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RSW Living Magazine

Golisano Children's Hospital Continues Forward With Plans for Growth Despite Global Pandemic

Golisano Children’s Hospital of Southwest Florida - 9981 S HealthPark Drive, Fort Myers, has continued to plan its future in Southwest Florida despite being in the midst of a global pandemic, including a new eye center, neurosurgery, and many other expansions in service to the Southwest Florida community.

We caught up with Alyssa Bostwick, chief nurse executive and vice president of operations for Golisano Children's Services, and Dr. Emad Salman, chief physician executive and vice president of operations at Golisano Children's Hospital, to discuss COVID-19's impact on the hospital's operations, what's to come in 2021, and much more.

What's the latest with Golisano Children's Hospital?

Dr. Salman: Despite everything going on with COVID, we have continued our plans for the future. There was a slight pause in March and April 2020, but since then, we've quickly adapted and continued with our plans. We have been working on an eye center funded by Southwest Florida Children's Charities. That project is still ongoing and we are hoping we will move into that space in the summer months. That is really a big project we've been working on for the past two years and it should come to fruition by the summer of this year.

We've continued to recruit physicians to the area, which has been a challenge with a lot of the travel restrictions that have been in place. We have several talented physicians that will be joining us over the summer to add more services to Golisano, including a new spine surgeon, an orthopedic surgeon, as well as a pediatric general surgeon. Those are new services that we are adding or complimenting those that are already here.

One project Alyssa has been working on over the past few years is bringing in a pediatric neurosurgeon to Southwest Florida so kids that may have head trauma or a brain tumor may not necessarily have to travel to Miami or St. Petersburg to get care. Hopefully, within the next year, that care will be provided locally and we can keep kids close to home. That's a huge project and we are actively interviewing candidates for that position and hopefully in the next few months identify a suitable candidate for that position and he or she will be here.

Bostwick: We had to take a complete pause on things for a couple of months. We realized very early on that we need to keep moving the ball forward as far as services to our community because our children still require those services with or without COVID-19. Our eye center should be opening in August. We've also completed recruitment for our pediatric GI service last year. We've also added adolescent medicine, which is a new service line for the community. We hope that neurosurgery will be up and running this summer. We're continuing to expand down in Collier County, as well. In our Naples health clinic, we are renovating space on our first floor into a hematology and oncology outpatient infusion space.

We're talking about increasing and improving access to our subspecialty services in Collier County through expansion to the second floor of that health clinic, as well. We continue to recruit into our pediatric mental and behavioral health providers, which have gone from one to 12 total providers over the last three to four years. We've had a 1,000-percent increase in those outpatient visits in the last three years. We're working on expanding into the community and putting outpatient offices in different areas in our area. Right now, we're centrally located in Fort Myers, but we're looking to expand into Bonita and another location in Fort Myers, and eventually into Cape Coral and Lehigh—to bring that care to where our kids are rather than asking them to come to where we are.

Finally, we've transitioned our parenting groups to be virtual over the last year so we're still providing that service and education to our parents.

How has COVID-19 impacted the hospital? What's the current plan as vaccinations become available? How will the hospital return to normalcy after the pandemic is over?

Dr. Salman: There has been a big difference in the number of patients who have used the emergency room in 2020—somewhere around a 30- to 40-percent decrease in the total number of people. That is also reflected in the number of patients that have been hospitalized in the last year. However, we have noticed that the patients that come to the emergency room, as well as those who come for office visits, are a lot sicker, which means parents are keeping their kids home until they are very sick before they bring them in to be seen.

Bostwick: We've seen a change in behavior in the community with our families. This started pretty soon after March into April of last year where we had a significant decrease in our emergency department's volume. We've seen families stay away from the emergency department. We've seen an increase in our ruptured appendicitis patients. So, where we've seen in the past patients come in early and it's caught and not ruptured, now we're seeing them come in a little bit later, requiring more care when they're ruptured. That increase in severity of illness is being seen across the board. Our first approach and call to action to the community was to not be afraid of the emergency room and to bring children in if they're sick and requiring care—not to delay care. We've done a lot of work with our marketing team to try to get the message out to our community and our families.

Dr. Salman: Over the last month or so, we've seen a slight increase in our numbers, so the comfort level of going to the hospital is coming back slowly. We're still not where we're supposed to be this time of year. It may take a couple of years before hospital emergency rooms are utilized in the same way again. That is not a Golisano trend. That is a national trend. What we've seen here is happening all over the country. Experts are predicting emergency rooms will not get to full capacity until 2023.

