David Monroe had lived the chief concern facing many private practice pediatricians, not hearing back from hospitals about his patients. Then he joined Howard County General, where pediatrics is part of the Hopkins Children's family, and did something about it. 

Not long after joining a large practice in the early 1990s, Howard County pediatrician David Monroe had somewhat of an epiphany that would play out in empathetic ways a decade later. Like the other pediatricians in the group, he wanted to hear back from hospital staff to whom he had referred patients. Were they treated? How? What was their status? Had they been discharged home? What was the post discharge plan? 

“But there was no real communication, no information or support from the hospitals,” Monroe says point blank. “It gave me a different perspective when I started working here.” 

Here as in Howard County General Hospital, a member of Johns Hopkins Medicine, where Monroe directs the Children’s Care Center, which includes both the inpatient pediatric unit and the pediatric emergency department. Reflecting on his private practice experience, he immediately stressed the need for a steady stream of patient information – from admission and diagnosis to treatment and discharge – back to the community pediatricians. To enhance communication, some 60 community pediatricians were invited to monthly meetings with Monroe and his staff to air out any subject, and to case conferences periodically where they could present on their own patients. 

“Our approach from the very beginning was to make it more of a partnership with the pediatricians,” Monroe says. 

But Monroe knew more needed to be done – like designing an innovative model in which the pediatric emergency room would be coupled with the six bed pediatric inpatient unit, allowing the emergent asthma patient to stay overnight rather than be transported miles away to an urban children’s hospital. 

Pediatric trained nurses would work in both the ED and inpatient unit as needed, enhancing continuity of-care, nursing efficiency and medication safety. Families liked having their hospitalized child close to home, as reflected in the ED consistently ranking in the 75th percentile in hospital patient-satisfaction surveys.  

“We were in the waiting room maybe 5 minutes before they took us back to a treatment room,” says Kathy Young of Columbia, Md ., who, following her pediatrician’s recommendation, recently brought her 6-year-old, Julian, into the ED after 24 hours of vomiting and unresolved fever. He immediately received intravenous fluids to treat his dehydration and Tylenol to bring his fever down. After a chest X-ray showed pneumonia in his left lung, he was rolled across the hall into the pediatric inpatient unit for a 3-day stay. 

“The admission was nothing, the wheels on the machine seemed to work,” Young adds. “The orange popsicle from the emergency room physician made his day, the respiratory therapists made him laugh, and the nurses were wonderful. Three days later he was back to his old self, though a little tired.” 

Commenting on the community pediatrician’s perspective on such cases, Monroe adds, “When pediatricians send someone to the emergency room, it almost always means they have exhausted the abilities available to them in a timely manner. So our staff is sympathetic to the fact that there’s no second guessing – this is what the patient, the family and the pediatrician need.” 

What they also need and want, Monroe notes, is community-based care. Thanks to economics, the community hospital model where private-practice pediatricians rounded and treated their patients, Monroe concedes, is long gone. But that doesn’t mean a community hospital like Howard County can’t infuse a sense of community and collaboration in caring for patients, a sense of ownership among private-practice pediatricians. Familiarity and flexibility in a small setting, Monroe notes, can facilitate care in ways that may be tricky to pull off in a large urban medical center.  

He cites the case of a newborn that prior to discharge from another hospital had arrested after receiving his initial immunizations. The cause was unclear, but the parents were concerned enough about a similar reaction to his next round of vaccines that Monroe arranged for the infant to receive them in the hospital’s resuscitation room. 

“This was not a standard situation but the family was up against a wall,” Monroe says. “So we worked with the family and pediatrician to find a safe, practical way to get the infant the medical care he needed.” 

In ways, Monroe adds, community care comes naturally at the Children’s Care Center. “This goes back to the view of Vic Broccolino (CEO of Howard County General Hospital), that we’re a community and all in this together,” Monroe says. “We know that our neighbors and our own family members are going to be treated here, so we try to keep that in mind in taking care of all patients.” 

And how would he describe the relationship with community pediatricians today? 

“They feel a high level of trust that we’ll do what they request of the patient diagnostically, give them feedback and return the patient with clear follow-up instructions,” Monroe says. “It’s a whole different atmosphere.”