GBMC Responds to MedStar Pediatric ED Closing

The closing of MedStar Franklin Square Hospital's pediatric emergency department and child abuse program left a significant gap in care for many, especially the Southeast Baltimore County community. While GBMC's Sexual Assault Forensic Examination (SAFE) and Domestic Violence programs were already on an accelerated advancement path, this new – and unexpected – development certainly put their plans on a fast track.

Since the closure came at the end of the winter season, in the six short weeks since the closing, GBMC has not seen an overwhelming influx of extra patients, but much work has been done behind-the-scenes to address the volume sure to come.

Laura Clary, RN, FNE-A/P, SANE-A, CPEN, Clinical Program Manager for GBMC's SAFE program, prepared by ensuring two forensic nurses from her team are on call at all times – one of which must be certified to treat pediatric cases. In the past, only one nurse was on call. But to ensure 24/7 coverage for pediatric patients, not only does at least one on-call forensic nurse need to be certified to treat pediatric patients, but every pediatric case requires an assist, which means if a pedatric case is called in, both nurses on-call must report.

At Franklin Square, Laura, who worked for the hospital for two years prior to her work at GBMC, said the Rossville hospital conducted approximately 50-65 acute, evidentiary exams a year, which will now be seen at GBMC. Instead of waiting for next year's grant cycle, Laura and Michelle Chudow, MD, Medical Director of the Baltimore County Child Advocacy Center and a consultant pediatrician for GBMC with an expertise in child abuse, are working tirelessly to expedite their formal implementation of a Child Protection Team at GBMC, a multi-disciplinary team that responds and evaluates suspected child abuse or neglect.

"Even before everything happened with Franklin Square, we were already planning on creating and building a child protection program," Dr. Chudow said. "I had already had a number of conversations with the radiology department, and with Dr. [Tim] Doran [GBMC Chairman for the Department of Pediatrics] about how to put together and complete a new Child Protection Team. The County, especially police and state's attorney's office, had already been sending most of the 12 and under SAFE patients that needed forensic evidence collection to GBMC anyway, so I think we're just seeing an expansion of something that was already in motion as far as the sexual abuse. GBMC's expertise in SAFE exams, under the leadership of Laura Clary, is unrivaled in the eastern seaboard region. The real new piece is the physical abuse portion because, at this point, GBMC is the only hospital in Baltimore County that employs a pediatrician with an expertise in child abuse: me."

Laura said having Dr. Chudow on-site and more involved in cases from the front-line has aided tremendously in smoother handoffs, ensuring a seamless continuation of care and that "these kids really do receive the best treatment from the time they work through the hospital all the way through their follow-up exam at the Child Advocacy Center."

"Being able to have her in the pediatric ER, she is able to share a lot of knowledge about abuse cases and help to train the other pediatricians, the nurses on signs to look out for," Laura said. "She is also able to help make determinations on whether an acute exam is warranted or really if a non-acute exam is the better route to go for that child. The pediatricians can use her as a resource when they have questions. … We have that really good communication and teamwork with the social workers, the detectives and Dr. Chudow. We've definitely strengthened our relationship with them."

And now Laura is also working to strengthen relationships and educate the community.

"A big focus on what we're going to have to do in the upcoming months is a lot of community education," Laura said. "We've already started working with EMS to ensure they know Franklin no longer offers that service and that we're the only Baltimore County hospital that does. It's a lot of outreach to the pediatrician's offices, to the EMS, to everybody else to make sure they know we're the SAFE center in Baltimore."

According to Dr. Chudow, Franklin Square's catchment area extended all the way to Delaware in some cases for acute SAFE exams. She has been working with child abuse physicians and investigators in Harford and Cecil Counties to assure smooth transitions across county lines for patients who need acute forensic exams.

"Franklin Square serves a huge catchment area, seeing 17,000 pediatric ED visits per year," Dr. Chudow said. "Franklin Square was the primary community hospital for the southeastern corner of Baltimore County."

GBMC now stands ready to help these families and their children.

If you would like to support kids who need SAFE and DV services, please contact Director of Philanthropic Engagement, Kate Thorne, at kthorne@gbmc.org.