Do you think fear or hesitation due to the pandemic is the chief primary cause of that?

Dr. Salman: I would say so, yes. We also noticed the same trend in some of our offices where the number of patients being seen has gone down. People are waiting and the things they used to go see a doctor previously have changed. Parents are being a lot more cautious before they venture out with their children. Kids have really been very good about wearing masks. This time of year is our respiratory season. Usually, we see many cases of the flu every day. We haven't seen as many cases this year. The flu vaccine was given a lot more this year than any other year because people were afraid because of COVID, but also kids are wearing masks and socially distancing and not necessarily interacting with each other, which has mitigated the transmission of the flu within the community. That has been seen in our emergency room as well as the hospital. We can manage the flu better if we take some of these precautions in future years.

Last year was an interesting time for us all. What's the biggest lesson you can take away from all of this?

Dr. Salman: I think we learned a lot of lessons. Number one: Masking does work. A mask is the easiest way to prevent transmission of an infection, as well as hand washing and social distancing. It has really taught us there's a lot we need to learn about some of these novel viruses and infections that are going to happen. We have opportunities to build a better infrastructure—both locally and at the national level. We need a better level of preparedness. I think we do a great job with natural disasters like hurricanes, but this was a disaster that was slow and continuous. It was a lot harder. With hurricanes, you have a big hit and a quick recovery period. With COVID, it has just gone on and pushed a lot of systems to the limit. Hopefully, we will make changes over the coming years to be better prepared for the next pandemic. I'll tell you, there will be another one. I don't want to be Dr. Doom and Gloom, but the reality is, there will be another pandemic and we need to get prepared. We should start preparing from yesterday.

Bostwick: We've always known and appreciated the power of community collaboration, but this has really taught us how to adapt quickly to change, take in information, analyze it and adapt, and communicate to be able to change rapidly. To Dr. Salman's point for disaster management, those are meant for short-term situations. To try to implement those processes over a year-long disaster essentially has been a challenge, but we have certainly learned and adapted in this last year. It's a matter of using the same resources and people to try to do the work every day. We've learned how to take care of each other. We've realized there's a lot of stress on all of us as we've tried to do the best we can in our community this last year.

Dr. Salman: We've used technology to try to meet some of those needs. Telehealth is something that a year ago was in its infancy especially in Southwest Florida. It's grown very fast and I don't think it's going to go away. It's given us an alternative way to provide care for some of our patients. It doesn't replace the face-to-face interaction we have, though I think it compliments it in many ways moving forward.

Tell us about your involvement in the community. What have you done this year in terms of local causes?

Bostwick: It's important to note that we put our focus on children and pediatrics in our community and our region. When we recognized and realized that the return to school was going to happen and be a challenge with the pandemic, we partnered very early with the Lee County School District, the community pediatricians inside and outside of the county, the Department of Health, and our own internal Lee Health infectious disease doctors to have weekly touchpoint calls to stay ahead of any curve or increase in cases we see in the community and help guide our community pediatricians and schools on how to best and most effectively/safely return our kids to the classroom, and to make sure we have a standard in our communication and practices. Those calls have occurred weekly since the beginning of school in August. Through that work, we've been able to partner with Lee County Schools and through the county board of commissioners to provide rapid testing, three days a week, in all of Lee County Schools as indicated if children are presenting sick to the nurses in the schools. 

It's also helped us open the lines of communication with each other in what we are beginning to see as the secondary effect of this pandemic, which is the effect on mental health. We have certainly seen that impact here at Golisano Children's Hospital. We have seen our emergency department visits for mental and behavioral health increase from the prior year by 36 percent. We were able to identify that early in the first few months of school and begin to have that conversation with the school district and our community pediatricians to bring it to the community to help open eyes and help point those kids in the right direction and to the right resources.

Dr. Salman: Under normal circumstances, if a child is sent home because they suspect they have a viral infection that could be COVID, they'll get an appointment to see a physician in a day or two, get the test, and it will take three to four days to get the results. In that time, that child is probably exposing more people, because they don't know if they have COVID or not. By doing a rapid test in the school, if it is positive, that child is quarantined immediately, and that way we minimize the exposure to other people and don't let them loose out in the public domain. That has really worked well and it has been a very good partnership. It also raises opportunities for future partnerships so we can collaborate and make sure our kids are well and healthy.

Anything else you'd like to say directly to the SWFL community?

Dr. Salman: As you can see we've been busy and that means we are here for you. We want to provide the best healthcare for the children of this region and we would love our kids to stay as close to home as possible. We're constantly looking at what our community needs are and how we can meet them.