<b><i>Total patient care is a reality, not a dream, at Shriners Hospitals for Children.</i></b> <table class="clsTableCaption" style="float: right; width: 31.2361%; height: 292px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2004-07_06/MarshallJanet.jpg" alt="Janet Marshall, CPO" /></td> </tr> <tr> <td style="width: 100%;">Janet Marshall, CPO</td> </tr> </tbody> </table> Janet 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. Marshall 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. "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." <h2>Making Hospital Stays Easier</h2> Child Life is a hospital department that helps ease the stresses of being in the hospital, Marshall explained. There, patients are entertained as well as educated regarding their surgery or their castings. Staff members bring dolls in to demonstrate how casting will be done or how a lengthening device is going to be put on. "This approach has definitely been a benefit to easing the anxiety levels of our kids and allowing them to get comfortable with the staff members who will be working with them," Marshall said. "When we have a clinic appointment, the children will be seen by a team, not just by the orthopedic surgeon, but accompanying him or her will be an orthotist or prosthetist, a physical therapist, a nurse practitioner, or physician assistants," she continued. "We also have different coordinators to help, and the nurses, of course, help coordinate in the clinic setting and make everything work smoothly." <h2>Not Only Free Care--But Quality Care</h2> Members of the extended team also could include physical therapists and others in the patient's own hometown, since Shriners' patients come from all over the world--and not only because care is free, Marshall noted. "We don't pride ourselves on the free care so much as quality care," said Marshall. "Doctors' and lawyers' kids come to see us, not because they can't afford to go elsewhere, but because we do have this wonderful approach and have the full setting available to see them in one spot and provide the full-care package. "The clinic team approach is probably our greatest asset, because we are dealing with everyone, and we communicate well with one another and accept advice from one another, keeping the patient's benefit in mind," she added. "Whatever is going to help them most is what we want. That open communication is a vital aspect of it. "You also get the parents networking. They're in the waiting area, but they're talking to one another in a setting that is common ground, where they can talk with other parents about problems and challenges and network on solutions." <h2>ACPOC: Team Approach to Networking</h2> Why has total patient care taken so long to catch on in other places? "Total care works because it really starts in our clinic setting, and as a clinic we have a total clinic team approach. This actually ties into my organization--because ACPOC also has a team approach in networking. It is one way that we are reaching more than just the Shriners systems; we are reaching out to the entire public with the value of the total-care concept." "Our guidelines are: they are children, and they have disabilities that require our attention," summarized Marshall. "The benefit of ACPOC is that we are communicating on all levels. Too often the doctors go to their organization, the nurses go to their organization, and the physical therapists go to their organization. The communication and networking that is truly an essential part of total care is missing whenever you don't have them all together and discussing a single problem from all these different perspectives." A joint annual meeting shared by ACPOC and the American Academy of Orthotists & Prosthetists (AAOP) is planned for March 1619, 2005, in Orlando and may open more doors to the total care concept. "Like everybody else," said Marshall, "we are feeling budget crunches; a shared meeting is one way of possibly contacting more people and yet holding our costs down a bit. So it's a benefit in terms of budget, and it's a benefit in terms of broadening our audiences and having a crossover between meetings. "I've been to other conferences that are helping to encourage this concept to go further," Marshall said, citing the annual meeting of the American Academy for Cerebral Palsy & Developmental Medicine (AACPDM). "It also is multidisciplinary, including physicians, therapists, orthotists and prosthetists, and motion analysis lab people. Any time you have a networking of different disciplines, it encourages communication, and communication encourages total patient care. Whenever we put up walls between us--and I don't know why that happens, but it does happen, out of competitiveness or egos or what-have-you--then you're limiting the benefit to the patient. But people are basically good and they want to help, and that's why they're in their profession." Marshall noted that there are fewer clinics. "It's a sad thing--even at ACPOC, we're seeing a reduced number of clinics. The clinics did bring the different professions together to evaluate patients, and I assume it's mostly for cost-related reasons that they are no longer running clinics like they used to, but there's a definite decline." Healthcare professionals can't discuss patients as effectively over the Internet or via fax, she pointed out. "When organizations get together to discuss common problems, it can make a difference, and hopefully more hospitals will develop settings that are family-friendly."
