitation Medicine
Consultative orthopedic services are presently provided at the Massachusetts Hospital School under the direction of the board certified Clinical Chief of Orthopedics. Orthopedic care is provided to inpatients and also to outpatients.
Rehabilitative care is provided by a board certified pediatrician with substantial experience in pediatric rehabilitation medicine, supported by MHS consulting staff, as well as by the comprehensive interdisciplinary teams of the Massachusetts Hospital School.
Dentistry and Oral Surgery
The Massachusetts Hospital School, directed by an experienced pediatric dentist, provides comprehensive dental, orthodontic, periodontal and restorative services.
Respiratory Care and Pulmonary Medicine
Pulmonary medical services at the Massachusetts Hospital School are now directed by a board certified internist who has additional subspecialty board certification in Pulmonary Medicine and Critical Care Medicine.
Clinical services include inpatient and outpatient consultation, pulmonary function testing, arterial blood gas sampling and interpretation, interpretation of chest radiographs, comprehensive respiratory therapy services, patient/family/care provider education with respect to pulmonary care, medical discharge planning, and consultation should acute tertiary care be necessary.
Infection Control and Infectious Diseases
A board certified pediatrician provides infectious disease consultation and direction, for all aspects of infection control at the Massachusetts Hospital School, with subspecialty board certification in pediatric infectious diseases.
Clinical care is provided through direct patient evaluation and consultation. Patient care is also supported by staff education, and by oversight of the Infection Control practitioner for the Massachusetts Hospital School.
Psychiatry, Psychology and Counseling Services
A board certified pediatric psychiatrist presently provides psychiatric consultation, with administrative support from the Director of Ancillary Services and hospital administration. This includes acute assessment, medication consultation, and guardianship evaluations as requested. The consulting psychiatrist also works with hospital administration, the Director of Psychology, and the Medical staff to review policy and procedure pertaining to behavioral programming in crisis intervention.
The Director of Psychology, who works closely with the consulting psychiatrist and the Director of Case Management, directs psychology Services. The Director of Psychology directs, supervises and participates in the provision of psychological services by the Department of Psychology. These services include psychological assessment, psychotherapy, and behavioral consultations and interventions, when needed. The psychology staff assists the patient and his/her parent/guardian, when appropriate, with adjustment to hospitalization, illness, and peer or family issues on a regular or as needed basis.
At MHS, case managers function as the liaison between MHS inpatients and their families and the MHS interdisciplinary staff. They work closely with the patient and his/her parent/guardian by keeping them aware of changes and/or progress being made by the patient. They also provide ongoing education and support to patients and their families. The case managers also assist in preparing the patient for discharge by making referrals to adult state agencies and to the community, to assist with housing/vocational and/or day habilitation services.
Credentialing for Medical Care Services:
Physicians, dentists and podiatrists are credentialed as specified by the Bylaws of the Medical and Dental Staff, Article III Section 5. Categories for staff appointment are as follows: honorary, active, consulting, courtesy, and allied health practitioner. Provisional status is mandated, Article III Section 3(g) for a minimum of six months after initial appointment.
Specific delineated clinical privileges are assigned upon initial appointment to the Medical and Dental Staff, reviewed and renewed every two years, in accordance with the Bylaws, Article III Section 5(c) and State law.
Staffing:
Physician coverage is provided for inpatients twenty-four hours per day, every day of the year, with support from four pediatric nurse practitioners. Physicians are "on-call" by beeper at all times, and available in-house Monday through Friday according to a formal call and schedule of hours.
Diagnoses:
The Massachusetts Hospital School specializes in the care of children, adolescents and young adults with physical and other disabilities requiring comprehensive medical support in order to participate fully in clinical and educational programming.
The majority of MHS inpatients have a diagnosis of meningomyelocele, muscular dystrophy, static encephalopathy (cerebral palsy), traumatic brain injury or traumatic spinal cord injury. Additional diagnoses include complex seizure disorders, arthrogryposis, and osteogenesis imperfecta, among other less common diagnoses.
On Site Services:
On site services include primary pediatric care and medical management, dental care, pulmonary and respiratory care, psychiatric consultation, orthopedic management and consultation, pain management consultation, and therapy services.
Outpatient services provided by staff consultants include podiatry, urology, gynecology, gastroenterology, dermatology, neurology, a comprehensive multidisciplinary clinic, cardiology, pulmonary medicine, rehabilitation medicine, brace and orthotic care, optometry and optical services, orthopedic services, hand consultation, acupuncture and Shiatsu massage.
- Radiology services are limited to plain radiographs, read and interpreted by a consulting radiologist and are taken by a contract vendor.
- A contract vendor provides laboratory services, with specimen collection primarily by Massachusetts Hospital School staff.
- Infectious disease consultation is available twenty-four hours of every day through a consulting pediatric infectious disease service.
- Pulmonary function testing and arterial blood gas collection are available on site. An outside contract vendor performs arterial blood gas measurement.
- Electrocardiograms and echocardiograms are done on site, interpreted by a consulting cardiologist.
- Renal, abdominal and pelvic ultra sonograms are done by an outside contract vendor through the outpatient department and are interpreted by the consulting radiologist and urologists.
Consultation:
The Medical and Dental Staff of the Massachusetts Hospital School includes a wide range of consulting specialists, available to Massachusetts Hospital School practitioners on an as-needed basis. Emergency consultations are accomplished by transfer to the appropriate, accepting specialty provider, tertiary care center or comprehensive emergency room, as administratively set forth in the Interagency Agreements for inter-hospital transfer.
Acute Care Services:
Acute care services at the Massachusetts Hospital School are limited to management of minor acute illnesses not requiring immediate physician presence. Medically unstable patients and/or patients in acute psychiatric distress, such that the safety of the patient, other patients, or staff is at risk, are transferred off site for acute care and management.
