University Children’s: An Emergency Department for Kids Backed by a Wide Range of Pediatric Subspecialists

By Donald Finley
Tuesday, October 24, 2017

As one of the newest emergency departments for kids, University Children’s ED has board-certified pediatric emergency medicine physicians and the latest technology.

Kelsey Sherburne, MD, pediatric hospitalist and Medical Director, Pediatric Acute Care, Assistant Professor of Pediatrics, UT Health

University Children’s Emergency Department is one of the region’s newest dedicated pediatric emergency departments, opening its doors in August 2016 at University Hospital. But over the course of a year, it has quickly proven itself to be the place for children with any kind of medical emergency — from worrisome middle-of-the-night fevers to the kinds of urgent problems that can develop quickly in children with complex or chronic medical conditions.

Staffed by four UT Health San Antonio board-certified pediatric emergency medicine physicians — with plans underway to add a fifth — the Children’s ED also has a wide range of pediatric subspecialists available around the clock to provide continuity of care for children with chronic or ongoing medical conditions, such as asthma, cancer or congenital heart defects, or to offer expert guidance when a serious problem is diagnosed.

“We have a large group of pediatric subspecialists right here in the hospital to back us up,” says Daniel J. Dire, MD, Medical Director of University Children’s Emergency Department and a Clinical Professor in the Departments of Pediatrics and Emergency Medicine at UT Health.

Daniel J. Dire, MD, Medical Director of University Children’s Emergency Department and a Clinical Professor in the Departments of Pediatrics and Emergency Medicine at UT Health

Grant Hogue, MD, Chief of Pediatric Orthopaedics and Spinal Deformity at UT Health San Antonio

Jose Enriquez, MD, pediatric emergency medicine physician, Assistant Professor of Emergency Medicine at UT Health San Antonio

These UT Health faculty pediatric subspecialists include nephrologists, cardiologists, gastroenterologists, pulmonologists, critical care intensivists, neurologists, endocrinologists and orthopedists.

In addition, the region’s only Level I pediatric trauma center and burn program is located a short distance away within University Hospital in case a minor injury or burn turns out to be a bigger problem.

For follow-up care after the initial emergency, patients can be directed to those UT Health pediatric subspecialists, whose outpatient clinics are located on the sixth floor of the clinical building at University Health System’s Robert B. Green Campus downtown.

A Centrally Located Center for Urgent Children’s Care

While it’s designed for lesser emergencies, PediExpress, University Health System’s pediatric urgent care center, sees its share of pretty sick kids.

“We’re definitely well equipped to take care of a wide variety of pediatric illnesses, including very acutely ill children,” says Robert Sanders, DO, a pediatrician with University Medicine Associates (University Health System’s nonprofit physician practice group) and Associate Medical Director of PediExpress. “We’re able to safely stabilize and transport those patients to the pediatric emergency room if needed with the help of our pediatric transport team.”

PediExpress is located on the first floor of the clinical building at the Robert B. Green Campus, 903 W. Martin St. It’s open from 8 a.m. to 8 p.m. Monday through Friday, and from 8 a.m. to 4 p.m. on Saturday.

Wait times are typically less than 30 minutes, making it a more convenient — and less costly — option than an emergency room for many urgent medical problems.

“Most people are out the door in less than an hour,” Dr. Sanders says.

The six-story clinical building, which opened in 2012, also houses a range of services that are available for those young urgent-care patients if needed, including X-rays, CT scans, ultrasound and a full-service laboratory.

Kids are also seen at University Health System’s other urgent care location at the Medical Center Pavilion, 4647 Medical Drive, across from University Hospital.

The Latest Technology

University Children’s ED features 16 patient rooms, including a negative pressure room for respiratory isolation, a procedure room, resuscitation room, behavioral health room and a three-bed resuscitation bay. It has its own patient entrance and ambulance bay on Merton Minter Boulevard, on University Hospital’s west side between Babcock and Wurzbach roads.

