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Pediatric surgery at Floating Hospital: A cut above


Ask Walter J. Chwals, MD, FACS, FCCM, FAAP, what distinguishes the pediatric surgery program at Floating Hospital for Children in Boston, and he replies, “It’s not just that we provide subspecialty service in all areas relating to the surgical diseases of childhood, but also that we are dedicated to initiating new programs and services that integrate important new advances, to benefit the patients we serve.” 

The comprehensiveness of Floating’s pediatric surgery services, combined with leadership that is committed to developing the program even further, is what convinced Chwals to join Floating Hospital as its Chief of Pediatric Surgery and Pediatric Surgeon-in-Chief. A nationally recognized expert in pediatric trauma and critical care with a research interest in neonatal and pediatric injury metabolism and nutrition, Chwals was recruited  in 2009 from Rainbow Babies and Children’s Hospital in Cleveland, where he worked with John Schreiber, MD – now Pediatrician-in-Chief and Chief Administrative Officer at Floating Hospital.

“We had a great partnership there,” Chwals states. “The opportunity to continue that partnership and help build the pediatric surgery program here was attractive, in large part because of the leadership’s demonstrated commitment to moving Tufts Medical Center and Floating Hospital forward.”

This commitment has produced a respected pediatric surgery program with significant resources already in place. The Kiwanis Pediatric Trauma Institute, for example – for which Chwals serves as director – is the first formally-established pediatric trauma center in the United States to provide medical care for injured children, medical research on pediatric trauma, and injury prevention programs for children and families. A partnership between the New England District of Kiwanis and Floating Hospital since 1981, the Institute treats the region’s most seriously injured children at Floating’s pediatric emergency department, which was one of the first Pediatric Trauma Centers to be accredited by the American College of Surgeons (ACS).

Another notable example is Floating’s specialized Ear, Nose and Throat (ENT) services, including cleft lip and palate reconstruction, voice disorders, cochlear implantation, and neonatal and pediatric airway disorders. “We’ve seen dramatic growth in this area since Mark Vecchiotti, MD became Chief of Pediatric Otolaryngology last year,” Chwals says.

“And in the realm of general surgery, there’s not much we don’t do,” he continues. “We cover a lot of territory including surgery involving the head and neck, thorax, abdomen, trauma, surgical oncology, pediatric vascular conditions, hepatobiliary conditions, colorectal and congenital anomalies. And we’re currently recruiting a third full-time surgeon for this team.”

Other highly regarded pediatric surgical subspecialty services at Floating Hospital include cardiothoracic surgery, neurosurgery, orthopedic surgery, plastic surgery and urology – along with an outstanding team of fellowship-trained pediatric anesthesiologists and pediatric intensivists who provide 24/7 coverage.

“All these are areas where we provide an excellent service, and all of them are growing,” Chwals notes. In fact, recruitment is underway in most of Floating’s pediatric surgery subspecialties, along with new staff to support them. Equally important, new clinical programs also are in development.
For example, a collaborative initiative currently being developed at Floating Hospital is a pediatric extracorporeal membrane oxygenation (ECMO) program. ECMO is a sophisticated technique of providing both cardiac and respirator support oxygen to patients whose heart and lungs are severely diseased or damaged.

“This type of treatment is essential for kids who are undergoing cardiac surgery, who have congenital diaphragmatic hernias, or who have acute severe respiratory insufficiency,” Chwals explains. “It also allows for complex surgery of the airways involving reconstruction of the trachea and bronchus.

“We’re working with Dr. Schreiber and Dr. Michael de Moor (Chief of Pediatric Cardiology) to launch this program which will enhance the pediatric cardiac surgery, neonatology and pediatric ICU services,” he adds. 

A similar collaborative approach is evident in the way Floating Hospital works with community hospitals to expand the scope of pediatric services available locally. Through partnerships with MetroWest Medical Center and Lowell General Hospital, families have access to Tufts-affiliated specialists – including pediatric surgeons – right in their own community. For example, pediatric surgeon Carl-Christian Jackson, MD, performs procedures not only at Floating Hospital’s main campus and but also at MetroWest Medical Center’s Framingham campus.

“Traveling to Boston for appointments can be inconvenient for patients and parents, so we come to them,” says Chwals, referring to the Pediatric Specialty Center at MetroWest and the Floating’s Pediatric Specialty Center at Lowell General’s Chelmsford campus. More community-based satellites like these are in the works, he notes.

“Floating Hospital surgeons provide specialized surgical care here at our tertiary/quaternary medical center,” he explains. “But when it’s safe to do so, it’s very important that the patient be returned to the community as soon as possible for ongoing care.

“There’s a bond that patients have with their primary care physicians – they know the child and the child’s family best and have established a relationship of sustained compassion and trust which is such an important part of patient care,” Chwals continues. “And it’s easier for parents to see kids in their local hospital, and easier for pediatricians to care for them there. So to the degree we can safely keep patients in the community where they live, that’s what we aim to do. These partnerships with community hospitals strengthen our ability to do so.

“It’s important that referring physicians understand that we’re partners with them, too,” he adds. “We consider them an essential part of the treatment team and are ever mindful of that relationship. Physicians should consider us an extension of the team for specialized care that will be delivered in a caring and expert environment. We’ll make every effort to ensure patients return to them as quickly and safely as possible. And we’ll keep them informed every step along the way.”

As part of an academic medical center, part of Floating Hospital’s mission also is to advance education and research. Chwals, who also is a Professor of Surgery and Pediatrics at Tufts University School of Medicine, articulates the commitment of the pediatric surgery service to that mission in this way:

“One of the key criteria for building the pediatric surgery service is devotion to education and research, both at the basic science and clinical levels, to help improve the practice of pediatric surgery on a global scale,” he says.

“We will always take excellent care of our patients, and benefit them by doing so,” he continues. “But when we teach residents and students, we’re able to help people we’ll never see. And when we publish our research, we help an even greater number of people throughout the world, sharing information that benefits other caregivers and their patients.

“To improve the science of medicine in general, and pediatric surgery in particular – that’s also a vital part of what we do,” he adds.