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Oh Baby! Green-Blue Merger Boosts Pediatric Care

By Douglas J. Gillert
American Forces Press Service

SAN ANTONIO, Texas, May 22, 1998 – Can patients and health care providers benefit from downsizing? Yes -- in the case of two major military medical centers whose proximity begged for closer ties.

In 1995, DoD directed Wilford Hall Medical Center and Brooke Army Medical Center to merge their pediatrics and OB-GYN programs. Because Wilford Hall was the larger of the two teaching and research hospitals, the Air Force's biggest medical center absorbed most of the workload.

But Wilford Hall also absorbed Army staff so that, three years later, Army and Air Force physicians share leadership responsibility, work together on surgical teams and learn together under a common residency program. In turn, their patients, who come from several states, receive care under the most comprehensive pediatrics care system in the military.

Today, the San Antonio Pediatric Center includes the Wilford Hall-Brooke patient load, which includes service members, families and retirees in Texas and parts of several surrounding states for emergency and critical cases, and Darnall Community Hospital at sprawling Fort Hood, a few hours by car north of San Antonio. Their critical case load comes from bases as far away as Fort Huachuca, Ariz.

"We decided to include Darnall because it provides education for our residents," said Army Dr. (Col.) John Roscelli, pediatrics residency program and chief of pediatrics at Brooke. "As a result of three hospital systems for graduate medical education, this health care system is the largest and most comprehensive in DoD for depth and scope of pediatrics expertise."

The merger consolidated inpatient care, labor and delivery at Wilford Hall, with clinics at Brooke and Darnall. It also consolidated neonatal and pediatrics intensive care and the pediatrics ward at Wilford Hall. All are staffed by Air Force and Army physicians and nurses. Residents spend their first year in the clinics, second year in the emergency room and third year in the ward. Each also spends a month of each year of residency at Darnall.

The center serves some 35,000 dependent children in the San Antonio area and another 50,000 from the Fort Hood community. Team physicians deliver 160 babies a month at Wilford Hall and another 300 babies a month at Darnall.

Medical leaders here decided to open a full-time neonatal intensive care unit at Fort Hood because of the large family population there. Medical faculty members rotate to staff it.

"Although we can and do bring sick babies here with our neonatal air transport system, we now can stabilize and keep more babies at Darnall," Roscelli said. "This is less disruptive to the families and keeps troops in training. Before, we had to bring them down here for one or two months, so having the ICU there has a big impact on military readiness, family costs and morale. We've reduced hospitalization here by 60 to 80 percent."

The merger also meant reduced staff requirements for the two medical centers. Before the consolidation, 210 nurses worked in pediatrics at Wilford Hall and another 86 pediatric nurses worked at Brooke. Today, Wilford Hall has about the same number, but it's a mixed Air Force-Army staff. And Brooke has just 23.

"Consolidation centralized and cut 25 percent of nurses, created better wards and ICUs, and provided robust, better care for our patients and better training for our residents," Roscelli said.

Evidence of the merger's success came in a recent inspection by the Joint Commission for Accreditation of Healthcare Organizations. "They viewed our pediatrics programs very positively at Wilford Hall and Brooke," Roscelli said.

"You won't find this level of medical expertise anywhere else," contended Army Dr. (Maj.) Randall Robinson, OB-GYN program director at Wilford Hall. He also believes the combined staff improves the quality of military medicine worldwide.

"The exposure our residents get here to the wide range of specialties is critical to their ability to go out to small units and clinics where they often are the only doctor," he said. "It's going to make them far more effective and provide their patients with higher quality care."

Roscelli compares the quality and level of care available to sick babies to that at a major university hospital. "Our 10-bed pediatrics ICU is the largest in the military," he said. "We have every subspecialty and surgical specialty in-house to take care of sick children. The quality of care they get here is as good or better than what's available in any university."

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