Building a Strong Foundation

CHaD’s roots go back to 50 years ago, when Dartmouth Medical School turned to Dr. Saul Blatman to chair the Department of Maternal and Child Health in 1972. This department included pediatrics as well as obstetrics and gynecology. Dr. Blatman, in turn, brought in several pediatricians who would change the hospital’s future, including pediatrician George Little, MD, active emeritus professor of Pediatrics and Obstetrics and Gynecology at the Geisel School of Medicine at Dartmouth. As the first chair of Pediatrics, Dr. Little is considered the “father of CHaD.” He created a Neonatology Unit in 1972, providing the perfect foundation for CHaD.

Pam Thompson, MS, RN, FAAN, was the nurse leader called the “mother of CHaD.” As vice president of nursing for Maternal and Child Health, she worked closely with Dr. Little on the concept of a “children’s hospital within a hospital.” This included envisioning the need for a Pediatric Intensive Care Unit (PICU), which eventually came to fruition with completion of DHMC in October 1991.

Sharon Brown served as an administrative leader in the outpatient department during CHaD’s development and was eventually named director of CHaD community relations. In the mid-1980s, Sharon was part of the planning group that developed broader pediatric specialty services, including cardiology, neurology, cancer, and surgery. When CHaD officially launched in 1992, some of those services expanded to Dartmouth Hitchcock Clinics Manchester, which helped integrate care in southern New Hampshire.

Expansion to address the needs of the community continued. A new Pediatric ICU opened in 1999. In 2017, CHaD became first unit within the DHMC campus celebrating a 25-year anniversary. This was an opportunity to refresh and remodel the unit, making it focused on the current standard of care and shifting from a central nursing station to being right outside the patient’s room. Upgrades included a therapeutic play space and bringing the ICU into the space.

Throughout the past three decades, Dartmouth Health Children’s expanded to offer primary, intensive, trauma, and specialty care statewide and beyond. CHaD is the only pediatric trauma center in New Hampshire accredited by the American College of Surgeons.

Connection and Collaboration

Dr. Keith Loud, physician-in-chief of Dartmouth Health Children’s, sees the expansion of the hospital and its programs as something unlike any other facility. “We have grown exponentially from the humble beginnings of Dr. Blatman to over 180 health-care providers in 35 pediatric specialties. The primary care network that all our faculty provides across the Dartmouth Health system annually sees
30 to 35,000 children.”

He continues, “What I am most proud of is that CHaD is a flagship for an integrated pediatric health system. As with DHMC itself, we are unique in being one of the few full-fledged children’s hospitals in the US based in a rural setting. It gives us a unique feel versus a city or suburban setting. Our patients and families appreciate the intimacy. They feel like they are connected with their team of providers, and that personal collaborative touch is what we believe sets us apart.”

Dr. Loud believes this aspect is what brings in top-quality health-care providers who are dedicated to their patients. “When recruiting staff, it is the relationships and personal caring of each other as faculty and residents that draws people to Dartmouth Health Children’s. Some people prefer the camaraderie and connection versus being anonymous in a larger facility. We go home into the community, see our colleagues, see our patients. It is a unique feel that creates a meaningful work environment, and that creates a cohesive team. You do not maintain a world-class children’s hospital in such a sparsely populated setting without deep and broad support for the community.”

Dr. Loud says that part of what makes Dartmouth Health Children’s special is the commitment from the community. “The CHaD HERO event on the Green, the largest annual fundraiser to support Dartmouth Health Children’s, is the physical manifestation of the community support,” says Dr. Loud. “These events include the half-marathon as well as walking, hiking, and biking options, and there is such great participation. We would not be able to do what we do without the support of the community; it is a treasure, and it speaks to the vibrancy of the region, the Upper Valley, and the state.”

Dr. Loud believes that Dartmouth Health Children’s benefits the com-munity on a larger scale as well. “I think that having this level of excellent health care available at exceptional facilities makes young people starting families or families with young children feel more comfortable moving and living here. Hopefully it helps attract families to the region, appeals to businesses to start up or relocate here, and enhances the local economy.”

Looking Ahead

What does the future hold in the next five to ten years? Dr. Loud sees the services provided not only improving but expanding and innovating. “Pediatrics is collaborative by nature. I believe we will continue to keep up with trends and create innovations and solutions for our patients’ health and safety and share what we learn with our network of other children’s hospitals. Our small size allows us to innovate rapidly and be a test site, so then we can disseminate our innovations rapidly. Patient-centered care will be something we continue to develop. For example, where families with babies in the neonatal unit can move in and be together—a program we piloted at the Catholic Medical Center in Manchester, which we have run for 15 years. We are looking for better, new care models like that, which we want to expand to this main campus.”

Dr. Loud explains, “We will continue to monitor the needs of the population and address them as they arise. Technology will enhance that ability. We already plan to expand behavioral and mental health care and provide more opportunities for telehealth services—and we foresee a new NICU and an improved pediatric care space at CHaD.”

Respiratory Therapist Theresa Tobin at work at CHaD.

He continues, “With the pandemic, we and everyone saw the promise of telehealth and its convenience. But it is even more important in a region like ours, where it can be challenging to come in person. If we can spare a family the 2.5-hour trip from the Canadian border, we will do that while still providing excellent health care to the patient.”

Dr. Loud explains why he and his team share a commitment to the children and families of the community that keeps them motivated to provide personalized care for each patient. “We get to work with children every day, and I constantly hear comments from residents and faculty that these kids, some facing the most challenging circumstances like cancer or diabetes, even at their lowest, they are smiling and laughing. And they cheer us up! How can you not feel satisfied at the end of the day, even coming off a pandemic? We are reenergized daily by the toughness and energy and enthusiasm of the patients and the dedicated pediatric professionals here. As much as we give to the children, they give back to us and keep us striving to do more, do better, and keep innovating.”

Dartmouth Health Children's Impact Over Three Decades

Providers include physicians, APPs, fellows, residents, psychologists, and audiologists. Number of patients (aged 18 and under) served at 12 locations in FY 2022:

• 296,000 outpatient and inpatient
visits (all locations)

• 226,000 outpatient visits

• 90,000 distinct patients seen

• 60,000 distinct patients seen in
pediatric primary care medical home

• 135,000 primary care visits

• 91,000 specialty care visits

• 9,800 emergency visits

• 1,400 newborn deliveries –
Children’s Hospital at DHMC

• 3,170 inpatient discharges

Staff: 125 core faculty

Fundraising dollars per year: Overall support tends to fluctuate based on
events, but totals vary between $5 and $8 million per fiscal year.