Step into the colorful reception-waiting area and you’re greeted by an almost-floor-to-ceiling bank of big-screen TVs broadcasting the San Diego Zoo Kids’ channel, a closed-circuit feed of zoo animals and informative programs. It was funded through a gift from National University in San Diego, California, shortly after the Children’s Emergency Department opened.

The San Diego Zoo Kids channel, a grant-funded, closed-circuit feed, is broadcast on a large screen in the University Children’s Emergency Department at University Hospital.

As a new emergency department, University Children’s ED is equipped with plenty of state-of-the-art technologies, including bedside ultrasound, GlideScope video laryngoscopes that provide real-time views of the patient’s airway, and large-screen monitors in rooms to display those airway procedures, as well as vital signs, electronic medical records and radiology images.

Building a dedicated and separate pediatric emergency department at University Hospital was a logical idea after the UT Health pediatric programs returned to University Health System, having parted with their former teaching hospital in 2013.

Dr. Dire, a major general and flight surgeon in the U.S. Army Reserve, was selected as the founding Medical Director after a distinguished military career that spanned almost four decades. He served as commanding officer of several Army hospitals, two medical groups, one medical brigade and the Army’s largest deployable medical command. His assignments included overseas deployments to Bosnia-Herzegovina, South Korea, Kosovo, Kuwait and multiple Central American countries.

Dr. Dire assembled a team that is skilled in providing fast and expert care to kids.

“The pediatric emergency physicians are all trained and credentialed in pediatric moderate and deep sedation,” Dr. Dire says. “We can sedate kids down here for fracture reductions and other procedures that ordinarily might have to go to the operating room in another facility.”

Because of the close ties to all those pediatric subspecialists at UT Health, University Children’s ED tends to see patients with a higher level of acuity than other children’s ERs, Dr. Dire said. Families of kids with chronic or complex illnesses are directed to go there if and when urgent problems develop.

Daniel J. Dire, MD, Medical Director of University Children’s Emergency Department and a Clinical Professor in the Departments of Pediatrics and Emergency Medicine at UT Health

Nurses are trained in basic and pediatric advanced life support, as well as advanced cardiac life support and the Emergency Nursing Pediatric Course, says Michele Jakubczyk, RN, Director of Pediatric Emergency Services and Pediatric Critical Care Transport at University Hospital. The team also participates in decontamination training and Satori alternatives for managing aggression.

“The Children’s ED staff utilizes protocols for many types of complex care patients. Hematology-Oncology has protocols for their patients that we use. We are an extension of that specialized care,” Jakubczyk says. “It starts here in the ED and continues until they get admitted to the hospital or are discharged from the ED. We have asthma and bronchiolitis protocols that provide algorithms for the respiratory therapists and nurses to perform interventions based on a severity scoring tool. This allows for standardized care and a collaborative effort in an approach that is quick to initiate and easy to understand.

A number of smaller regional hospitals have adapted the same scoring system as University Health System’s asthma protocol, “so if they transfer the child to us we’re on the same page,” Jakubczyk says.

A Dedicated Transport Team

Jakubczyk also heads University Health System’s Pediatric Critical Care Transport Team, which works hand-in-hand with the Children’s Emergency Department and inpatient pediatric departments.

The 15-member transport team, which includes pediatric critical care registered nurses and respiratory therapists, uses helicopters, ambulances and fixed-wing aircraft — including University Health System’s specially equipped pediatric and neonatal ambulance — to transport pediatric patients from across town or across the state to University Hospital for a higher level of care and specialized treatment.

The hospital has a dedicated, specially trained team to provide extracorporeal membrane oxygenation (ECMO) to very sick kids needing advanced life support. ECMO performs the work of the child’s heart and lungs to allow them to recover.

University Hospital Sky Tower

The fact that University Hospital — including its University Children’s Emergency Department — is an academic healthcare center with a mission to train new physicians and other health professionals gives it an advantage for patients and families, Dr. Dire says. He notes that a number of studies have shown that teaching hospitals provide better care.

One reason is a commitment to evidence-based medicine.

“We try to stay on the cutting edge of what’s going on in our specialty,” Dr. Dire says.

For more information about the University Children’s Emergency Department at University Hospital, go to or call 210-358-5437.