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What Patients Can Be Managed?

What Patients Can Be Managed?

The Middleman Family Pavilion at Children's Hospital of Philadelphia, King of Prussia, provides inpatient care for a breadth of illnesses and conditions across our wide range of subspecialties. In addition to the services available since the King of Prussia hospital opened – including our 24/7 Pediatric Emergency Department, PICU and Cancer Center – we are continually expanding our specialized services to ensure that patients have access to comprehensive care for the routine and the rare within our facility, close to home.

However, there are still some services that are only available at our Philadelphia Campus. For patients seen in our Emergency Department who require support or subspecialty services not available at our King of Prussia hospital, phone consult and/or transfer to Philadelphia Campus is available as needed.

The King of Prussia Specialty Care Center adjacent to the hospital also offers a variety of outpatient clinics across a wealth of medical and surgical subspecialties. Learn more here.

To reach our Provider Priority Line, dial 800-TRY-CHOP and press 2.

Learn about our support services and inpatient teams here.

Conditions Managed at the Middleman Family Pavilion

Adolescent Medicine (Consult) 

Included in the King of Prussia Hospital Population:  

  • Contraception
  • Dysfunctional/Abnormal vaginal bleeding
  • Dysmenorrhea
  • Ovarian cysts (not surgical cases)
  • Pelvic inflammatory disease
  • Pelvic pain

Excluded from King of Prussia Hospital Population:  

  • Ovarian cysts (surgical cases)

Consult Availability:

  • Provider-to-provider available 24/7
  • Telehealth Consults, 8 a.m. - 12 p.m. everyday
  • Urgent Consults, Attendings on service will determine who is able to complete consult. Could be telehealth or in-person depending on provider availability.  

Adolescent Medicine (Primary Team) 

Included in the King of Prussia Hospital Population:  

  • If there is uncertainty regarding best placement, patient to be admitted at the hospital where they initially presented.
  • Patient may be transferred during admission if Philadelphia Campus is deemed more appropriate. 

Excluded from King of Prussia Hospital Population:  

  • Patient who has used MBU in the past or will need MBU resources
  • Comorbid diagnoses requiring multiple sub-specialty in-person consultation and support for optimized collaboration of care.
  • If possible, any patients with history of long hospital length stays (over 14 days)

Consult Availability:

  • Provider-to-provider available 24/7
  • Telehealth Consults, 8 a.m. - 12 p.m. everyday
  • Urgent Consults, Attendings on service will determine who is able to complete consult. Could be telehealth or in-person depending on provider availability.  

Allergy/Immunology

Included in the King of Prussia Hospital Population: 

  • Asthma
  • Acute hives
  • Anaphylaxis
  • Drug Allergy/Desensitization
  • Immunology admissions considered on case-by-case basis

Excluded from King of Prussia Hospital Population: 

  • Patients requiring positive pressure room

Consult Availability:

  • Provider-to-provider available 24/7
  • Telehealth available as needed

Cardiology

Included in the King of Prussia Hospital Population:  

  • Stable biventricular circulation with non-cardiac admission
  • Supplemental remote cardiac monitoring
  • Additional considerations on case-by-case discussion with cardiology

Excluded from King of Prussia Hospital Population: 

  • Cyanotic heart disease
  • Arrhythmia
  • Shunt-dependent congenital heart disease
  • Single ventricle congenital heart disease

Consult Availability:

  • Provider-to-provider available 24/7
  • Telehealth available as needed

ENT (Surgery Team)

Included in the King of Prussia Hospital Population: 

  • CPAP Patients
  • Young patients with major ear surgery and young patients with cochlear implants
  • Micro Laryngoscopy with supraglottoplasty or manipulation
  • Deep Neck infections

Excluded from King of Prussia Hospital Population: 

  • Airway procedures
  • Triple scopes

Consult Availability:

  • 24/7 on-site surgical APP with attending back-up available by phone
  • In-person attending as available

Endocrinology 

Included in the King of Prussia Hospital Population:  

  • Known diabetes patients with diabetic ketosis without acidosis
  • Known diabetes patients with diabetic ketoacidosis (PICU admission)

Excluded from King of Prussia Hospital Population:  

