Project Peds: Sri Lanka

“Smart” Solution"

Physical Elements

Goal:     To build a pediatric facility that is both “resource efficient” and “clinical flow smart” in managing disease

Utilizing charitable services from healthcare construction architects and engineers in the US from both of our partner pediatric hospitals, we created a “smart” design.  To ensure the applicability and practicality of these solutions, we included Matara pediatricians and administrators in the process and tailored proven models to local-specific issues.

• Expanding the hospital both in size and # of beds to alleviate overall spatial concerns
• Creating  disease-specific units, as well as physically separate isolation units to prevent the spread of contagious diseases
  • Disease-specific resources and specially trained staff will be focused in these particular units
  • As units become specialized and focused on a system such as respiratory, then staff will become proficient and better trained in managing these specific subset of illnesses and diseases
• Incorporating the “clinical pod” concept to optimize resources as well as nursing and ancillary staff care
  • Each unit is subdivided into pods, usually 4-8 beds, with a wash basin and routine, basic supplies, creating a controlled, manageable environment
  • Nurses and ancillary staff would be designated to pods as their point-of-care areas
  • This would help staff focus on a subset of patients, streamline clinical workflow and limit patient-patient contact
• Building a pediatric intensive care unit to manage the ventilator-dependent asthma patients
• Augmenting facilities for the general public and creating distinct patient and non-patient areas because Sri Lanka’s family-oriented culture tends to brings several visitors to patient areas often adding to the confusion, clutter and overcrowded conditions
  • A Mother’s area with 40 cots, general public bathrooms (separate from patient bathrooms) and proper waiting areas

New Matara Pediatric Facility:  Size - # of Beds by Unit

155-bed Pediatric Facility will be approximately 25,000 sq. ft area and two floors. 

Ground floor

• 4 General Pediatric Units
  • Unit 01 – Respiratory (16)
  • Unit 02 – General  (20)
  • Unit 03 – Gastrointestinal (16)
  • Unit 04 – General (20)
• Isolation unit (20) & High Dependency Unit (HDU) (10)
• Emergency care room

First Floor

• Pediatric ICU(12) & Neonatal ICU (10)
• Nursery & Neonatology unit w/Incubators (15)
• Premature baby unit –PBU (16)
• Healthcare Learning Center

Intellectual Elements

Goal:     To reduce the number of asthma exacerbations leading to hospitalizations, ventilatory support and/or mortality

The tools we plan on using to identify and education the pediatric asthma population include:

• Asthma surveillance tool
  • A survey (developed by the Los Angeles County Medical Center University of Southern California (LAC+USC) Department of Allergy and Immunology)  consisting of seven questions that have been validated and shown to identify children with asthma with high levels of sensitivity (87%) and specificity (83%)

• Asthma Education Videos (targeted to parents and children)
  • Culturally-sensitive videos designed to provide a brief general background on the disease and to explain early stage symptoms
  • Teach children on how to properly widely available inhalers (A significant worldwide issue)
  • Reduce the cultural stigma associated with inhaler use

In addition to these measures, we are planning to train both the medical staff at our future Matara pediatric facility as well as the rural healthcare providers (caregivers, mid-wives, etc.) on to better manage asthma.  Current practices in Matara for asthma are inconsistent between pediatricians as well as inadequate because of insufficient number of skilled nurses to carry out management plans.  We have designed a sequential three step process:

• Provide general medical training (Neonatal Advance Life Support and Pediatric Advance Life Support) to nurses and healthcare providers to provide a foundation of skills
• Develop the asthma management pathways based on best practices proven in the US yet customized to be effective in the local environment and culture
• Didactic Grand Rounds (lectures on current advances in medicine) in the Matara Pediatric Learning Center intended for continued, long-term education within our facility as well as the entire region

 The Asthma Program will be based in Matara, Sri Lanka with program implementation timed around the building and opening of the new Matara Pediatric Facility.  It will focus on long-term surveillance database implementation and community education.  WCI will recruit a US board certified or board eligible pediatrician with interest and experience in global health and asthma education.  This clinical fellow will spearhead the Asthma Program.  The development and implementation of the program will span over 2 years, yet the program will continue running indefinitely.