Complex Care Service (CCS)

Due to the increasing number of children with complex health care needs, Children's Hospital has created an inpatient team and an outpatient clinic solely dedicated to the care of these children and their families. These patients have medical problems involving a minimum of 3 organ systems and often participate in cooperative multidisciplinary programs at Children's Hospital such as the Myelodysplasia Program, the Cerebral Palsy Program and others. During the junior year, residents rotate for 1 or 2 two week blocks on the inpatient CCS service comprised of 2 residents, a nurse practitioner, a clinical nurse specialist, a CCS social worker and a CCS attending. Patients may be hospitalized for acute medical problems such as aspiration pneumonia or increased seizure frequency, or they may be admitted for intensive management of more chronic issues, such as progressive weight loss. The service has an average daily census of 12-13 patients, most of whom require multiple medications and a range of assistive technologies. Residents gain proficiency in assessing medication interactions and are exposed to a wide variety of medical devices including gastrostomy and jejunostomy tubes, tracheostomy tubes, urinary stomas, ventriculoperitoneal shunts and Baclofen pumps. Because many patients need input from multiple subspecialty teams, residents learn to synthesize consultant recommendations to deliver optimal care. A didactic lecture series provides education on the common problems that arise in children with complex medical disorders.  Overnight, CCS juniors help to supervise interns on the pulmonary rotation, which adds more supervisory and teaching experiences to the junior year.