HJAR Nov/Dec 2020

HEALTHCARE JOURNAL OF ARKANSAS  I  NOV / DEC 2020 49 limited in certain aspects, most notably pediatric neurosurgery. Until pediatric criticalcareisbroughttotheregion,support for perioperative neurosurgical patients will not be possible. This current gap also affects other surgical services, as patients requiring high acuity postoperative care, or additional respiratory support due to underlying comorbidities, must still leave NWA for operative treatment. Emergent care of injured children has also historically had a strong foundation in NWA. Patients transferred out of region have most commonly suffered head injuries or severe multisystem injuries requiring intubation or critical care. Through the Arkansas Department of Health, the Trauma Regional Advisory Council (TRAC-NW) has established robust pediatric protocols for initial EMS assessment and triage that have been in place for at least a decade. The addition of an emergency department staffed by pediatric board-certified emergency medicine physicians, supported by the full-time surgical specialties, has elevated the initial hospital care of injured children. Patients with solid organ injuries, long Marcene McVay-Gillam, MD, FACS, FAAP Chair of Surgery Arkansas Children’s Northwest requiring specialty pediatric surgical expertise. It was not until the past five years that board-certified pediatric surgical subspecialists have come to NWA to live and work full time. There is now full-time access to the following pediatric subspecialties: otolaryngology/ENT, orthopedics and general surgery. Arkansas Children’s announced the plan to build a children’s hospital in NWA in August of 2016, and with overwhelming local support, Arkansas Children’s Northwest (ACNW) opened less than two years later as a free-standing children’s hospital. On average, there are 250 surgeries performed at ACNW per month. Physicians were recruited from within the state as well as from around the country, collaborating to reach the end goal of providing safe, efficient and high-quality pediatric subspecialty care. In addition to the subspecialties above, having access to pediatric anesthesiologists in NWA has allowed additional subspecialists to provide operative care to children on a scheduled but intermittent basis (i.e., ophthalmology and urology). Surgical subspecialty care remains bone fractures and less severe head or brain injuries can be safely managed in the region without transfer. Though lack of operative neurosurgical care presents a challenge topromptmanagement of severe head injuries, a number of children with nonoperative neurosurgical (brain and spine) injuries no longer require transfer and are managed with telemedicine consultation with the neurosurgeons at ACH. ACNW sought and achieved Level IV Pediatric trauma center designation by the Arkansas Department of Health this year with plans to seek Level III status after the addition of critical care services. This is an added resource to the community for the prompt assessment and management of injured children, even if they ultimately require transfer out of region due to severe injury. Of the children treated at ACNW for significant traumatic injury, less than 15 percent require transfer out. That number is expected to decrease as more services are available. With continued growth in population, economy and healthcare, Northwest Arkansas is poised to be a top 100 major metropolitan service area. The robust population growth of Northwest Arkansas has created an increased need for all medical care. Diversity and wide variations in socioeconomic status continue to create challenges toqualitydeliveryof healthcare, but physical distance is becoming less of a barrier to care for children in the region. n Marcene McVay-Gillam, MD, FACS, FAAP is a board-certified pediatric surgeon based at Arkansas Children’s Northwest in Springdale (ACNW). She is the chair of surgery at ACNW, as well as the trauma medical director, and is an assistant professor of Surgery at the University of Arkansas for Medical Sciences. Dr. McVay-Gillam completed medical training at UAMS and Arkansas Children’s Hospital and served the United States Air Force as a pediatric and general surgeon prior to returning to Arkansas. She is currently NWA’s only full-time pediatric surgeon. “ “ Surgical subspecialty care remains limited in certain aspects, most notably pediatric neurosurgery. Until pediatric critical care is brought to the region, support for perioperative neurosurgical patients will not be possible.