Complex Care Service (CCS)
Due to the increasing number of children with complex health care needs, Boston 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 three organ systems and often participate in cooperative multidisciplinary programs at Boston Children’s Hospital such as the Myelodysplasia Program, the Cerebral Palsy Program and others. Junior residents rotate for two 2-week blocks (one block of days and one of night float) on the inpatient CCS service comprised of two 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. 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.