Intensive care services are not provided at the Hospital School. Emergency interventions by Hospital staff are directed towards patient stabilization and transfer to an appropriate accepting outside facility.
Patient Population - Overview
- 86 inpatients
- Most Common Diagnoses: Cerebral palsy, spina bifida, muscular dystrophy brain and spinal cord injury
- Wide Variety of Rare Diseases: HIV, CVA, Sickle Cell Disease, Hallervorden-Spatz, Adrenal Leukodystrophy, Pelizaeus-Merzbacher, etc.
- Conditions are chronic and have many associated complications requiring coordinator of multiple medical specialists
- Complications include: cardiomyopathy, restrictive lung disease, seizure disorder, neurogenic bladder and bowel, contractures, spasticity.
- Rehabilitation needs include: functional mobility, feeding and nutrition, communication, independent living skills, etc.
Admission Process/Treatment/Discharge Process
Patients must meet admission criteria. Pediatrics, psychology, nursing, physical therapy and case management evaluate prospective patients. MHS must represent the least restrictive level of care. Patients are admitted based on identified rehabilitative or medical needs. As per Medicaid guidelines, psychosocial issues may play a role in the decision-making process (e.g. lack of competent caregiver in home; substance abuse; lack of available therapy services in the community).
After admission, an interdisciplinary team develops a plan of care based on identified patient needs. The team establishes both short-and long-term goals and intervention to meet these objectives. The team meets monthly to discuss progress and adjust the treatment plan as needed.
The team evaluates a patient's progress on an on-going base. Once a patient has reached his/her full potential or fails to make further progress discharge planning begins.
In addition the rehabilitative programming, MHS patients receive primary and specialty medical care at the institution. The Department of Pediatrics' provides well-child care, acute care for intercurrent illnesses, and coordination of medical specialties. The timely availability of these services enables the patient population to take full advantage of therapeutic, educational and recreational services. Services available at MHS include cardiology, gastroenterology, neurology, optometry, orthopedics, physiatrist, podiatry, psychiatry, pulmonary, and urology.
Several procedures are also performed on site. Patients with spasticity receive Botox chemoneurolysis injections and intrathecal baclofen pump programming and refills at MHS. In addition, pulmonary function testing, echocardiography and state of the art methods of providing pulmonary toilet (e.g. in/insufflators, intrapulmonary percussive ventilation) are available in the hospital. The availability of these services in conjunction with primary pediatric care provides a cost effective alternative to care that would otherwise necessitate in inpatient admission or outpatient visit to a Tertiary Medical Center.
Clinical Research
MHS is collaborating with several other organizations on clinical research initiative studying methods to improve outcomes for children with special health care needs. The hospital has enrolled 123 subjects in a pilot project studying the effects of weight bearing in non-ambulatory children. This study is performed in collaboration with the Department of Orthopedics at Children's Hospital. Subjects are placed in standers for up to a total for two hors per day. Bone densitometry is measured every three months. Thus far, results indicate dose-dependent relationship between hours spent weight bearing and bone density.
In addition, MHS is working with the Northeast Spinal Cord Initiative to study the effect of functional electrical stimulation on strength and cardiovascular health in spinal cord injury. Four subjects are currently enrolled in this study. Under supervision of a physical trainer, the subjects ride an FES bicycle three times per week. This device, on loan from the Travis Roy Foundation, delivers electrical stimulation to the leg muscles enabling paralyzed patients to peddle a stationary bicycle. Although the results are preliminary, all subjects have demonstrated increased muscle strength and functional ability. In particular, one patient has weaned off of nighttime ventilatory support.
MHS is also participating in a third project studying transition issues for disable adolescents. This endeavor involves collaboration wit the Department of Public Health, Boston University School of Public Health and the Northeast Independent Living Center. Focus groups consisting of disable adolescents have been formed to identify the barriers to a successful transition to independent adulthood for this population.
Other Programs and Future Initiatives
Nursing Department
Scope of Service
The Massachusetts Hospital School is a unique health care facility for physically disabled children, adolescents and young adults. The Nursing Department provides comprehensive rehabilitation care to patients affected with Cerebral Palsy, Muscular Dystrophy, Myelodysplasia, trauma induced disability and other low incidence physically debilitating or congenital disorders. MHS offer professional nursing service in inpatient, school, outpatients and summer programs. Nursing care is carried out by a variety of staff. The Registered Nurse assigns appropriate portions of that care to both Licensed Practical Nurses and non-licensed staff. Nursing care is delivered in accordance with the laws of the Commonwealth of Massachusetts and the regulations of the Board of Registration of Nursing.
Nursing expertise and skills are integrated into a variety of medical and pediatric activities to provide needed services to our patients. The nursing staff continually assesses and evaluates the physiologic, developmental and psychosocial needs of the patient and is involved with the planning of care to be delivered. The nurse's role, as a part of the interdisciplinary team, involves participation in the development, coordination, implementation and evaluation of the interdisciplinary plan of care.
Nursing care is delivered from Sunday through Friday afternoon on one of five patient care units: Nelson I, Nelson II, Baylies, Ellis, and Gates. On Fridays the residential patients go home on leave and return on Sunday evenings. Patients not on Nelson Units, who are unable to go home because of medical, family, or social reasons, are transferred to the Nelson Units for continuation of care. In addition, nursing care is also delivered at the Brayton School during school hours and in the Out-Patient Department as specialized clinics that are regularly scheduled.
The Director of Nursing is available Monday through Friday on the Bradford Unit or can be contacted at extension 8485 or by beeper. A Nursing supervisor is available 24 hours a day and can be contacted by phone or beeper. The nursing supervisor suite is located on the Nelson Unit adjacent to the Bradford Unit.
