At the Technology Dependence Center (TDC), a multidisciplinary team works with you and your family, your child's primary care physician and other consulting physicians to provide patient care and coordinate equipment and home nursing needs. All TDC clinicians specialize in the care of children requiring extra technology to breathe.
The attending physician leads the team and is ultimately responsible for your child's management. The attending outlines a plan of treatment to support your child and his caregivers, depending on his diagnosis. The treatment plan may be to withdraw him from the technology gradually or increase the technology according to his needs. All care is provided while maintaining the stability of your child's vital signs and general health status. The treatment plan is developed based on your child's quality of life choices.
Fellows are pediatricians who are training to specialize in pulmonary medicine. They may be asked to see your child with an attending in the hospital or they may see your child as a new patient in the office setting. Once they are involved with your child, they remain her pulmonary doctor, along with an attending physician, for the duration of their three years of training. A fellow sees patients during office visits to record a medical and surgical history and conduct a physical exam. This typically includes an assessment of growth, measurements of oxygenation and ventilation and, when possible, other indicators of lung function. As needed, the fellow then consults with the APNs, nutritionist, the social worker and the attending physician to discuss their findings. They then formulate the treatment plan in accordance with the family and attending physician. The fellow is responsible for ordering tests, medications and for communicating your child's results to you and your family.
Advanced practice nurses (APNS) may be nurse practitioners or clinical specialists. They are available by phone to manage the day-to-day issues of technology at home as well as coordinate the multiple aspects of care required for a child dependent on technology. This includes communication with your child's home care or school nurses, prescribing medications as your child's condition changes, ordering new equipment, problemsolving developmental or care issues and education and reinforcement of the plan of care. APNs become involved with your child either when he is discharged from the hospital or during his initial office visit. If your child is readmitted to the hospital, the APNs communicate with the inpatient team to continue the current plan of care and provide support to your child and/or you and your family. During office visits, an APN functions in a role similar to the fellows. Finally, the APN assists in the transition to a higher or lower level of care, by providing guidance for utilization of resources and preplanning for the event.
The social worker for the Technology Dependence Center (TDC) is a full time support person who promotes family-centered care through counseling, resource coordination and advocacy. The social worker is available to your family at every outpatient TDC visit and during hospitalizations for respiratory illnesses. The social worker's role is to address issues related to family coping with chronic illness, facilitate clear communication between your family and the TDC team for ease of healthcare planning and decisionmaking and problemsolving with outside agencies such as insurance companies and school systems.
The nutritionist develops a nutrition plan to ensure that your child receives adequate calories, fluid, protein, vitamins and minerals. This promotes the growth of healthy lungs, brain and all body organs and tissues. Correct nutrition also promotes the achievement of developmental milestones. For our technology population, weight gain and growth play a major role in determining the need for mechanical support, therefore all patients need to be monitored closely. Between clinic visits, home weights and other nutritional information are monitored by phone.