<b><i>Total patient care is a reality, not a dream, at\r\nShriners Hospitals for Children.<\/i><\/b>\r\n<table class="clsTableCaption" style="float: right; width: 31.2361%; height: 292px;">\r\n<tbody>\r\n<tr>\r\n<td style="width: 100%;"><img src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2004-07_06\/MarshallJanet.jpg" alt="Janet Marshall, CPO" \/><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style="width: 100%;">Janet Marshall, CPO<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nJanet 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.\r\n\r\nMarshall 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 ears. 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.\r\n\r\n"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."\r\n<h2>Making Hospital Stays Easier<\/h2>\r\nChild Life is a hospital department that helps ease the stresses\r\nof being in the hospital, Marshall explained. There, patients are\r\nentertained as well as educated regarding their surgery or their\r\ncastings. Staff members bring dolls in to demonstrate how casting\r\nwill be done or how a lengthening device is going to be put on.\r\n"This approach has definitely been a benefit to easing the anxiety\r\nlevels of our kids and allowing them to get comfortable with the\r\nstaff members who will be working with them," Marshall said.\r\n\r\n"When we have a clinic appointment, the children will be seen by\r\na team, not just by the orthopedic surgeon, but accompanying him or\r\nher will be an orthotist or prosthetist, a physical therapist, a\r\nnurse practitioner, or physician assistants," she continued. "We\r\nalso have different coordinators to help, and the nurses, of\r\ncourse, help coordinate in the clinic setting and make everything\r\nwork smoothly."\r\n<h2>Not Only Free Care--But Quality Care<\/h2>\r\nMembers of the extended team also could include physical\r\ntherapists and others in the patient's own hometown, since\r\nShriners' patients come from all over the world--and not only\r\nbecause care is free, Marshall noted.\r\n\r\n"We don't pride ourselves on the free care so much as quality\r\ncare," said Marshall. "Doctors' and lawyers' kids come to see us,\r\nnot because they can't afford to go elsewhere, but because we do\r\nhave this wonderful approach and have the full setting available to\r\nsee them in one spot and provide the full-care package.\r\n\r\n"The clinic team approach is probably our greatest asset,\r\nbecause we are dealing with everyone, and we communicate well with\r\none another and accept advice from one another, keeping the\r\npatient's benefit in mind," she added. "Whatever is going to help\r\nthem most is what we want. That open communication is a vital\r\naspect of it.\r\n\r\n"You also get the parents networking. They're in the waiting\r\narea, but they're talking to one another in a setting that is\r\ncommon ground, where they can talk with other parents about\r\nproblems and challenges and network on solutions."\r\n<h2>ACPOC: Team Approach to Networking<\/h2>\r\nWhy has total patient care taken so long to catch on in other\r\nplaces? "Total care works because it really starts in our clinic\r\nsetting, and as a clinic we have a total clinic team approach. This\r\nactually ties into my organization--because ACPOC also has a team\r\napproach in networking. It is one way that we are reaching more\r\nthan just the Shriners systems; we are reaching out to the entire\r\npublic with the value of the total-care concept."\r\n\r\n"Our guidelines are: they are children, and they have\r\ndisabilities that require our attention," summarized Marshall. "The\r\nbenefit of ACPOC is that we are communicating on all levels. Too\r\noften the doctors go to their organization, the nurses go to their\r\norganization, and the physical therapists go to their organization.\r\nThe communication and networking that is truly an essential part of\r\ntotal care is missing whenever you don't have them all together and\r\ndiscussing a single problem from all these different\r\nperspectives."\r\n\r\nA joint annual meeting shared by ACPOC and the American Academy\r\nof Orthotists & Prosthetists (AAOP) is planned for March 1619,\r\n2005, in Orlando and may open more doors to the total care concept.\r\n"Like everybody else," said Marshall, "we are feeling budget\r\ncrunches; a shared meeting is one way of possibly contacting more\r\npeople and yet holding our costs down a bit. So it's a benefit in\r\nterms of budget, and it's a benefit in terms of broadening our\r\naudiences and having a crossover between meetings.\r\n\r\n"I've been to other conferences that are helping to encourage\r\nthis concept to go further," Marshall said, citing the annual\r\nmeeting of the American Academy for Cerebral Palsy &\r\nDevelopmental Medicine (AACPDM). "It also is multidisciplinary,\r\nincluding physicians, therapists, orthotists and prosthetists, and\r\nmotion analysis lab people. Any time you have a networking of\r\ndifferent disciplines, it encourages communication, and\r\ncommunication encourages total patient care. Whenever we put up\r\nwalls between us--and I don't know why that happens, but it does\r\nhappen, out of competitiveness or egos or what-have-you--then\r\nyou're limiting the benefit to the patient. But people are\r\nbasically good and they want to help, and that's why they're in\r\ntheir profession."\r\n\r\nMarshall noted that there are fewer clinics. "It's a sad\r\nthing--even at ACPOC, we're seeing a reduced number of clinics. The\r\nclinics did bring the different professions together to evaluate\r\npatients, and I assume it's mostly for cost-related reasons that\r\nthey are no longer running clinics like they used to, but there's a\r\ndefinite decline." Healthcare professionals can't discuss patients\r\nas effectively over the Internet or via fax, she pointed out. "When\r\norganizations get together to discuss common problems, it can make\r\na difference, and hopefully more hospitals will develop settings\r\nthat are family-friendly."