  • New onset diabetes
  • Hyperinsulinism
  • Hypoglycemia evaluation
  • Diabetes insipidus

Consult Availability:

  • Provider-to-provider available 24/7
  • In person, as available
  • Telehealth

GI/Hepatology

Included in the King of Prussia Hospital Population:  

  • Uncomplicated abdominal pain
  • Gastroesophageal reflux
  • Constipation/cleanout
  • First time pancreatitis
  • Failure to thrive/Nutritional rehabilitation
  • Nasogastric tube/gastric tube feeds initiation

Excluded from King of Prussia Hospital Population: 

  • Inflammatory bowel disease
  • Patient cared for by Liver, Motility, Intestinal Rehabilitation Programs
  • Transplant patients
  • Home TPN
  • Patients with concern for Esophageal Foreign Body

Consult Availability:

  • Telephone/telehealth consultation: Weekdays from 8 a.m.-5 p.m.  
  • Off-hours telephone consults provided by GI fellow
  • Provider to Provider available 24/7 

Hematology

Included in the King of Prussia Hospital Population:  

  • Post op patients with sickle cell disease (simple procedures such as myringotomy tubes)
  • Established Idiopathic Thrombocytopenic Purpura (ITP) requiring therapy
  • Patients with fever and central line with or without Neutropenia
  • Autoimmune neutropenia with fever and neutropenia
  • Splenectomy with fever (not sickle cell) who require admission (typically can be discharged post Ceftriaxone).
  • Iron deficiency anemia

Excluded from King of Prussia Hospital Population:  

  • Patients with acute new onset thrombosis or cared for by the Philadelphia thrombosis team.
  • Patients with bleeding disorders who are bleeding and require admission for close monitoring and treatment.
  • Patients with sickle cell disease with an acute medical issue who meet criteria for hospitalization
  • Patients with sickle cell requiring a major procedure (risk of ACS) and need admission post for observation.

Consult Availability:

  • Oncology inpatient attending available in person during the day
  • Telehealth consults for those consults not covered by the Oncology inpatient attending.
  • Provider to Provider available 24/7

Metabolism

Included in the King of Prussia Hospital Population:  

  • IV hydration in metabolism patients not requiring special formula

Excluded from King of Prussia Hospital Population: 

  • Metabolic crisis
  • Patients requiring special formula

Consult Availability:

  • Telehealth
  • Provider-to-provider available 24/7

Neonatology

Included in the King of Prussia Hospital Population: 

  • Therapeutic hypothermia for hypoxic ischemic encephalopathy
  • Seizure management
  • Management of acute and chronic respiratory failure
  • Sepsis/meningitis
  • Preterm infants >/= 24 weeks and 800g born at outside hospital
  • Non-urgent surgical patients (g tube placement, inguinal hernia repair)
  • ROP screening and intervention including avastin and laser treatment
  • Newborns and infants requiring consultative services (in person or via telehealth): hematology, neurology, pulmonology, endocrine, genetics, infectious disease, ophthalmology, cardiology, orthopedics, general surgery
  • Feeding evaluations
  • Sleep studies

Excluded from King of Prussia Hospital Population:

  • Acute surgical concerns
  • Critical airway management
  • Double volume exchange transfusions
  • Acute IVH, intracranial thrombi or perinatal strokes

Nephrology

Included in the King of Prussia Hospital Population:  

  • Mild Rhabdomyolysis in otherwise healthy patient
  • Acute pyelonephritis
  • Transplant with dehydration/ Viral illness/Diarrhea
  • Mild acute kidney injury
  • Mild acute glomerulonephritis
  • CKD patients with acute illness/dehydration

Excluded from King of Prussia Hospital Population:  

  • Patients requiring dialysis

Consult Availability:

  • Telehealth
  • Provider-to-provider available 24/7

Neurology

Included in the King of Prussia Hospital Population: 

  • First seizure patients without need for inpatient workup
  • Febrile seizures
  • Well-established, stable, epilepsy patients
  • Selected Epilepsy Monitoring Unit patients
  • Botulism
  • Patients requiring spot or video EEG

Included in the King of Prussia Hospital Population for ICU:

  • New seizure or concern for seizure​ 
  • Post-ictal and not at baseline​ 
  • Status Epilepticus including intubated with midazolam infusion​ 
  • Epilepsy with intercurrent illness and increased seizure burden​ 
  • Altered mental status​ 
  • Post-cardiac arrest (brief)​ 
  • Infant botulism ​​​​​​​

Excluded from King of Prussia Hospital Population: 

  • Complex/refractory epilepsy patients
  • Patient requiring or potentially requiring Neurosurgical care
  • Concern for stroke/acute neurologic syndrome
  • New onset severe headache
  • Spinal cord symptoms
  • Suspected neuromuscular disorder (ex: Guillain Barre Syndrome, botulism)
  • Demyelination disorders
  • Persistent altered mental status
  • Scheduled EEG monitoring​  
  • Neuro-related complaint requiring urgent work up (sedated MRI over weekend, sedated LP on floor) 
  • Patient with epilepsy on ketogenic diet (except exclusively on KetoVie 4:1 formula PO/GT)
  • Patient with epilepsy requiring VNS evaluation 
  • Patient with migraine requiring nerve block ​  
  • Encephalopathy without clear etiology
  • Patient requiring or potentially requiring neurosurgical evaluation 

Excluded from the King of Prussia Population for ICU:

  • Per discretion of neurology and KOPH team ​
  • Status Epilepticus with management beyond midazolam​ 
  • Weekend or overnight initiation of EEG
  • Weekend or overnight in person consultation needed ​​​​​​​

Consult Availability:

  • Provider to Provider available 24/7
  • In-person consults available Monday-Friday from 8 a.m to 5 p.m.
  • Phone consults during other hours

EEG:

  • Available most Monday-Friday from 8 a.m - 4 p.m including urgent routine EEGs and EEG monitoring.

Oncology (Primary Team)

Included in the King of Prussia Hospital Population: 

  • Low risk patients with fever
  • Routine scheduled chemotherapy admissions
  • Nutritional/hydration support
  • Nausea/vomiting
  • Prolonged infusions/simple transfusions
  • Pain/mucositis management
  • Post PEG asparaginase reactions
  • Newly diagnosed ALL that meet King of Prussia hospital eligibility
  • End-of-life care requiring hospitalization

Excluded from King of Prussia Hospital Population:

  • New oncology diagnoses except newly diagnosed ALL that meet King of Prussia Hospital eligibility
  • High risk patients with fever that may require in person consultations not available at King of Prussia hospital
  • Patients receiving daily radiation
  • Bone marrow transplant and CART patients
  • Neurooncology patients
  • Patients requiring interventional radiology consultation
  • Neuroblastoma on immunotherapy
  • Vascular malformations
  • Patients requiring positive pressure room
  • Patients with acute bleeding that need sustained blood product support i.e. cannot wait several hours for products after initial emergency transfusions
  • Patients with acute neurologic toxicity requiring in-person neurology consultation

Consult Availability:

  • King of Prussia Onco IP SvcAttending: in person, 8 a.m. – 5 p.m.
  • BMT team at Philadelphia Campus 
  • Neuro-Onc team at Philadelphia Campus 
  • CART MD: daytime M-F; Onco fellow nights/weekend
  • PC Solid team
  • CVAP MD: daytime M-F; Onco fellow nights/weekend

Orthopedics (Surgery Team)

Included in the King of Prussia Hospital Population:

  • Fractures and other non-emergent add-on cases (e.g. SCFE, septic joints, etc.)
  • Sports injuries
  • Limb reconstruction (all hip, foot and limb reconstruction procedures)
  • Benign bone lesions, biopsy of potential malignancies, pathological fractures
  • Simple growing spine: VEPTR expansion
  • Ambulatory CP surgeries: muscle lengthening/ osteotomies
  • OR casting (e.g. scoliosis and Spica cast placement)
  • Implant removal

Excluded from King of Prussia Hospital Population:

  • Spinal deformity correction
  • Emergent fractures that require surgery
  • Inpatient rehab patients admissions after surgery
  • Microvascular surgery
  • Multi-trauma patients

Consult Availability:

  • 24/7 on-site surgical APP with attending back-up available by phone
  • In-person attending as available

Plastics (Surgery Team)

Included in the King of Prussia Hospital Population:

  • Cleft lip and palate repairs/ Cleft lip adhesions
  • Alveolar cleft repair
  • Rhinoplasty with autograft/ nasal reconstruction
  • Extracranial contouring
  • Removal of mandibular distractors
  • Removal of hardware
  • Breast reduction
  • Stage 1 facial reanimation
  • Facial fractures or repairs
  • Wound debridement/ VAC applications
  • Oral tumor removal
  • Le Fort I and II
  • Cleft lift for pilonidal disease
  • Tissue expander placement and removal
  • Cleft palate repair and BSSO

Excluded from King of Prussia Hospital Population:

  • Any procedure not listed in the "Included in the King of Prussia Hospital Population" column

Consult Availability:

  • 24/7 on-site surgical APP with attending back-up available by phone
  • In-person attending as available

PICU (Primary Team)

Included in the King of Prussia Hospital Population:

  • Acute respiratory failure requiring HFNC, CPAP, BiPAP
  • Acute respiratory failure requiring invasive conventional ventilation
  • CPAP/BiPAP initiation for OSA
  • DKA in patients with known diabetes
  • Post-operative patients who require ICU care
  • Chronic respiratory failure (non-invasive or T/V) with intercurrent illness
  • Septic shock

Excluded from King of Prussia Hospital Population:

  • Difficult/Critical airway status w/o tracheostomy
  • Tracheostomy with home training needs
  • VV or VA ECMO
  • Unrepaired CHD, single ventricle physiology, cardiomyopathy, or lethal arrhythmia
  • Active cardiac disease, pulmonary hypertension, lymphatics patients
  • Neurosurgery patients or acute TBI
  • Neuro eval for ICH, stroke, status epilepticus that does not return to baseline, unexplained encephalopathy or demyelinating disorders
  • Post cardiac arrest
  • Trauma
  • Organ transplant evaluation (lung, acute liver failure, etc.)
  • Dialysis need
  • New onset DKA

Consult Availability:

N/A

Pulmonology

Included in the King of Prussia Hospital Population:

  • Asthma
  • Sleep study finding requiring urgent intervention (CPAP or T&A)
  • Uncomplicated pneumonia or bronchiolitis
  • Select technology dependent patients (ICU)

Excluded from King of Prussia Hospital Population:

  • Cystic fibrosis
  • Transplant patients
  • Primary ciliary dyskinesias
  • Interstitial lung disease
  • Bronchiolitis obliterans
  • Pulmonary alveolar proteinosis
  • Pulmonary hemorrhage
  • Foreign body aspirations
  • Congenital central hypoventilation syndrome
  • Pulmonary hypertension requiring more than sildenafil therapy
  • Muscular dystrophy patients with respiratory complaints
  • Respiratory complaints in transplant, muscular dystrophy, CDH or giant omphalocele patients

Consult Availability:

  • Provider-to-provider available 24/7
  • In-person Consults available Monday - Friday with APP
  • Attending available Mondays and Thursdays 

Rheumatology

Included in the King of Prussia Hospital Population:

  • Uncomplicated Kawasaki’s Disease
  • Uncomplicated HSP
  • Suspected rheumatologic/inflammatory disorder to determine need for transfer to Philadelphia Campus

Excluded from King of Prussia Hospital Population:

  • Patients who require in-person evaluation by Rheumatology team 

Consult Availability:

  • Provider-to-provider available 24/7
  • Telehealth

Urology (Surgery Team)

Included in the King of Prussia Hospital Population:

  • Hypospadias/Chordee/Circ
  • Orchiopexy/Orchiectomy
  • Hernia/Hydrocele
  • Vesicostomy or revision
  • Ureteral implant
  • Ureterostomy
  • Cystoscopy/retrograde/stent/uncomplicated ureteroscopy
  • Uncomplicated laparoscopy (UDT, hernia, reimplant, nephrectomy)

Excluded from King of Prussia Hospital Population:

  • Any robotic procedure
  • Any stone procedure
  • GU trauma
  • Abdominopelvic reconstruction

Consult Availability:

  • 24/7 on-site surgical APP with attending back-up available by phone
  • In-person attending as available
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